HEAD & NECK ANATOMY

7. The Neck
DR. MOHAMAD BAKER ABU-SNAINA
GENERAL SURGEON
 lies between:
The neck
 Above: the lower margin of the
mandible.
 Below: the suprasternal notch & the
upper border of the clavicle.
 It is strengthened by the cervical part
of vertebral column which is
surrounded by a mass of extensor &
flexor muscles.
 In the central region
 Anteriorly: parts of the respiratory
system, the larynx & the trachea.
 Posteriorly: parts of the alimentary
system, the pharynx & the esophagus.
 The neck
 At the sides of these structures are
the vertically running carotid
arteries, internal jugular veins, the
vagus nerve, & the deep cervical
lymph nodes.
 Skin of the Neck: the natural lines of
cleavage of the skin ( langer`s lines)
are constant & run almost
horizontally around the neck.
• This is important clinically because
an incision along a cleavage line will
heal as a narrow scar.
 The neck
 The superficial fascia forms a thin
layer that encloses platysma muscle.
• The cutaneous nerves, the superficial
veins & the superficial lymph nodes
embedded in the superficial fascia.
 The platysma muscle is a thin but
clinically important muscular sheet
embedded in the superficial fascia.
 Origin: deep fascia over pectoralis major &
deltoid.
 Insertion: body of mandible & angle of mouth.
 Nerve Supply: Facial nerve cervical branch.
 Action: Depresses mandible & angle of mouth.
 Cutaneous Nerves
 Posterior rami of C 2-5 supplies
the skin overlying the trapezius
muscle on the back of the neck &
on the back of the scalp as high as
the vertex.
 Anterior rami of C2-4 supplies
the skin of the front & sides of
the neck through branches of
cervical plexus
 The lesser occipital nerve (C2)
supply the skin over the lateral
part of the occipital region and
the medial surface of the auricle.
 Cutaneous Nerves
 Great auricular nerve (C2+3) supply
the skin over the angle of the
mandible, the parotid gland & on
both surfaces of the auricle.
 Transverse cutaneous nerve (C2+3)
supply the skin on the anterior &
lateral surfaces of the neck, from the
body of the mandible to the sternum
 The supraclavicular nerves (C3+4)
emerge from beneath the posterior
border of the sternocleidomastoid
muscle & descend across the side of
the neck.
 Cutaneous Nerves
 Medial supraclavicular nerve
crosses the medial end of the
clavicle & supplies the skin as far as
the median plane.
 Intermediate supraclavicular nerve
crosses the middle of the clavicle &
supplies the skin of the chest wall.
 Lateral supraclavicular nerve
crosses the lateral end of the
clavicle & supplies the skin over the
shoulder and the upper half of the
deltoid muscle.
 Superficial Veins of the neck
External Jugular
Vein.
Anterior Jugular
Vein.
 External Jugular Vein
• It begins just behind the angle of the
mandible by the union of posterior
auricular vein with the posterior division
of retromandibular vein.
• Descends obliquely across the SCM
& just above the clavicle in the
posterior triangle, pierces the deep
fascia & drains into subclavian vein.
 Tributaries
• Posterior auricular vein & Posterior
division of retromandibular vein.
• Posterior external jugular vein.
• Transverse cervical vein.
• Suprascapular & Anterior jugular vein.
 Anterior Jugular Vein
• It begins just below the chin, by
the union of several small veins.
• It runs down the neck close to
the midline.
• Just above the suprasternal
notch, veins of the two sides are
united by a transverse trunk
called the jugular arch.
• The vein then turns sharply
laterally & passes deep to SCM
muscle to drain into the external
jugular vein.
 Superficial Lymph Nodes
• The superficial cervical
lymph nodes lie along the
external jugular vein
superficial to the
sternocleidomastoid muscle.
• They receive lymph vessels
from the occipital & mastoid
lymph nodes & drain into the
deep cervical lymph nodes.
