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privacy policy
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The lymphatic system of the vessels and nodes of the maxillofacial region is divided into the lymph nodes of the face, submandibular region and neck (Fig. 48). The outflow of lymph from the organs of the oral cavity begins with networks of lymphatic capillaries, which merge into ever larger lymphatic vessels, interrupted by lymph nodes.
Lymph from the maxillary sinus and the tubercle of the upper jaw flows into the periopharyngeal and deep cervical lymph nodes. The first lymphatic barrier to the outflow of lymph from the teeth are the submandibular and chin nodes. Lymph from the face and jaws enters the jugular lymphatic trunks through the lymphatic pathways of the neck.
The superficial and deep lymphatic vessels of the head and neck follow mainly the course of the blood vessels, heading from top to bottom. In the occipital region and behind the auricle lie the occipital and posterior ear lymph nodes. From these nodes, the lymphatic vessels go down the posterior edge of the sternocleidomastoid muscle to the superficial cervical lymph nodes lying here.
From the facial area, lymph is directed to the buccal and parotid, and then to the chin and submandibular lymph nodes. The latter are directed to the diverting lymphatic vessels from the deep parts of the face, gums, teeth, tongue, mucous membrane of the oral and nasal cavities. From these groups of nodes, lymph flows into the deep cervical lymph nodes that lie along the main neurovascular bundle of the neck. These nodes receive lymph from the pharynx, larynx, upper esophagus and trachea, as well as from the thyroid gland. In the course of the trachea, tracheal nodes are located, connected by vessels with the lymph nodes of the tracheobronchial group and the nodes of the mediastinum. In the lower part of the neck, the vessels of the superficial and deep lymph nodes of the neck are brought together and form a jugular trunk on each side: the left jugular trunk flows into the thoracic duct, and the right into the right lymphatic duct, which give lymph to the venous bed of the superior vena cava system.
Superficial lymphatic vessels of the face lymph is diverted to the chin, submandibular, superficial lymph nodes of the parotid gland.
The chin nodes are located around the anterior abdomen of the digastric muscle and receive lymph from the skin of the chin, lower lip, gums from the area of \u200b\u200bthe incisors and the tip of the tongue. The submandibular nodes surround the submandibular salivary gland and collect lymph from the skin of the inner parts of the upper and lower eyelids, nose, cheeks, upper and lower lips, from the conjunctiva of the eye, mucous membrane of the nasal cavity, vestibule of the mouth, lateral sides of the tongue, premolars and molars. The lymphatic vessels of this system follow the course of the facial vein, some of them are interrupted in the buccal and mandibular nodes located at the lower edge of the lower jaw body.
Figure: 48.Lymphatic vessels and nodes of the head:
1 lymphatic vessels; 2 superficial parotid lymph nodes; 3-submandibular lymph nodes; 4 chin lymph nodes.
The parotid nodes are located on the surface and in the thickness of the parotid salivary gland and receive lymph from the forehead, temple, eyelids, lacrimal glands, outer and middle ear and lower cheek region. The superficial lymph nodes of the parotid gland receive lymph from the outer parts of the eyelids, the skin of the forehead, some of the vessels of these areas enter the lymph nodes behind the ear.
Deep lymphatic vessels of the face take the lymph of the tonsils and flow into the deep cervical lymph nodes: jugular-scapular-hyoid node, jugular-cervical nodes, digastric-jugular node. Lymph from the palatine tonsils also flows into the submandibular, parotid, pharyngeal nodes. The lymphatic vessels of the palatine tonsils merge with the vessels of the root of the tongue, pharynx and other organs of the head.
The regional lymph node receiving lymph from the tonsils is a node located at the confluence of the facial vein with the internal jugular vein - the jugular-digastric lymph node, which is the source of adenophlegmon in the neck. This node on the skin is projected at the border of the upper and middle third of the anterior edge of the sternocleidomastoid muscle.
From the nasal cavity, lymph flows into the lymph nodes located near the pharynx, accompanying the internal jugular vein, and into the deep cervical nodes.
The pharyngeal nodes are located between the pharynx and the vertebral column and receive lymph from the walls of the nasal cavity, soft palate, tonsils and pharynx. Descending to the neck, the lymphatic vessels of the head flow into the cervical nodes (superficial and deep), from which the bodice enters the lymphatic jugular trunks.
