The Neck (3)

Dr. Sina Mojaverrostami

Assistant professor in TUMS

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 Session Overview (Anterior and posterior
regions of the neck)
Anterior region of the neck
Infrahyoid region:
muscles, Thyroid gland, Larynx, Trachea, Esophagus

Prevertebral area: Muscles

Suprahyoid region:
Muscles, nerves, Submandibular gland

Posterior region of the neck: muscles

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 Anterior region of the neck

The anterior region (triangle) is situated at the front of the neck. It is bounded:
Superiorly – inferior border of the mandible and imaginary line between angle of mandible and
mastoid process.
Laterally – anterior border of the sternocleidomastoid muscle.
Inferiorly- Jugular notch of the sternum

Anterior region of the neck is divided into the 2 regions based on the hyoid bone.
Superior to hyoid bone you can find: Suprahyoid region
Inferior to hyoid bone you can find: Infrahyoid region

In Suprahyoid region 2 triangles can be found: Submental and Digasteric triangles

In the Infrahyoid region you can find 2 other triangles: Muscular and Carotid triangles

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 The infrahyoid region

The infrahyoid region is situated at the front of the neck below the hyoid bone. It is
bounded:
Superiorly – hyoid bone
Laterally – anterior border of the sternocleidomastoid muscle.
Inferiorly- Jugular notch of the sternum

In this region, from superficial part to deep you can find:

1. Superficial fascia and different superficial structures
2. Infrahyoid muscles: Omohyoid,Sternohyoid, Sternothyroid and Thyrohyoid
3. Thyroid gland
4. Larynx and trachea
5. Esophagus
6. Prevertebral muscles

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In superficial fascia of the infrahyoid region there are 3 important
structures: Platysma, transverse cervical nerve and anterior jugular vein.

The anterior jugular vein arises from the confluence of the superficial
submandibular veins. Its origin is located near the hyoid bone,
approximately 1 centimeter lateral to the midline of the neck.
The vein takes an inferior course down the neck, passing between the
midline of the neck and the anterior margin of the sternocleidomastoid
muscle. In the upper half of the neck, the anterior jugular vein receives a
small portion of blood from the larynx and thyroid gland via the laryngeal
and small thyroid veins.
In the lower half of the neck, the anterior jugular vein turns laterally,
reaching the space between the deep surface of the sternocleidomastoid
and superficial surfaces of the infrahyoid muscles.
Here, each anterior jugular vein gives off a branch towards its
contralateral counterpart, comprising the jugular venous arch just above
the jugular notch of sternum.
The inferior thyroid veins empty into the jugular venous arch. The main
trunk of the vein remains beneath the sternocleidomastoid where it
drains into the external jugular vein.
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 Infrahyoid muscles
The infrahyoid muscles are a group of four muscles under the hyoid bone
attaching to the sternum, larynx and scapula and They can be divided into
two groups:
Omohyoid muscle and Sternohyoid muscle are located in superficial layer.
Sternothyroid muscle and Thyrohyoid muscle are located in deep layer.

All of the infrahyoid muscles are innervated by Ansa cervicalis except ,

Thyrohyoid muscle . The omohyoid, sternothyroid and sternohyoid
muscles are supplied by the ansa cervicalis (C1-C3), which arises from
the cervical plexus. The thyrohyoid muscle is not innervated by the ansa
cervicalis but rather by nerve fibers from the anterior ramus of spinal
nerve C1 which reaches the muscle via the hypoglossal nerve (CN XII).

Trauma in the region of the cervical spine can damage the ansa
cervicalis, resulting in paresis or even paralysis of the infrahyoid muscles.
Clinically, those may be presented as swallowing difficulties, a hoarse
voice and throat tightness. Incorrect positioning during surgery or medical
interventions in the cervical region can also lead to nerve injuries.

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 1. Omohyoid muscle
The narrow flat omohyoid muscle consists of two bellies, an inferior
and a superior belly, joined by an intermediate tendon; similar to
the digastric muscle.
The inferior belly of omohyoid muscle originates from the superior
border of the scapula, medial to the suprascapular notch. From
there, the muscle inclines anteriorly and superiorly towards the
lower part of the neck, inserting into the omohyoid’s intermediate
tendon at the level of the arch of cricoid cartilage in the
lateral cervical region.
The superior belly of omohyoid arises from the intermediate
tendon, near the level of the internal jugular vein. Here, the muscle
changes its direction and courses almost vertically to insert at the
lower border of the body of the hyoid bone, lateral to the insertion
of the sternohyoid muscle.

