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Lymph nodes of the head, neck and arm

Lymph nodes of the head, neck and upper limb function to receive, filter and transport lymphatic fluid from surrounding tissues and viscera back into the bloodstream via the thoracic duct, right lymphatic duct and/or subclavian lymphatic trunk. Lymph nodes and vessels of the head, neck and upper limb are generally divided into superficial and deep groups. 

Lymph nodes of the head filter lymph from regions of the head, face and scalp and typically drain to the superficial and deep lymph nodes of the neck. There are three main groups of lymph nodes within the head: the lingual lymph nodes, facial lymph nodes and a group of lymph nodes which form a ring at the junction between the head and neck known as the pericervical lymphatic circle

The lymph nodes of the neck are typically organized into superficial and deep nodes which are further classified into anterior and lateral cervical lymph nodes. These lymph nodes receive lymphatic drainage from the lymph nodes of the head and drain into either the thoracic duct  on the left or the right lymphatic duct. 

Lymph nodes of the upper limb include the cubital, axillary, infraclavicular and interpectoral lymph nodes. Superficial and deep afferent and efferent lymphatic vessels drain lymph to and from these nodes to ultimately reach the subclavian lymphatic trunk. 

This article will discuss the anatomy and function of the lymph nodes of the head, neck and arm.

Key points about the lymph nodes of the head, neck and upper limb
Definition Lymph nodes of the head, neck and upper limb receive, filter and transport lymphatic fluid from surrounding lymph nodes and viscera back into the bloodstream
Lymph nodes of head Facial nodes (buccinator, nasolabial, malar and mandibular nodes)

Pericervical lymphatic circle
(occipital, mastoid, parotid (superficial and deep), submandibular and submental lymph nodes)
Lymph nodes of neck Anterior cervical nodes:
Superficial anterior cervical nodes
Deep anterior cervical nodes (prelaryngeal, thyroid, pretracheal and paratracheal nodes)

Lateral cervical nodes
:
Superficial lateral cervical nodes
Deep lateral cervical nodes (superior and inferior deep lateral cervical nodes)
Accessory nodes
Supraclavicular nodes

Pharyngeal lymphoid ring and nodes
:
Pharyngeal lymphoid ring (pharyngeal, lingual, palatine and tubal tonsils)
Retropharyngeal nodes
Lymph nodes of arm Cubital nodes (supratrochlear nodes)
Axillary nodes (lateral, anterior, posterior, central, apical)
Infraclavicular nodes
Interpectoral nodes
Contents
  1. Lymph nodes of the head
    1. Pericervical lymphatic circle 
    2. Facial lymph nodes
    3. Lingual lymph nodes
  2. Lymph nodes of the neck
    1. Superficial anterior cervical lymph nodes
    2. Deep anterior cervical lymph nodes
    3. Superficial lateral cervical lymph nodes
    4. Deep lateral cervical lymph nodes
    5. Accessory lymph nodes
    6. Supraclavicular lymph nodes
    7. Retropharyngeal lymph nodes
  3. Lymph nodes of the arm
    1. Cubital lymph nodes
    2. Lymph nodes of axilla
    3. Infraclavicular lymph nodes
    4. Interpectoral lymph nodes
  4. Spread of malignant disease in the neck
  5. Sources
+ Show all

Lymph nodes of the head

Pericervical lymphatic circle 

At the junction between the head and neck are five groups of lymph nodes which form the pericerivcal lymphatic circle, also called the pericervical collar. These are the occipital, mastoid, superficial and deep parotid, submandibular and submental lymph nodes. These nodes present in a ring-like arrangement and function to receive lymph from regions of the nose, cheeks, ear, scalp and chin. They drain to the superficial or deep lymph nodes of the neck via efferent vessels.

Facial lymph nodes

Above the pericervical lymphatic circle is another group of lymph nodes known as the facial lymph nodes. As the name suggests, this group of lymph nodes receive lymph from regions of the face and drain to the submandibular lymph nodes via efferent vessels. These lymph nodes travel along the facial vein and are made up of the buccinator, nasolabial, malar and mandibular lymph nodes.

Lingual lymph nodes

At the center of the pericervical lymphatic circle are the last group of lymph nodes of the head: the lingual lymph nodes. This group of visceral nodes are found along the genioglossus muscle and function to drain lymph from the tongue. Efferent lymph vessels of the lingual lymph nodes drain to the jugulodigastric lymph node of the superior deep lateral cervical nodes, as well as the submandibular and submental lymph nodes.