 Bones of the Neck
Cervical Vertebrae
• The cervical part of the
vertebral column.

Hyoid Bone.
• A single mobile bone found
in the midline of the neck
below the mandible.
 Hyoid Bone
• A single mobile bone found in the midline
of the neck below the mandible.
• Does not articulate with any other bones.
• U shaped & consists of a body & two
greater & two lesser cornua.
• Attached to
 Skull by the stylohyoid ligament.
 Thyroid cartilage by thyrohyoid membrane
• It forms a base for the tongue & is
suspended in position by muscles that
connect it to the mandible, to the styloid
process of temporal bone, to the thyroid
cartilage, to the sternum & to the scapula.
Key Neck Muscles
 Sternocleidomastoid Muscle
• When the SCM muscle contracts, it
appears as an oblique band crossing
the side of the neck.
• It divides the neck into anterior &
posterior triangles.
• The anterior border covers the
carotid arteries, the internal jugular
vein & the deep cervical lymph nodes
& overlaps the thyroid gland.
• The muscle is covered superficially by
skin, fascia, the platysma muscle &
the external jugular vein.
• The posterior border is related to the
cervical plexus, the phrenic nerve &
upper part of brachial plexus.
 Sternocleidomastoid Muscle
• Origin: by 2 heads from
Manubrium sterni & medial third
of clavicle.
• Insertion: Mastoid process of
temporal bone & occipital bone.
• Nerve supply: Spinal part of
accessory nerve & C2+3.
• Action: Two muscles acting
together extend head & flex
neck; one muscle rotates head to
opposite side.
 Scalenus Anterior Muscle
• Deeply placed, descends vertically from
the vertebral column to the 1st rib.
 Important Relations:
• Anteriorly: the carotid arteries, the
vagus nerve, the internal jugular vein &
deep cervical lymph nodes.
• Posteriorly: the pleura, the origin of the
brachial plexus, & the 2nd part of the
subclavian artery.
• Medially: the vertebral artery & vein &
the sympathetic trunk. On the left side,
is related to the thoracic duct.
• Laterally: branches of the cervical
plexus, the roots of the brachial plexus,
& the 3rd part of the subclavian artery.
 Scalenus Anterior Muscle
• Origin: Transverse processes of
third, fourth, fifth, and sixth
cervical vertebrae
• Insertion: First rib
• Nerve supply: C4, 5, & 6.
• Action: Elevates first rib;
laterally flexes & rotates
cervical part of vertebral
column.
 Scalenus Medius
• It lies behind the scalenus anterior.
• Origin: Transverse processes of
upper six cervical vertebrae.
• Insertion: the upper surface of the
1st rib behind the groove for
subclavian artery & behind the
roots of the brachial plexus.
• Nerve supply: Anterior rami of
cervical nerves.
• Action: Elevates first rib; laterally
flexes and rotates cervical part of
vertebral column.
 Deep Cervical Fascia
• The deep cervical fascia
supports the muscles, the
vessels & viscera of the neck.
• In certain areas, it is
condensed to form well-
defined, fibrous sheets:
 Investing layer.
 Pretracheal layer.
 Prevertebral layer.
 Carotid sheath.
 Deep Cervical Fascia
 Investing Layer
• It is a thick layer that encircles the neck.
• It splits to enclose the trapezius & the SCM muscles.
 Pretracheal Layer
• It is a thin layer that is attached above to the laryngeal cartilages .
• It surrounds the thyroid & the parathyroid glands, forming a sheath for
them & encloses the infrahyoid muscles.
 Prevertebral Layer
• It is a thick layer that passes like a septum across the neck behind the
pharynx & the esophagus & in front of the prevertebral muscles & the
vertebral column.
• It forms the fascial floor of the posterior triangle & it extends laterally
over the 1st rib into the axilla to form the important axillary sheath.