Topography of the lymphatic system of the facial region of the head
Lips
The lymphatic vessels of the lips divert lymph to the submandibular, buccal, parotid, superficial and cervical lymph nodes located along the posterior edge of the sternocleidomastoid muscle, as well as to the deep cervical lymph nodes located along the internal jugular vein and in the fiber of the carotid triangle. Vessels from the middle part of the lower lip carry lymph to the submental nodes. The lymphatic vessels on both sides of the lips are widely anastomosed among themselves. Therefore, the pathological process can cause damage to the lymph nodes of the other side.
Oral cavity
The network of lymphatic vessels of the hard palate receives lymph from the teeth, gums, and upper jaw. The vessels that discharge the lymph flow into the periopharyngeal and deep cervical nodes.
Teeth
The network of lymphatic capillaries in the dental pulp forms 3-5 vessels that pass through the root canal of the tooth. From the teeth of the upper jaw, the vessels flow into the infraorbital highway and from the teeth of the lower jaw into the mandibular highway. The regional lymph nodes of the teeth of the upper jaw are the submandibular, and the teeth of the lower jaw are the submandibular, submental, parotid, retropharyngeal. Further, the lymph enters the superficial and deep cervical lymph nodes.
Language
The lymphatic vessels of the tip of the tongue are directed to the chin lymph node, and from the lateral edges and back to the submandibular lymph nodes. The main part of the lymph vessels of the body of the tongue falls into the upper deep cervical lymph nodes located along the jugular vein. During surgery for tongue cancer, it is necessary to remove not only the submandibular and submental lymph nodes, as they are often affected by metastases.
Topography of the lymphatic system of the neck
Lymphatic formations of the neck can be conditionally divided into superficial and deep systems, although all lymphatic vessels and nodes are largely interconnected. Ultimately, from all the vessels and nodes, lymph enters the two large cervical lymphatic ducts - the right and left jugular lymphatic trunks, while the first flows into the right lymphatic duct, and the second into the thoracic duct.
The superficial lymphatic system of the neck is represented by a network of lymph nodes and vessels located in the submandibular region, in the chin triangle, as well as along the sternocleidomastoid muscle, where they are located along the posterior edge of the muscle or its outer surface, along the external jugular vein, as well as along the anterior jugular vein. The first lymphatic barrier is usually the chin, submandibular, and facial lymph nodes. It is in these groups of nodes that lymph flows from the lower lip, anterior parts of the tongue, the floor of the mouth and the mucous membrane of the cheeks.
Deep lymphatic vessels are located along the internal jugular vein and are the second major collector of regional metastases. Of the deep lymph nodes, peri-organ lymph nodes (pre-epiglottis, prethyroid, pretracheal, retropharyngeal) and lymph nodes of the lateral triangle of the neck, which are located along the accessory nerve and in the supraclavicular zone, should be noted. The anterior peri-organ, inferior jugular and supraclavicular nodes are, as it were, the second regional barrier to metastasis for a number of tumors of the head and neck organs. Knowledge of the areas of regional metastasis and a clear understanding of the anatomical sheath of the neck serve as the basis for the radicalism of the developed operations to remove metastases to the lymph nodes of the neck.
Nodi lymphatici occipitales (in the amount of 1 - 2) take lymph from the soft integument of the occipital and partly parietal regions and are located above protuberantia ocdpitalis extema at the attachment point m. trapezius.
Nodi lymphatici auriculares posleriores(2 - 3 in number) lie behind the auricle at the attachment site m. stemocleidomastoideus; they take in lymph from the outer ear, temporal and parietal regions.
Nodi lymphatici auriculares inferiores located under the earlobe; they receive lymph from the external auditory canal, the tympanic membrane, and partly from the temporal region and the auricle.
Nodi lymphatici auriculares anteriores (2 - 4 in number) are located in front of the auricle, on its surface, partly in the thickness glandula parotis; they take in lymph from the forehead, partly from the temporal region and eyelids.