Function: depress the hyoid bone following its elevation during the
act of swallowing. This action reopens the laryngeal inlet, which is
normally closed of during swallowing to prevent inhalation of the
food bolus. Thus, the act of opening the laryngeal inlet reestablishes
breathing after swallowing. 7
 2. Sternohyoid muscle

The Sternohyoid muscle originates from the upper posterior aspect

of manubrium of sternum and the posterior surface of
the medial end of clavicle .
It extends superomedially and inserts to the inferior border of body
of hyoid bone, where it adjoins the insertion of the contralateral
sternohyoid muscle.
The action of the sternohyoid muscle is to depress the hyoid bone
after it has been elevated by the suprahyoid muscles. The elevation
of the hyoid bone and thus the larynx, happens during swallowing.
This action closes the airways, preventing the food from being
inhaled.

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 3. Sternothyroid muscle
Sternothyroid is comparatively wider and shorter when
compared to the other infrahyoid muscles and located
deep to the sternohyoid muscle. It originates from the
posterior edge of the costal cartilage of the first rib as well
as the posterior surface of the manubrium of the sternum.

At its origin, the muscle is in contact with the contralateral

sternothyroid. However, the vertically oriented fibers
diverge as they travel superiorly to insert on the oblique
line of the thyroid cartilage. Here, the muscle outlines the
upper limit of the thyroid gland. This, together with
the sternohyoid muscle, limits the cranial extension of an
enlarged thyroid gland.
When acting alone, the sternothyroid muscle pulls the
lamina of the thyroid cartilage away from the hyoid bone,
thus opening the laryngeal inlet. This is particularly
beneficial during forced inspiration so that air enters
the lower airway.
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 4. Thyrohyoid muscle
The Thyrohyoid muscle is considered as a cranial extension
of sternothyroid. It originates from the oblique line of the lamina
of thyroid cartilage, where sternothyroid ends. The vertical fibers of the
muscle continue cranially and converge (but do not meet) toward their
insertion on the inferior border of the body and greater horn (cornu) of
the hyoid bone.

Thyrohyoid, unlike the other infrahyoid muscles, is not innervated by

the ansa cervicalis. Instead, nerve fibers from the anterior rami of
the first cervical spinal nerve (C1) reach the muscle via the hypoglossal
nerve (CN XII).
Thyrohyoid has two major functions. Firstly, it acts in conjunction with
the other infrahyoid muscles and depresses the hyoid bone, which is
helpful after swallowing has taken place. Secondly, when the hyoid
bone is stabilized by the suprahyoid muscles, thyrohyoid elevates
the larynx. This feature is important for vocalists who try to hit high
notes.

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 Thyroid Gland

• The thyroid gland consists of two lobes (right and left),

usually connected by an isthmus.
• The isthmus is located anterior to the 2nd and 3rd
tracheal rings, deep to the infrahyoid muscles.
• An extra lobe, called a pyramidal lobe, is sometimes
present projecting superiorly from the isthmus. The
pyramidal lobe is a remnant of the thyroglossal duct
and is considered a normal component of the
thyroid gland.

CLINICAL ANATOMY: Pyramidal lobes and accessory

thyroid tissue develop from remnants of the epithelium
and connective tissue of the embryonic thyroglossal
duct. Pyramidal lobes are present in approximately 50%
of individuals.

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 Thyroid Gland: Blood Supply and Venous Drainage
• Arterial blood supply to the thyroid gland is via the Figure 2
following vessels (Figures 1 and 2).
• The superior thyroid artery is the first branch
of external carotid of the external carotid
artery.
• The inferior thyroid artery is a branch of
thyrocervical trunk, which branches from the
first part of the subclavian artery.
• A third branch, the thyroid ima artery, is an
uncommon source of blood to the thyroid
gland. When present, it arises from the
brachiocephalic trunk or arch of the aorta
Figure 1
and follows a midline course along the
anterior surface of the trachea to enter the
thyroid gland’s inferior surface (Figure 1).

CLINICAL ANATOMY: A thyroid ima artery (Figure 1) is a rare anomaly important for
surgeons to be aware of during head and neck surgical procedures (thyroidectomy)
and emergent airway creation (tracheostomy). If inadvertently cut, it can be a source
of hemorrhaging that is difficult to control, especially if the cut vessel retracts
posterior to the manubrium.

• Venous drainage of the thyroid gland is via the following veins.