 The carotid sheath
• Is a local condensation of the prevertebral, the pretracheal, & the
investing layers of the deep fascia that surround the common &
internal carotid arteries, the internal jugular vein, the vagus nerve, &
the deep cervical lymph nodes.
 Cervical Ligaments
• Stylohyoid ligament: Connects the
styloid process to the lesser cornu of
the hyoid bone.
• Stylomandibular ligament: Connects
the styloid process to the angle of the
mandible.
• Sphenomandibular ligament: Connects
the spine of the sphenoid bone to the
lingula of the mandible.
• Pterygomandibular ligament: Connects
the hamular process of the medial
pterygoid plate to the posterior end of
the mylohyoid line of the mandible. It
gives attachment to the superior
constrictor & the buccinator muscles.
 Muscular Triangles of the Neck
• The sternocleidomastoid muscle divides the
neck into anterior & posterior triangles.
Anterior triangle Posterior triangle
 Above by the body of the  Posteriorly by the trapezius
mandible muscle.
 Posteriorly by the SCM muscle.  Anteriorly by the SCM muscle.
 Anteriorly by the midline.  Inferiorly by the clavicle.
 Subdivided into:  Subdivided by the inferior
 Carotid triangle. belly of omohyoid muscle into
 Digastric triangle.  Large occipital triangle above
 Submental triangle.  Small supraclavicular triangle
 Muscular triangle. below.
Muscular Triangles of the Neck
Arteries of the
Head & Neck
 Common Carotid Artery CCA
 Right CCA arises from the brachiocephalic
artery behind the right sternoclavicular joint.
 Left CCA arises from the arch of the aorta
in the superior mediastinum.
• CCA runs upward under cover of anterior
border of SCM muscle, from sterno -
clavicular joint to the upper border of the
thyroid cartilage where it divides into the
external & internal carotid arteries.
• Embedded in the carotid sheath
throughout its course & is closely related
to the internal jugular vein & vagus nerve.
• Apart from the two terminal branches, the
CCA gives off no branches.
 Carotid Sinus
• Is localized dilatation at the terminal
part of the CCA or the beginning of
the internal carotid artery.
• The tunica media of the sinus is
thinner than elsewhere, but the
adventitia is relatively thick &
contains numerous nerve endings
derived from glossopharyngeal
nerve.
• It serves as a reflex pressoreceptor
mechanism, a rise in blood pressure
causes slowing of heart rate &
vasodilatation of the arterioles.
 Carotid Body
• Is a small structure that lies
posterior to the point of
bifurcation of the common carotid
artery.
• It is innervated by the
glossopharyngeal nerve.
• The carotid body is a
chemoreceptor, being sensitive to
excess carbon dioxide & reduced
oxygen tension in the blood.
• Such a stimulus reflexly produces a
rise in blood pressure & heart rate
& an increase in respiratory
movements.
 Relations of Common Carotid Artery
• Anterolaterally: skin, fascia, SCM,
sternohyoid, sternothyroid & the
superior belly of omohyoid.
• Posteriorly: transverse processes of
the lower 4 cervical vertebrae, the
prevertebral muscles & the
sympathetic trunk. In the lower part of
the neck are the vertebral vessels.
• Medially: the larynx & pharynx &
below these, the trachea & esophagus,
lobe of the thyroid gland.
• Laterally: The internal jugular vein &
posterolaterally the vagus nerve.
 External Carotid Artery ECA
• Begins at the level of the upper border
of the thyroid cartilage.
• Terminates in the substance of the
parotid gland behind the neck of the
mandible by dividing into superficial
temporal & maxillary arteries.
• It supplies structures in the neck, face
scalp, tongue & the maxilla.
• Close to its origin, the artery emerges
from undercover of the SCM muscle,
where its pulsations can be felt.
• At first, it lies medial to the internal
carotid artery, but as it ascends in the
neck, it passes backward & lateral.
 Relations of the ECA
 Anterolaterally:
• Overlapped at its beginning by anterior border
of SCM & above this level, it is superficial,
being covered by skin & fascia.