Nodi lymphatici submaxillares (submandibulares) number 8 - 10, located in the fascial bed of the submandibular salivary gland, under the edge of the lower jaw, along the a. maxillaris externa... They take lymph from lymphoglandulae auriculares anteriores, from the soft integuments of the face, eyelids, walls and organs of the oral cavity and partly the nose, as well as from the deep lymphatic vessels of the face, carrying lymph from the orbit, conjunctiva of the eye and from the bones of the facial skull. On the path of lymph flow from the anterior parts of the face lie lymphoglandulae buccaleslocated on the outer surface m. buccinator.
First description head and neck cancer dates back to 3500 BC, it is contained in the ancient Egyptian papyrus of Ebers, where it is proposed to use cinnamon, honey, oil and resin to treat "devouring gum ulcers". But it was only by 1790 that the understanding developed that the prognosis for malignant diseases depends on the defeat of the lymph nodes. The first attempts at surgical intervention on lymph node metastases date back to the 19th century.
In 1837 John Collins Warren performed removal of a single lymph node of the neck, trying to stop the metastatic spread of the tumor. By the end of the 19th century, the number of attempts to surgically affect the affected lymph nodes increased significantly. This was facilitated by the introduction of the rules of asepsis and antisepsis, the development of new methods of anesthesia, and the improvement of surgical techniques.
Resection lymph nodes a single block in the late stages of the disease was first performed in Europe: (Langenbeck, Billroth, Konrad, Volkmann, Kocher). The concept of elective cervical lymphadenectomy was first introduced by Sir Henry Trentham Butlin in 1885, which led to significant increases in survival and regional control of tumor growth.
At the beginning XX century Techniques for surgical removal of neck lymph nodes continued to improve, while George Washington Crile described radical cervical lymph node dissection. Today, there are three main types of cervical lymph node dissection and several of their subtypes.
Their introduction into clinical practice has significantly improved treatment outcomes. in patients with head and neck cancer... To perform these operations, a detailed knowledge of the anatomy of the head and neck is required.
and) . The lymph nodes of the neck are located within seven anatomical regions.
Level I: nodes of this level are subdivided into submental (IA) and submandibular (IB).
The submental lymph nodes (IA) are located within the triangle bounded by the anterior abdomens of the digastric muscles and the hyoid bone. The submandibular (IB) is located in the area bounded by the anterior abdomen of the digastric muscle, the mandible and the stylohyoid muscle.
Level II: contains the superior jugular lymph nodes. Lymph nodes of this level are also subdivided into IIA and IIB.
Level II of the lymph nodes of the neck behind and from the lateral side is limited by the posterior edge of the sternocleidomastoid muscle, the base of the skull from above, the lower edge of the hyoid bone from below, the stylohyoid muscle from the front and from the medial side. The division into IIA and IIB lymph nodes occurs relative to the vertical plane formed here by the accessory nerve: the PA nodes are located anteriorly and medially, IIB nodes are posterior and lateral.
Level III contains middle jugular lymph nodes. This level is limited by the lower edge of the hyoid bone from above, the lower edge of the cricoid cartilage from below. From the medial side, this level is limited by the lateral edge of the sternohyoid muscle, from behind and from the lateral side - by the posterior edge of the sternocleidomastoid muscle.
Level IV contains the lower jugular lymph nodes. Above, its border is the lower edge of the cricoid cartilage, the lower border is represented by the clavicles, the posterior border is the posterior edge of the sternocleidomastoid muscle, the anterior - the lateral edge of the sterno-thyroid muscle.
Level V contains the lymph nodes of the posterior triangle of the neck. Allocate levels VA and VB.
From above, the V level is limited by the intersection of the sternohyoid and trapezius muscles from above, by the clavicles from below, by the posterior edge of the sternocleidomastoid muscle in front, by the anterior edge of the trapezius muscle behind. The nodes of the VA and VB level are distinguished, which are located above and below the horizontal plane formed by the arc of the cricoid cartilage, respectively.
Level VI contains anterior cervical lymph nodes, including prelaryngeal (Delphic), pretracheal and paratracheal. Above, this level is limited by the hyoid bone, below by the jugular notch of the sternum, from the lateral sides - by the common carotid arteries.
Lymphatic drainage in the head and neck area.
b) Lymphatic drainage from cervical lymph nodes... Knowledge of the pathways of lymph flow from the organs of the head is also important for choosing the correct method of cervical lymph node dissection. The figure below shows the pathways of lymph flow to the lymph nodes of the neck. Usually, lymph nodes are located along large veins, sometimes along large nerves.