Key points about the lymph nodes of the head
Facial nodes Buccinator, nasolabial, malar, mandibular nodes

Drainage
: Lateral eyelid, nose and cheek

Direction of flow
: Facial nodes → submandibular nodes → jugulodigastric node → inferior deep lateral cervical nodes → supraclavicular nodes → jugular trunk → thoracic duct (left) or right lymphatic duct
Pericervical lymphatic circle Occipital, mastoid, parotid, submandibular, submental nodes

Drainage
: Scalp, skin of neck, eyelids, root of nose, ear, cheek,

Direction of flow
: Pericervical lymphatic circle → deep lateral cervical nodes/ superficial lateral cervical nodes → supraclavicular nodes → jugular trunk → thoracic duct or right lymphatic duct
Lingual nodes  Drainage: Tongue

Direction of flow
: Lingual nodes → submandibular and submental nodes → jugulodigastric node → deep lateral cervical nodes → supraclavicular nodes → jugular trunk → thoracic duct (left) or right lymphatic duct
Submental nodes  Drainage: Chin, lower lip, cheek, gingiva around incisors, top of tongue, back of oral cavity

Direction of flow
: Submental nodes → submandibular nodes → deep lateral cervical nodes → jugular trunk → thoracic duct (left) or right lymphatic duct
OR
Submental nodes → juguloomohyoid node → jugular trunk → thoracic duct (left) or right lymphatic ducts
Submandibular nodes Drainage: Submandibular and sublingual glands, bottom of oral cavity, tongue, palate, gingiva, teeth, skin of eyelids, lips, nose and chin

Direction of flow
: Submandibular nodes → jugulodigastric node → deep lateral cervical nodes → supraclavicular nodes → jugular trunk → thoracic duct (left) or right lymphatic duct

Lymph nodes of the neck

The neck is home to an extensive network of lymph nodes and vessels which can largely be classified into superficial and deep anterior cervical lymph nodes and superficial and deep lateral cervical lymph nodes.

Superficial anterior cervical lymph nodes

Located along the anterior jugular vein are the superficial anterior cervical lymph nodes, which drain to the deep lateral cervical lymph nodes or directly to the supraclavicular lymph nodes via efferent vessels. This group of lymph nodes receives lymph from the skin of the infrahyoid region, the infrahyoid muscles, the isthmus of the thyroid gland and the infraglottal part of the larynx.

Deep anterior cervical lymph nodes

The deep anterior cervical lymph nodes are subdivided into four groups of lymph nodes which are named according to their location. These include the prelaryngeal, thyroid, paratracheal and pretracheal lymph nodes. This group of lymph nodes drain the deep structures of the neck, specifically the larynx and thyroid gland. The deep anterior cervical lymph nodes usually drain directly to the deep lateral cervical lymph nodes but in some cases can also drain to the superficial anterior cervical lymph nodes.

Take a closer look at the lymphatics of the head and neck in the study unit below:

Superficial lateral cervical lymph nodes

The superficial lateral cervical lymph nodes are located along the extent of the external jugular vein and are therefore sometimes referred to as the ‘external jugular nodes’. This group of lymph nodes receive lymph from the parotid nodes of the head and drain to the supraclavicular nodes at the root of the neck.

Deep lateral cervical lymph nodes

Located along the extent of the internal jugular vein are the deep lateral cervical lymph nodes. These nodes are often referred to as the internal jugular nodes due to their location. They can be divided into a superior and inferior group. The superior deep lateral cervical lymph nodes are located above the superior belly of the omohyoid muscle. One of the largest nodes in this region is known as the jugulodigastric lymph node. The inferior deep lateral cervical nodes are located below the superior belly of the omohyoid muscle. The large juguloomohyoid lymph node can be found along the middle portion of the internal jugular vein. Efferent vessels from the deep lateral cervical lymph nodes join to form the jugular trunks which drain into the right lymphatic and thoracic ducts, or directly into the subclavian vein.

Accessory lymph nodes

The most laterally located lymph nodes of the neck are known as the accessory lymph nodes. These nodes travel in close proximity to the accessory nerve and receive lymph from the skin of the scalp, skin of the lateral and posterior neck and shoulder, oropharynx, nasopharynx and thyroid gland. Efferent vessels of the accessory lymph nodes empty into the supraclavicular nodes at the root of the neck. 