• The superior and middle thyroid veins drain to the internal jugular,
• The inferior thyroid veins drain into the brachiocephalic veins (Figure 2). 12
 Parathyroid Glands
The parathyroid glands are usually located on the posterior surface of each lobe internal
to the connective tissue sheath of the thyroid gland.
• Normally two glands are present on each lobe, although the total number of glands
are 4 (2 superior and 2 inferior glands)
• Parathyroid glands are difficult to locate in the embalmed cadaver.

CLINICAL ANATOMY: An ectopic parathyroid gland is defined as a gland not in its typical location. The most
common site for an ectopic inferior parathyroid gland is intrathymic, which results from abnormal
migration during embryogenesis. The common site for an ectopic superior thyroid gland is in the
tracheoesophageal groove, which is most likely the result of pathological displacement from its normal
anatomical position. Ectopic parathyroid glands are an important diagnostic challenge for surgeons.

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• The larynx is an air passageway that connects the laryngopharynx to the
Larynx
trachea.
• Its main functions are to maintain a patent airway, phonation, and prevent
food from entering the air passageways.
• It is composed of nine cartilages (3 paired and 3 unpaired) connected by
ligaments and membranes.
• The thyroid cartilage is the largest cartilage forming the larynx. It is
unpaired and is composed of two large plates that are joined
anteriorly to form a protrusion called the laryngeal prominence
(Adam’s apple). The superior boundary of the thyroid cartilage is
typically at the vertebral level C3 .
• The cricoid cartilage is an unpaired cartilage inferior to thyroid
cartilage. It forms a complete ring around the larynx and is connected
by ligaments to both the thyroid cartilage and the trachea. It is located
at the level of the C6 vertebra. Its inferior edge delineates the
boundary between the larynx and the trachea of the respiratory tract,
and between the pharynx and the esophagus of the digestive tract.

• The arytenoid cartilages are paired pyramidal-shaped cartilages that rest on the superior side
of the posterior portion of the cricoid cartilage.
• Attached to the apex of each arytenoid cartilage are the corniculate cartilages.
• The cuneiform cartilages are 2 small, club-shaped cartilages that lie anterior to the corniculate
cartilages in the aryepiglottic folds. They form small, whitish elevations on the surface of the
mucous membrane just anterior of the arytenoid cartilages.
• The epiglottis is an unpaired cartilage of the larynx composed of elastic cartilage, which
allows it to be flexible. During swallowing, the epiglottis covers the laryngeal inlet. When not
actively swallowing, the unattached end projects superiorly from the larynx and extends into
the oropharynx. 14
 Trachea

 The trachea (windpipe) extends from the inferior

end of the larynx into the mediastinum of the
thoracic cavity where it bifurcates (divides) into a
right and left main bronchus. The termination point
of the trachea is at the level of the body where the
manubrium meets the body of the sternum.

 The tracheal wall consists of “C” shaped

cartilaginous rings of hyaline cartilage that
maintain the trachea as patent tube (an open
passageway). The function of the tracheal rings (and the
cricoid cartilage as well) is to keep the airway patent
during inspiration.

 The ends of the cartilage in the wall of the trachea

are joined by smooth muscle called the trachealis
muscle. The trachealis muscle contracts during
coughing to decreases the lumenal diameter, which
increase the velocity of air moving through the
trachea to assist with movement of mucus or a
foreign substance toward the throat.

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 Tracheostomy vs. Cricothyrotomy
The procedure by which a round or square opening is made in the anterior wall of the trachea in order to insert a tube is called a tracheostomy; it is
performed to establish an alternate airway for patients whose trachea or larynx is obstructed. This procedure is used when the airway needs to be
maintained for several days or more. Because large blood vessels and the thyroid gland overlie the trachea, the above procedures are usually done
under controlled conditions. In an emergency, an incision can be made in the median cricothyroid ligament (a cricothyrotomy) to quickly establish a
temporary airway due to the absence of major vessels in this location. However, an incision at this location can potentially injure the vocal folds.

Tracheostomy Cricothyrotomy

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 The esophagus
The esophagus (oesophagus) is a 25 cm long fibromuscular tube extending from
the pharynx (C6 level) to the stomach (T11 level). It consists of muscles that run both
longitudinally and circularly, entering into the abdominal cavity via the right crus of
the diaphragm at the level of the tenth thoracic vertebrae.
The esophagus is divided into three parts:
Cervical which travels through the neck
Thoracic which is located in the thorax, more specifically in the mediastinum
Abdominal which travels past the diaphragm into the abdomen, reaching the stomach

The trachea and esophagus travel closely together through the neck (Trachea is located
anterior to the esophagus), with the vertebral column situated posterior to the
esophagus.