• It is crossed by the hypoglossal nerve, the
posterior belly of the digastric muscle & the
stylohyoid muscles.
• Crossed by facial nerve within parotid gland.
• The internal jugular vein first lies lateral to the
artery & then posterior to it.
 Medially: The wall of pharynx & ICA.
• Stylopharyngeus muscle, the glossopharyngeal
nerve & the pharyngeal branch of the vagus
pass between the ECA & ICA.
 Branches of the ECA
• Superior thyroid artery.
• Ascending pharyngeal artery.
• Lingual artery.
• Facial artery.
• Occipital artery.
• Posterior auricular artery.
• Superficial temporal artery.
• Maxillary artery.
 Branches of the ECA
Superior Thyroid Artery
• Curves downward to the upper pole
of the thyroid gland.
• It is accompanied by the external
laryngeal nerve, which supplies the
cricothyroid muscle.
Ascending Pharyngeal Artery
• Ascends along & supplies the
pharyngeal wall.
Lingual Artery
• loops upward & forward & supplies
the tongue.
 Branches of the ECA
 The facial artery
• loops upward close to the outer surface
of the pharynx & the tonsil.
• It lies deep to the submandibular salivary
gland & bends around the lower border
of the mandible.
• It then ascends over the face close to the
anterior border of the masseter muscle.
• Then ascends around the lateral margin
of the mouth & terminates at the medial
angle of the eye.
• Branches of the facial artery supply the
tonsil, the submandibular salivary gland &
muscles & skin of the face.
 Branches of the ECA
Occipital Artery
• Supplies the back of the scalp.
Posterior Auricular Artery
• Supplies the auricle and the scalp.
Superficial Temporal Artery
• Ascends over the zygomatic arch,
where it may be palpated just in
front of the auricle.
• It is accompanied by the
auriculotemporal nerve & it
supplies the scalp.
 Branches
Maxillary Artery
of the ECA
• It runs forward medial to the neck of the
mandible & enters the pterygopalatine
fossa of the skull.
• It gives off many branches one of them is
the middle meningeal artery.
• Branches supply the upper & the lower
jaws, the muscles of mastication, the
nose, the palate & the meninges.
o Middle Meningeal Artery: Enters the
skull through the foramen spinosum
• It runs laterally within the skull & divides
into anterior & posterior branches.
• The anterior branch is important
because it lies close to the motor area of
the cerebral cortex of the brain.
 Internal Carotid Artery ICA
• It begins at the bifurcation of the
common carotid artery at the level of
the upper border of the thyroid
cartilage.
• It supplies the brain, the eye, the
forehead & part of the nose.
• The artery ascends in the neck
embedded in the carotid sheath with
the internal jugular vein & vagus
nerve.
• At first it lies superficially; it then
passes deep to the parotid salivary
gland.
 Internal Carotid Artery ICA
• leaves the neck by passing into
the cranial cavity through the
carotid canal in the petrous part
of the temporal bone.
• It then passes upward & forward
in the cavernous venous sinus.
• Then passes upward again medial
to the anterior clinoid process of
the sphenoid bone.
• Then inclines backward, lateral to
the optic chiasma.
• Terminates by dividing into the
anterior & the middle cerebral
arteries.
 Relations of the ICA in the Neck
 Anterolaterally
• Below the digastric: skin, fascia, anterior
border of the SCM & hypoglossal nerve.
• Above the digastric: the stylohyoid & the
stylopharyngeus muscle, glossopharyngeal
nerve, the pharyngeal branch of the vagus,
the parotid gland & the ECA.
 Posteriorly:
• The sympathetic trunk, the longus capitis
muscle, & the transverse processes of the
upper three cervical vertebrae.
 Medially:
• Pharyngeal wall & superior laryngeal nerve
 Laterally:
• The internal jugular vein & the vagus nerve
 Branches of ICA
 No branches in the neck.