Outgoing lymphatic ducts submental and submandibular lymph nodes carry out lymph drainage from the bottom of the oral cavity, apex of the tongue, lower lip. Further, the efferent lymphatic ducts follow to the cervical lymph nodes of the internal jugular vein to the hyoid bone (levels IIA and IIB), as well as to the submandibular lymph nodes. In the anterior cervical lymph nodes, lymph flows from the subglottic and ligamentous parts of the larynx, the tops of the pear-shaped sinuses, and the cervical esophagus.
Further outflow occurs to the lymph nodes of the II level and the upper nodes of the mediastinum. In the lymph nodes of the II level, lymph flows from the oral cavity, nasopharynx, oropharynx, hypopharynx, larynx, as well as the scalp, auricles, and the back of the neck. Also, lymph flows into the nodes of the 11th level from other groups of lymph nodes, especially the anterior cervical, submental and submandibular.
Further from the lymph nodes of the II level lymph flows to the nodes of levels IV and V. The nodes of groups IV and V receive lymph from the nasopharynx, oropharynx, the skin of the posterior parts of the scalp and neck. Further, the efferent ducts of these levels are connected to the ducts from levels II and III, forming the jugular lymphatic trunk. On the right, the jugular trunk ends at the confluence of the internal jugular vein and the right subclavian vein. On the left, the jugular trunk flows into the thoracic duct.
at) Thoracic duct... The thoracic duct starts from the thoracic duct cistern, a saccular formation located downward from the right crus of the diaphragm at the level of the vertebrae L1 and L2. The duct enters the thorax laterally from the descending part of the aorta and medial to the azygos vein. Further in the chest, it rises, crossing the aortic arch in the upper mediastinum. Then the duct deviates laterally at the level of the C7 vertebra. Then the duct runs along the medial edge of the anterior scalene muscle, making a loop downward and crossing the first segment of the subclavian artery in front.
It ends at the connection level left internal jugular vein and left subclavian vein, downward from the collarbone. Lymph flows into the thoracic duct from the lower extremities (through the right and left lymphatic trunks) and the abdominal cavity.
Instructional video of anatomy, topography of the thoracic duct and right lymphatic duct
You can download this video and watch it from another video hosting on the page:Continuing the topic of the body's lymphatic system, in this article we will define the geography of the lymph nodes on our face.
Why is it so important for us to know the location of the lymph nodes on the head and neck? First, it will be our lifesaver when we get tired of waking up with a puffy face or puffy eyes, even if we didn't drink liquids at night. Then, with light, barely noticeable movements, we will show the stagnant liquid the way where it needs to go. Secondly, it is important to be careful in the areas in which the lymph nodes are located, so as not to damage them during massage or other manipulations on the face.
Speaking of lymph, it is appropriate to draw an analogy with the sewage system in the house. Pure water flows through pipes to the tap so that we can drink it and, thus, nourish our body, cleanse our body. The role of pipes with clean water in the body is played by arteries that carry oxygen and nutrients to tissues and organs along with the blood. The used water goes through the sewer system and then goes to the treatment plants. The pipes through which the waste fluid leaves are the lymphatic vessels. They carry their effluents first to small intermediate stations - regional lymph nodes, and then to the main waste processing plant - supraclavicular lymph nodes.
What happens if the sewage system at home gets clogged? When water comes in but has nowhere to go? A blockage occurs - dirty water stagnates in the container, begins to smell unpleasant, "bloom" ...
On our face, such a blockage can be caused either by strong muscle blocks that impede the flow of lymph, or inoperative lymph nodes. Lymph stagnation causes swelling on the face and neck, the effect of a face soaked in water. Since lymph removes metabolic products of cells and tissues, the "bloom" of stagnant water is immediately reflected on the face - through a network of lymphatic capillaries, dirt thrown onto the skin in the form of rashes, acne, eczema.
The picture turns out to be disgusting and therefore it is very valuable to give your face and neck a lymphatic drainage massage, which helps to improve the outflow of excess fluid from the face, provided that the lymph nodes are working. If they do not function, then the liquid will accumulate and stagnate.
The cause of blockage of the nodes can be sore throats, infectious diseases, trauma (strong physical impact on the nodes), hypothermia or, conversely, overheating. You can check the correct functioning of the lymph nodes with a special lymphologist.