Those arteries supplying the cervical part originate from the inferior thyroid artery, a
branch of the thyrocervical trunk of the subclavian artery.

Veins from the cervical part drain into the inferior thyroid veins.

The parasympathetic component of the cervical part is supplied by the recurrent

laryngeal nerve (a branch of the vagus nerve (CN X)) while the sympathetic fibers arise
from the cervical sympathetic trunk.

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 Prevertebral muscles

The prevertebral muscles are a group of deep cervical muscles inside

the neck located anterior and laterally at the upper vertebral column.
They are enveloped by the prevertebral fascia of the deep cervical fascia.
Their main task is the bending forward of the skull (ventral flexion).

Longus colli muscle

Longus capitis muscle
Rectus capitis anterior
Rectus capitis lateralis muscles

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 Longus colli muscle
Longus colli is a paired muscle located on the anterior aspect of the vertebral column
is also known as longus cervicis.
Longus colli runs the entire length of the neck; between the atlas (first cervical
vertebra) and T3 (third thoracic vertebra). It is narrow at its superior and inferior ends
and has a broad central section. The muscle consists of three parts:
Superior oblique part - originates from the anterior tubercles of transverse processes
of the third, fourth and fifth cervical vertebrae (C3-C5). The muscle ascends gradually
in a superomedial direction to terminate on the anterior tubercle of anterior arch of
atlas (C1).
Vertical intermediate part - arises from the anterior surfaces of bodies of lower three
cervical and superior three thoracic vertebrae (C5-T3). This muscle section inserts onto
the anterior surface of bodies of second, third and fourth cervical vertebrae (C2-C4).
Inferior oblique part - is the smallest section of the longus colli muscle. It arises from
the anterior surfaces of bodies of first three thoracic vertebrae (T1-T3). It ascends
superolaterally, terminating onto the anterior tubercles of transverse processes of fifth
and sixth cervical vertebrae (C5-C6).

Longus colli muscle is innervated by the anterior rami of the second to

sixth cervical spinal nerves (C2-C6).

Bilateral contraction of the muscle causes flexion of the neck (i.e. forward movement).
Unilateral contraction, especially of the inferior oblique part, also results in
weak lateral flexion (ipsilaterally) and contralateral rotation of the neck.
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 Longus capitis muscle
Longus capitis is a long flat muscle of the anterior neck. It runs up the length of the
cervical spine, adjacent to the vertebral bodies.
Longus capitis muscle originates from its inferior aspect, from the anterior tubercles
of transverse processes of the third, fourth, fifth and sixth cervical vertebrae. From
these straps, the muscle fibers run superomedially, converging into a single broad
muscle belly. The muscle has one insertion on the basilar part of occipital bone,
anterior to the insertion of the rectus capitis anterior muscle and lateral to the
pharyngeal tubercle.

The longus capitis muscle is innervated by anterior rami of the spinal nerves C1-
C3 and occasionally C4, that are the branches of the cervical plexus.

The longus capitis muscle acts as a weak flexor of the head and cervical spine.

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 Rectus capitis anterior muscle

Rectus capitis anterior muscle originates from the anterior surface of lateral
mass of atlas (first cervical vertebra) and the root of its transverse process. It
then extends superomedially and inserts to the inferior surface of basilar part
of occipital bone.

This muscle is innervated by the anterior rami of spinal nerves C1 and C2.

The function of the rectus capitis anterior is to flex the head on the neck at the
atlantooccipital joint and to stabilize the atlantooccipital joint.

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 Rectus capitis lateralis muscle

Rectus capitis lateralis is a short, flat muscle. It arises from the superior surface of
the transverse process of the atlas (C1). The vertically oriented fibers travel
superiorly to insert onto the inferior surface of the jugular process of the occipital
bone.

Motor innervation to rectus capitis lateralis is provided by branches of the anterior

rami of the first two cervical spinal nerves (C1-C2).

The primary function of rectus capitis lateralis is to stabilize the atlanto-occipital

joint during movement. Unilateral contraction produces ipsilateral flexion of the
neck.