 Ophthalmic Artery
• It arises from the internal carotid
artery as it emerges from the
cavernous sinus.
• Passes forward into the orbital
cavity through the optic canal, & it
gives off the central artery of the
retina which is an end artery & the
only blood supply to the retina.
 Posterior Communicating Artery
• Runs backward to join the
posterior cerebral artery.
 Branches of the ICA
 Anterior Cerebral Artery
• This is a terminal branch of the
internal carotid artery.
• It passes forward between the
cerebral hemispheres.
• Supply the medial & the
superolateral surfaces of the
cerebral hemisphere.
• It is joined to the artery of the
opposite side by the anterior
communicating artery.
 Branches of the ICA
 Middle Cerebral Artery
• The largest terminal branch of the internal carotid artery.
• Supplies the entire lateral surface of the cerebral
hemisphere except:
 The narrow strip along the superolateral margin (which is
supplied by the anterior cerebral artery)
 The occipital pole & inferolateral surface of the
hemisphere (both of which are supplied by the posterior
cerebral artery).
• Thus it supplies all the motor area except the leg area.
• It also gives off central branches that supply central
masses of gray matter & the internal capsule of the brain.
 Circle of Willis
• lies in the subarachnoid space at
the base of the brain.
• Formed by the anastomosis
between the branches of:
 The two internal carotid arteries.
 The two vertebral arteries. (branch
of subclavian)
• The anterior communicating,
posterior cerebral & basilar
(formed by the junction of the two
vertebral arteries) are all arteries
that contribute to the circle.
• Cortical & central branches arise
from the circle & supply the brain.
 Subclavian Arteries
 Right Subclavian Artery
• Arises from the brachiocephalic artery,
behind the right sternoclavicular joint.
• Arches upward & laterally over the
pleura & between the scalenus anterior
& medius muscles.
• At the outer border of 1st rib, it
becomes the axillary artery.
 Left Subclavian Artery
• Arises from the arch of aorta.
• Ascends to the root of the neck &
arches laterally in a manner similar to
that of the right subclavian artery.
• The scalenus anterior muscle passes
anterior to the artery on each side &
divides it into three parts.
First Part of the Subclavian Artery
• Extends from the origin of
the subclavian artery to the
medial border of the
scalenus anterior muscle.
• This part gives off:
“Branches of 1ST Part of
Subclavian Artery”
 Vertebral artery.
 Thyrocervical trunk.
 Internal thoracic artery
 The vertebral artery
• Ascends in the neck through the
foramina in the transverse processes of
the upper six cervical vertebrae.
• It passes medially above the posterior
arch of the atlas & ascends through the
foramen magnum into the skull.
• On reaching the anterior surface of the
medulla oblongata it joins the vessel of
the opposite side to form the basilar
artery.
• Branches in the neck: Spinal & muscular
arteries.
• Branches in the skull: Meningeal,
anterior & posterior spinal, posterior
inferior cerebellar & medullary arteries.
 The basilar artery
• Formed by the union of the tow
vertebral arteries at the lower border
of the pons.
• Ascends in a groove on the anterior
surface of the pons.
• It gives off branches to the pons, the
cerebellum & the internal ear.
• It finally divides into the two
posterior cerebral arteries.
• Cortical branches supply the
inferolateral surfaces of the temporal
lobe & the visual cortex on the lateral
& the medial surfaces of the occipital
lobe.
 The thyrocervical trunk
• A short trunk that gives off three
terminal branches.
 The inferior thyroid artery
ascends to the posterior surface
of the thyroid gland, It supplies
the thyroid & the inferior
parathyroid glands.
 The superficial cervical artery is
a small branch that crosses the
brachial plexus.
 The suprascapular artery runs
laterally over the brachial plexus
& follows the suprascapular
nerve onto the back of the
scapula.
 The internal thoracic artery
• The internal thoracic artery
descends into the thorax
behind the 1st costal cartilage
& in front of the pleura.
