The Lymph Glands and Vessels of the Head and Neck

1. The submaxillary lymph glands (Lg. submaxillares) (Figs. , ) are arranged in two elongated groups in the submaxillary space along each side of the omo-hyoid muscles. The two groups are in apposition in front of the insertion of these muscles and diverge posteriorly in the form of a V, extending backward about four or five inches (ca. 10 to 12 cm.). They are covered by the skin and a thin layer of fascia and panniculus, and are therefore palpable. Anteriorly they are firmly attached to the mylo-hyoidei, but otherwise they are rather movable in the normal state. Each group is related externally to the external maxillary artery and the anterior belly of the digastricus, below to the external maxillary vein, and above to the lingual and sublingual veins.

They receive afferent vessels from the lips, nostrils, nasal region, cheeks, the anterior part of the tongue, the jaws, the floor of the mouth, and the greater part of the hard palate and nasal cavity. The efferent vessels pass to the anterior cervical and pharyngeal glands.

The superficial lymph vessels of the face converge to twelve to fifteen trunks which turn around the lower border of the jaw with the facial vessels. Those of the lips form plexuses at the commissures. The nasal mucous membrane is richly supplied with lymph vessels which accompany the veins; posteriorly they communicate with the subdural and subarachnoid spaces and send efferents to the pharyngeal and anterior cervical glands.

2. The pharyngeal lymph glands (Figs. , , ) may consist of two groups. One lies on the lateral surface of the pharynx along the course of the external carotid artery. These glands are related externally to the stylo-maxillaris and digastricus and often to the submaxillary gland also, above to the guttural pouch. Other glands (Lg. retropharyngeales) are commonly found on the guttural pouch along the course of the internal carotid artery. They lie below the artery and are covered by the aponeurosis of the mastoido-humeralis and the cervical end of the submaxillary gland.

They receive afferent vessels from the cranium, the posterior part of the tongue, the soft palate, pharynx, guttural pouch, larynx, posterior part of the nasal cavity, and efferents from the submaxillary glands.

3. The anterior cervical lymph glands (Lg. cervicales craniales) are situated chiefly along the course of the common carotid artery in the vicinity of the thyroid gland, under cover of the cervical angle of the parotid gland. Some occur between the thyroid and the submaxillary salivary gland, others above and partly upon the thyroid. They are related deeply to the posterior part of the larynx, the trachea, the thyroid gland, and the œsophagus; below to the external maxillary vein and the outer border of the omo-hyoideus.

These glands are variable. Often there are none in front of the thyroid and the group may extend back a considerable distance along the course of the carotid artery.

Their afferents are deep lymph vessels from the head, the pharynx, larynx, guttural pouch, and thyroid gland, and efferents from the submaxillary and pharyngeal glands. Their efferent vessels go to the middle and posterior cervical glands.

4. The middle cervical lymph glands (Lg. cervicales mediæ) form an inconstant group situated a little in front of the middle of the neck on the trachea below the carotid artery. The group is usually small and in some cases is absent, being replaced by a number of glands occurring at intervals along the course of the carotid artery. In other subjects the group consists of several glands of considerable size. They are intercalated in the course of the tracheal lymph ducts.

5. The posterior cervical or prepectoral lymph glands (Lg. cervicales caudales) form a large group below the trachea at the entrance to the thorax (Fig. ). They occupy the interstices between the vessels and muscles and extend forward a variable distance on the ventral aspect of the trachea. They are covered by the panniculus and sterno-cephalicus. Their afferent vessels come from the head, neck, thorax, and thoracic limb. They receive efferent ducts of the anterior and middle cervical, prescapular, and axillary glands. Their efferents go to the thoracic duct on the left, to the right lymphatic duct on the right, or open directly into the vena cava.

6. The prescapular or superficial cervical lymph glands (Lg. cervicales superficiales) lie on the anterior border of the anterior deep pectoral muscle, in relation to the omo-hyoideus internally and the mastoido-humeralis externally (Figs. , , ). They are on the course of the ascending branch of the inferior cervical artery. They receive afferents from the neck, breast, shoulder, and arm. Their efferents pass to the prepectoral glands.

The tracheal ducts, right and left (Ductus trachealis dexter, sinister), are collecting trunks for the lymph of the head and neck. They lie on the trachea in relation to the carotid arteries. The right one goes to the prepectoral glands or to the right lymphatic duct, the left one to the terminal part of the thoracic duct.