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 Suprahyoid region

The Suprahyoid region is situated at the front of the neck superior the hyoid
bone. It is bounded:
Superiorly – inferior border of mandible and imaginary line between angle of
mandible and mastoid process
Laterally – anterior border of the sternocleidomastoid muscle
Inferiorly- hyoid bone

In this region two triangles are located: Submental and Digasteric triangles.

Suprahyoid muscles are located in 3 layers:

Superficial: Digastric muscle and Stylohyoid muscle
Intermediate: Mylohyoid muscle
Deep: Geniohyoid

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 Suprahyoid Muscles
The the suprahyoid muscles are attached to the hyoid bone and project in a superior direction.
• They are located deep to the investing fascia of the deep cervical fascia.
• They function primarily to elevate the hyoid during speaking and swallowing.
• Muscles
• Digastric muscle
• Anterior belly: innervated by CN V3
• Posterior belly: innervated by the facial nerve
• Stylohyoid muscle: innervated by the facial nerve
• Mylohyoid muscle: innervated by CN V3
• Geniohyoid: innervated by C1

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 Digastric muscle
The digastric muscle is comprised of two parts; anterior and posterior bellies, joined by an
intermediate tendon.
The posterior belly originates at the medial surface of mastoid notch of temporal bone. From
here it travels anteroinferiorly towards the hyoid bone, piercing the stylohyoid muscle before
attaching into the intermediate tendon of digastric muscle.
The anterior belly of the digastric muscle originates from the digastric fossa of lower border
of mandible, close to the midline near the mandibular symphysis (symphysis menti). This
portion of the muscle extends posteroinferiorly from the mandible, joining with the
intermediate tendon.
Above the hyoid bone, these two muscle bellies unite as the intermediate tendon. This
tendon formed by a thickening of the investing layer of the deep cervical fascia.

As the posterior belly of digastric descends towards the hyoid bone, it travels closely behind
(posterior) the stylohyoid muscle. The internal jugular vein, external and internal carotid
arteries, and vagus, glossopharyngeal and hypoglossal nerves. These structures pass deep to
the posterior belly of the digastric muscle.

The anterior belly is innervated by the nerve to mylohyoid muscle. The posterior belly of the
digastric muscle is innervated by the digastric branch of the facial nerve.

Digastric has two main functions:

Depression of the mandible when the hyoid bone is fixed.
Elevation of the hyoid bone and larynx when the mandible is fixed. 25
 Stylohyoid muscle
Stylohyoid is a small, thin muscle that arises from the posterior surface of the styloid process of
temporal bone. The point of origin is very close to the base of the styloid process. The muscle
travels anteroinferiorly and medially, attaching to the body of hyoid bone.

Stylohyoid receives innervation from the stylohyoid branch of the facial nerve.

Contraction of the stylohyoid muscle results in elevation and retraction (posterior movement) of
the hyoid bone.

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 Mylohyoid muscle
Mylohyoid is a sheet like muscle, originating from the entire length of the mylohyoid line on the
inner surface of mandible. It courses inferomedially, with its fibers inserting onto the mylohyoid
raphe (median fibrous raphe) and superior aspect of body of hyoid bone. The anterior fibers
insert into the mylohyoid raphe forming a connection in the midsagittal plane, while the
posterior fibers insert to the hyoid bone only.
The mylohyoid raphe extends from the symphysis menti of mandible to the body of hyoid bone.

The superior surface of mylohyoid muscle is related to the structures of the oral cavity; it lies
directly beneath the geniohyoid, hyoglossus and styloglossus muscles, hypoglossal (CN
XII) and lingual nerves, submandibular ganglion, sublingual and submandibular glands, and
the lingual artery and vein.
The inferior surface of the muscle relates to the structures of the anterior neck
triangle; platysma, anterior belly of digastric muscle, submandibular gland, mylohyoid nerve and
artery, and the facial and submental arteries and veins.

Mylohyoid innervation is supplied by the nerve to mylohyoid muscle. This nerve is a branch of
the inferior alveolar nerve, which in turn comes from the mandibular nerve.

The mylohyoid muscle has the following actions;:

It elevates both the hyoid bone and floor of mouth, when the mandibular attachment is fixed
It depresses mandible with the hyoid attachment fixed

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 Geniohyoid muscle

The geniohyoid muscle originates from the inferior mental spine, located on
the posterior surface of the mandible near the lower part of the
mandibular symphysis. From there, the muscle fibers radiate
posteroinferiorly, close to the central line and insert to the superior border
of the body of the hyoid bone.