We will start from the situation when the lymph nodes on the head and neck are healthy and work correctly. How to activate the process of removing excess fluid from the face and neck?
The movement of lymph in our body is triggered by muscle contraction. When we are not moving, the lymph moves slowly, due to the movement of the chest during breathing. This is why swelling often occurs after immobile long sleep.
Therefore, physical exercise or just active movement significantly accelerates the flow of lymph. Also, massage has a beneficial effect on the movement of lymph and the acceleration of its course.
Light pressure leads to tissue compression, which increases the amount of tissue fluid that is directed to the lymphatic vessels. Barely noticeable touching and stroking the skin along the movement of the lymph exert pressure on the vessels and push the fluid to the nearest group of lymph nodes. We seem to show the lymph where it needs to carry the excess that it has collected from the working organism.
So, we come to the analysis of the map of the main lymph nodes on the head.
Important note: The lymphatic system of the head descends from top to bottom, in contrast to the lymphatic system of the body, which moves from bottom to top: from the heels to the supraclavicular lymph nodes.
Facial(buccal) lymph nodes collect lymph from the eyeball, facial muscles, the mucous membrane of the cheeks, lips and gums, etc.
Submandibularlymph nodes — collect lymph from the chin, from the upper and lower lips, cheeks, nose, gums and teeth, etc.
Chinlymph nodes collect lymph from the same areas of the head as the submandibular regions, as well as from the tip of the tongue.
Parotidlymph nodes — lymph is collected from the forehead, temple, lateral part of the eyelids, outer surface of the auricle, temporomandibular joint, etc.
Behind-the-earlymph nodes — collect lymph from the same areas, as well as from the back surface of the auricle, external auditory canal and tympanic membrane.
Suboccipital lymph nodes. In them lymphatic vessels fall from the back of the temporal, parietal and occipital regions of the head.
Cervical lymph nodeslocated on the back and side of the neck.
You can feel the procedure and the effectiveness of lymphatic drainage massage by going through the procedure in a beauty salon.
It is possible to independently master the skill of lymphatic drainage massage of the face and neck at master classes in gymnastics for the face, announcements of which appear in the group
So, let's draw an analogy with the sewage system at home. What happens when it gets clogged? Dirty water stagnates in the container, begins to smell unpleasant, "bloom" ... On our face, such a blockage can cause either strong muscle blocks that impede the flow of lymph, or inoperative lymph nodes.
Lymph congestion causes swelling on the face and neck, the effect of a face soaked in water. Since lymph removes metabolic products of cells and tissues, the "bloom" of stagnant water is immediately reflected on the face - through a network of lymphatic capillaries, dirt is thrown onto the skin in the form of rashes, acne, eczema.
Do you need it? If not. Then the explanation of this diagram is for you.
Superficial lymph nodes of the head and neck - right side view in 3/4 turn.
1. Chin lymph nodes (nodi lymphatici submentales).
2. Submandibular lymph nodes (nodi lymphatici submandibulares).
3. Facial buccal lymph nodes (nodi lymphatici faciales / buccinatorii /).
4. Mandibular lymph nodes (nodi lymphatici mandibulares).
5. Superficial cervical lymph nodes (nodi lymphatici cervicales superficiales).
6. Deep cervical lymph nodes (nodi lymphatici cervicales profundi).
7. Supraclavicular lymph nodes (nodi lymphatici supraclaviculares).
8. Occipital lymph nodes (nodi lymphatici occipitales).
9. Mastoid lymph nodes (nodi lymphatici mastoidei).
10. Parotid lymph nodes (nodi lymphatici parotidei).
Pink - areas of lymphatic anastomoses, where bilateral or cross metastasis of tumors is possible.
Bonus! An amazing massage that relieves facial swelling
- It should be carried out in the evening (before bedtime) and in the morning (immediately after waking up).
- The technology is very simple: you need to gently press your palms on your eyes, forehead, jaws (as in the picture below):
- In each pose, you need to linger for at least 10 seconds.
- The effectiveness of this massage is that it stimulates the lymphatic vessels, thereby relieving swelling.
- After the massage, wash alternately with cold and warm water.
Before carrying out any manipulations, consult your doctor!
from Anatomy for Masseurs