Supraclavicular lymph nodes

At the root of the neck are a bundle of lymph nodes known as the supraclavicular lymph nodes. This group of lymph nodes receive lymphatic drainage from structures of the head and neck via the afferent vessels from the deep lateral cervical lymphatic vessels.
Efferent vessels of the supraclavicular lymph nodes and the deep lateral cervical lymph nodes come together to form the jugular trunk on each side. The jugular trunk transports lymph from the head and neck to the thoracic duct on the left and to the right lymphatic duct on the right.

Retropharyngeal lymph nodes

The retropharyngeal lymph nodes are located posterior to the pharynx and are organized into three lines (one medial and two lateral). These nodes receive afferents from the nasal cavities, paranasal sinuses, soft palate, palatine arch, auditory tube and middle ear

Efferent vessels from the retropharyngeal nodes drain to the superior and inferior deep lateral cervical lymph nodes of the neck.

Key points about the lymph nodes of the neck
Superficial anterior cervical nodes Drainage: Skin of infrahyoid region, infrahyoid muscles, isthmus of thyroid gland, infraglottal part of larynx

Direction of flow
: Superficial anterior cervical nodes → supraclavicular nodes → jugular trunk → thoracic duct (left) or right lymphatic duct
Deep anterior cervical nodes  Prelaryngeal, thyroid, pretracheal, paratracheal nodes

Drainage
: Larynx, thyroid gland, trachea

Direction of flow
: Deep anterior cervical nodes → deep lateral cervical nodes → supraclavicular nodes → jugular trunk → thoracic duct (left) or right lymphatic duct
Superficial lateral cervical nodes  Drainage: Receives lymph from parotid nodes

Direction of flow
: Superficial lateral cervical nodes → supraclavicular nodes → jugular trunk → thoracic duct (left) or right lymphatic duct
Deep lateral cervical nodes  Superior deep lateral cervical nodes (jugulodigastric node), accessory nodes, inferior deep lateral cervical nodes (jugloomohyoid node)

Drainage
: Receives lymph from head and neck

Direction of flow
: Deep lateral cervical nodes → jugular trunk → thoracic duct (left) or right lymphatic duct
Supraclavicular nodes  Drainage: Receives lymph from head and neck via accessory chain or deep lateral cervical nodes

Direction of flow
: Supraclavicular nodes → jugular trunk → thoracic duct (left) or right lymphatic duct
Retropharyngeal nodes  Drainage: Nasal area and pharyngeal lymphoid ring (pharyngeal, lingual, palatine and tubal tonsils)

Direction of flow
: Deep lateral cervical nodes → jugular trunk → thoracic duct (left) or right lymphatic duct
Jugular trunk Formed by efferent vessels of deep lateral cervical and supraclavicular nodes

Direction of flow
: Jugular trunk → thoracic duct/ directly into the left subclavian vein/left internal jugular vein or directly into the right lymphatic duct
Right lymphatic duct Drainage: Right side of head and neck

Direction of flow: Right brachiocephalic vein
Thoracic duct Drainage: Collects lymph from left side of head and neck

Direction of flow
: Junction of left subclavian and internal jugular veins

Lymph nodes of the arm

Lymphatic drainage of the upper limb typically accompanies and follows venous drainage. 

Cubital lymph nodes

Superficial lymphatic vessels arise from lymphatic plexuses in the hand and ascend within the forearm alongside the superficial veins of the forearm to reach the cubital lymph nodes. Cubital lymph nodes are located proximal to the medial epicondyle of the humerus and medial to the basilic vein within the cubital fossa, near the bifurcation of the brachial artery. This group of nodes receive lymphatic drainage from the skin and subcutaneous layer of the forearm and drain into the brachial axillary lymph nodes of the arm via efferent vessels. 

Cubital lymph nodes situated superior to the medial epicondyle of the humerus are known as the supratrochlear nodes. The supratrochlear nodes (1-2 lymph nodes) are a subgroup of the cubital lymph nodes and specifically function to drain lymph from fingers 3-5 and the medial portions of the forearm.

Lymph nodes of axilla

There are approximately 20-30 axillary lymph nodes which are divided into five main groups: lateral (humeral), anterior (pectoral), pos­terior (subscapular), central and apical axillary lymph nodes. The axillary lymph nodes collectively drain the vessels of the upper limb, chest walls, anterolateral abdominal wall (above the umbilicus) and the lateral quadrants of the breast.

The lateral group (brachial axillary lymph nodes) is formed by 4-6 axillary lymph nodes which are located posteromedial to the axillary vein. This group of lymph nodes receive lymphatic drainage from the whole upper limb via its afferent vessels and drain to the central and apical axillary nodes as well as the inferior deep lateral cervical lymph nodes of the neck via efferent vessels. 