• It descends vertically one
fingerbreadth lateral to the
sternum; in the sixth
intercostal space, it divides
into the superior epigastric &
the musculophrenic arteries.
 Second Part of the Subclavian Artery
• The second part of the
subclavian artery lies behind
the scalenus anterior muscle.
Branches
• The costocervical trunk runs
backward over the dome of
the pleura & divides into the:
 Superior intercostal artery,
which supplies the 1st & the 2nd
intercostal spaces.
 Deep cervical artery, which
supplies the deep muscles of
the neck.
Third Part of the Subclavian Artery
• Extends from the lateral border of
the scalenus anterior muscle across
the posterior triangle of the neck to
the lateral border of the 1st rib,
where it becomes the axillary
artery.
• Here, in the root of the neck, it is
closely related to the nerves of the
brachial plexus.
Branches
• The third part of the subclavian
artery usually has no branches.
• Occasionally, the superficial cervical
arteries, the suprascapular arteries,
or both arise from this part.
 Veins of the Face & the Neck
Facial Vein
Maxillary Vein
Superficial Temporal Vein
Retromandibular Vein
Anterior Jugular Vein
External Jugular Vein
Internal Jugular Vein
Subclavian Vein
 Veins of the Face & the Neck
 Facial Vein
• Formed at the medial angle of the
eye by the union of the supraorbital
& supratrochlear veins.
• Connected through the ophthalmic
veins with the cavernous sinus.
• Descends down the face with the
facial artery & passes around the
lateral side of the mouth & crosses
the mandible.
• Joined by the anterior division of the
retromandibular vein & drains into
the internal jugular vein.
 Veins of the Face & the Neck
 Maxillary Vein
• Formed in the infratemporal fossa
from the pterygoid venous plexus.
• Joins the superficial temporal vein to
form the retromandibular vein.
 Superficial Temporal Vein
• Formed on the side of the scalp.
• It follows the superficial temporal
artery & the auriculotemporal nerve &
then enters the parotid salivary gland,
where it joins the maxillary vein to
form the retromandibular vein.
 Veins of the Face & the Neck
 Retromandibular Vein
• Formed by the union of superficial
temporal & maxillary veins.
• On leaving the parotid salivary gland, it
divides into an anterior branch, which
joins the facial vein & posterior branch,
which joins the posterior auricular vein
to form the external jugular vein.
 Anterior Jugular Vein
• It descends in the front of the neck
close to the midline.
• Just above the sternum, it is joined to
the opposite vein by the jugular arch.
• It joins the external jugular vein deep
to the SCM muscle.
 Veins of the Face & the Neck
 External Jugular Vein
• Formed behind the angle of the jaw by
the union of the posterior auricular vein
with the posterior division of the
retromandibular vein.
• It descends across the SCM muscle &
beneath the platysma muscle & drains
into the subclavian vein behind the
middle of the clavicle.
• Tributaries
 Posterior external jugular vein
 Transverse cervical vein
 Suprascapular vein Anterior jugular vein.
 Veins of the Face & the Neck
 Internal Jugular Vein
• A large vein that receives blood from
the brain, face & neck.
• It starts as a continuation of the
sigmoid sinus & leaves the skull
through the jugular foramen.
• Descends in the carotid sheath lateral
to the vagus nerve & the internal &
common carotid arteries.
• It ends by joining the subclavian vein
behind the medial end of the clavicle to
form the brachiocephalic vein.
• It is closely related to the deep cervical
lymph nodes.
Relations of the Internal Jugular Vein
 Anterolaterally:
• The skin, the fascia, the SCM & the parotid salivary gland.
• Its lower part is covered by the sternothyroid, sternohyoid, &
omohyoid muscles.
• Higher up, it is crossed by the stylohyoid, the posterior belly
of the digastric, & the spinal part of the accessory nerve.