The anterior group (pectoral axillary lymph nodes) of 4-5 axillary lymph nodes are located along the inferior border of the pectoralis minor muscle. These lymph nodes receive lymphatic drainage from the skin and muscles of this region as well as the breast. Efferent vessels of this group drain to the central and apical axillary lymph nodes. 

The posterior group (subscapular axillary lymph nodes), located along the inferior margin of the posterior axillary wall, consists of 6-7 axillary lymph nodes. This group of nodes receive lymphatic drainage from the posteroinferior region of the neck, the shoulder and back, and empty into the central and apical axillary lymph nodes via its efferent vessels. 

The central group of axillary lymph nodes (3-4) lie within the axillary fat and receive afferent vessels from the anterior, posterior and lateral axillary lymph nodes. This group of nodes give off efferent vessels which drain into the terminal group of axillary lymph nodes, the apical axillary lymph nodes. 

The final and terminal group of lymph nodes in the axilla are the apical axillary nodes. This group comprises 6-12 axillary lymph nodes and is located posterior to the superior part of the pectoralis minor muscle extending to the apex of the axilla, medial to the axillary vein. This group of lymph nodes drain all the other axillary lymph nodes. Efferent vessels of the apical axillary lymph nodes unite to form the subclavian trunk which drains into the jugulosubclavian venous junction, the subclavian vein, the jugular trunk or occasionally to the right lymphatic duct on the right and to the thoracic duct on the left. 

Take a closer look at the lymphatics of the axillary region with this article on the axillary lymph nodes.

Infraclavicular lymph nodes

Located within the deltopectoral groove (between the deltoid and the pectoralis major muscles) are lymph nodes (1-2) known as the infraclavicular lymph nodes. This group of lymph nodes receive lymphatic drainage from regions of the axilla and anterior thoracic wall. Efferent vessels of this group pass through the clavipectoral fascia and drain into the apical axillary nodes.

Interpectoral lymph nodes

The interpectoral lymph nodes (1-4) are located within the pectoral fascia between the pectoralis major and pectoralis minor muscles. They lie in close proximity to the axillary lymph nodes and receive lymphatic drainage from surrounding muscles and tissue. Efferent vessels of this group drain into the apical axillary lymph nodes.

Do you prefer learning by doing? Check out our free exam-prep guide to learning the lymphatic system, complete with quizzes and labeling activities.

Key points about the lymph nodes of the arm
Cubital nodes Supratrochlear nodes

Drainage
: Fingers 3-5, skin and subcutaneous layer of forearm

Direction of flow
: Cubital nodes → lateral axillary nodes → central axillary nodes → apical axillary nodes → subclavian trunk → thoracic duct (left) or right lymphatic duct
Lateral axillary nodes Drainage: Upper limb

Direction of flow
: Lateral axillary nodes → central axillary nodes → apical axillary nodes → subclavian trunk → thoracic duct (left) or right lymphatic duct
Anterior axillary nodes Drainage: Anterior thoracic wall and anterior abdominal wall

Direction of flow
: Anterior axillary nodes → central axillary nodes → apical axillary nodes → subclavian trunk → thoracic duct (left) or right lymphatic duct
Posterior axillary nodes Drainage: Shoulder and back region

Direction of flow
: Posterior axillary nodes → central axillary nodes → apical axillary nodes → subclavian trunk → thoracic duct (left) or right lymphatic duct
Central axillary nodes Drainage: Upper limb and anterior thoracic wall

Direction of flow
: Central axillary nodes → apical axillary nodes → subclavian trunk → thoracic duct (left) or right lymphatic duct
Apical axillary nodes Drainage: Axilla, upper limb and anterior thoracic wall

Direction of flow
: Apical axillary nodes → subclavian trunk → thoracic duct (left) or right lymphatic duct
Infraclavicular nodes  Drainage: Axilla and anterior thoracic wall

Direction of flow
: Infraclavicular nodes → apical axillary nodes → subclavian trunk → thoracic duct (left) or right lymphatic duct
Interpectoral nodes Drainage: Regions of axilla

Direction of flow
: Interpectoral nodes → apical axillary nodes → subclavian trunk → thoracic duct (left) or right lymphatic duct
Subclavian trunk Drainage: Upper limb and thorax

Direction of flow
: Subclavian trunk → thoracic duct (left) or right lymphatic duct

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