 Posteriorly:
• The transverse processes of the cervical vertebrae, the levator
scapulae, the scalenus medius, the scalenus anterior, the
cervical plexus, the phrenic nerve, the thyrocervical trunk, the
vertebral vein, & the first part of the subclavian artery.
• On the left side it passes in front of the thoracic duct.
 Medially:
• Above lie the internal carotid artery & the 9th, 10th, 11th, &
12th cranial nerves.
• Below lie the common carotid artery & the vagus nerve.
Tributaries of the Internal Jugular Vein
• Inferior petrosal sinus.
• Facial vein.
• Pharyngeal veins.
• Lingual vein.
• Superior thyroid vein.
• Middle thyroid vein.
 Veins of the Face & the Neck
Subclavian Vein
• Is a continuation of the axillary vein at
the outer border of 1st rib.
• It joins the internal jugular vein to form
the brachiocephalic vein & it receives
the external jugular vein.
• In addition, it often receives the thoracic
duct on the left side & the right
lymphatic duct on the right.
o Relations
• Anteriorly: The clavicle
• Posteriorly: The scalenus anterior muscle
& the phrenic nerve
• Inferiorly: The upper surface of the 1st rib
Lymph Drainage of the Head & Neck
The lymph nodes of the head &
neck are arranged as:
 Regional collar that extends
from below the chin to the
back of the head.
 Deep vertical terminal group
that is embedded in the
carotid sheath in the neck.
 Regional Nodes
 Occipital nodes:
• Situated over the occipital bone.
• Receive lymph from the back of scalp.
 Retroauricular (mastoid) nodes:
• Lie behind the ear over mastoid process.
• Receive lymph from scalp above the ear,
auricle, & external auditory meatus.
 Parotid nodes:
• Situated on or within the parotid gland.
• Receive lymph from the scalp above the
parotid gland, eyelids, parotid gland,
auricle & the external auditory meatus.
 Regional Nodes
 Buccal (facial) nodes:
• lie in the cheek over the buccinator muscle.
• Drain lymph that ultimately passes into submandibular nodes.
 Submandibular nodes:
• Lie superficial to the submandibular salivary gland just below
the lower margin of the jaw.
• Receive lymph from the front of the scalp, nose; the cheek;
the upper & the lower lip (except the central part); the frontal,
maxillary, & ethmoid sinuses; the upper & lower teeth (except
the lower incisors); the anterior 2/3 of the tongue (except the
tip); the floor of the mouth & vestibule; & the gums.
 Submental nodes:
• Lie in the submental triangle just below the chin.
• Drain lymph from the tip of the tongue, the floor of the
anterior part of the mouth, the incisor teeth, the center part
of the lower lip, & the skin over the chin.
 Regional Nodes
 Anterior cervical nodes:
• lie along the course of the anterior jugular veins.
• Receive lymph from skin & superficial tissues of front of neck.
 Superficial cervical nodes:
• These lie along the course of the external jugular vein.
• Drain lymph from the skin over the angle of the jaw, the skin
over the lower part of the parotid gland, & the lobe of the ear.
 Retropharyngeal nodes:
• Lie behind the pharynx and in front of the vertebral column.
• Receive lymph from the nasal pharynx, the auditory tube &
the vertebral column.
 Laryngeal nodes:
• Lie in front of the larynx, receive lymph from the larynx.
 Tracheal (paratracheal) nodes:
• Lie alongside the trachea, receive lymph from neighboring
structures, including thyroid gland.
 Deep Cervical Nodes
• It form a vertical chain along the course of the internal
jugular vein within the carotid sheath.
• They receive lymph from all the groups of regional nodes
• The jugulodigastric node, which is located below &
behind the angle of the jaw, is mainly concerned with
drainage of the tonsil & the tongue.
• The jugulo-omohyoid node, which is situated close to the
omohyoid muscle, is mainly associated with drainage of
the tongue.
• The efferent lymph vessels from the deep cervical lymph
nodes join to form the jugular trunk, which drains into
the thoracic duct or the right lymphatic duct.