The paired geniohyoid muscles, placed next to each other, meet in the
midline of the mouth floor. They lie inferior to the genioglossus muscles
and right above the mylohyoid muscles.

Geniohyoid muscle is innervated by the anterior ramus of spinal nerve C1

carried by the hypoglossal nerve.

The main function of the geniohyoid muscle is to elevate the hyoid bone
and draw it anteriorly. This has as a consequence the
attached larynx and pharynx to move anterosuperiorly.
If the hyoid muscle is fixed (by other muscles) the geniohyoid muscle assists
in mouth opening by depressing the mandible and pulling it inwards.
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 Submandibular gland
The submandibular gland consists of a superficial part and a deep
part, which are separated by the mylohyoid muscle. The two parts
are continuous with each other and form a ”U” shape that hooks
around to posterior border of the mylohyoid muscle.
• The superficial part is located outside the oral cavity and is the
largest portion of the gland. It is located in the submandibular
triangle medial to the body of the mandible. However, it is
common for the gland to project inferiorly beyond the inferior
margin of the mandible..
• The deep part hooks around the posterior margin of mylohyoid
muscle to enter the oral cavity proper. It lies on the lateral Parotid
surface of the hyoglossus muscle lateral to the root of the Gland
tongue.
• The submandibular (Wharton’s) duct arises from the deep part Sublingual
of the gland and ascends on its path to open as 1-3 orifices on a papilla
small sublingual papilla (caruncle) at the base of the lingual
frenulum. In the oral cavity, the lingual nerve on its path to the Sublingual
tongue, loops under the submandibular duct. gland

Mylohyoid
muscle
Submandibular Submandibular
gland duct (green) gland (deep)
crossing lingual Submandibular
nerve (white). gland (superficial)
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 Hypoglossal nerve

The hypoglossal nerve is the twelfth paired cranial nerve.

Its name is derived from ancient Greek, ‘hypo‘ meaning under,
and ‘glossal‘ meaning tongue. The nerve has a purely somatic
motor function, innervating all the extrinsic and intrinsic
muscles of the tongue (except the palatoglossus, innervated
by vagus nerve).

The hypoglossal nerve arises from the hypoglossal nucleus in

the medulla oblongata of the brainstem. The nerve exits the
cranium via the hypoglossal canal of the occipital bone.
Now extracranial, the nerve receives a branch of the cervical
plexus that conducts fibres from C1/C2 spinal nerve roots.
These fibres do not combine with the hypoglossal nerve – they
merely travel within its sheath.
It then passes inferiorly to the angle of the mandible, crossing
the internal and external carotid arteries, and moving in an
anterior direction to enter the tongue.

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 Posterior region of the neck

This region is located behind the cervical vertebrae. It is bounded:

Superiorly – External occipital protuberance and superior nuchal line
Laterally – imaginary line between mastoid process and acromion process.
Inferiorly- imaginary line between 7th cervical Spinous process and acromion
process.

Contents:
1. Skin of this region innervated by Greater occipital (C2), third occipital (C3)
and C4.
2. Superficial and deep fascia.
3. Nuchal ligament: is a ligament at the back of the neck that is continuous
with the supraspinous ligament.
4. Muscles:
Trapezius, Splenius capitis, Splenius cervicis, Levator scapulae

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 Lymph Drainage
Five groups of superficial lymph nodes form a ring around the base of the skull.
These nodes are responsible for the lymphatic drainage of the face and scalp.
• Occipital nodes: drainage is from the posterior scalp and neck
• Mastoid nodes (retro-auricular/posterior auricular nodes): drainage is
from the posterolateral half of the scalp
• Pre-auricular and parotid nodes: drainage is from the anterior surface of
the auricle, the anterolateral scalp, the upper half of the face, the eyelids,
and the cheeks
• Submandibular nodes: drainage is from structures along the path of the
facial artery as high as the forehead, as well as the gingivae, the teeth, and
the tongue
• Submental nodes: drainage is from the center part of the lower lip, the
chin, the floor of the mouth, the tip of the tongue, and the lower incisor
teeth.

The superficial cervical nodes are a collection of lymph nodes along the
external jugular vein on the superficial surface of the sternocleidomastoid
muscle. They primarily receive lymphatic drainage from the posterior and
posterolateral regions of the scalp through the occipital and mastoid nodes, and
send lymphatic vessels in the direction of the deep cervical nodes.

Lymphatic flow from these superficial lymph nodes passes in several directions:
• Drainage from the occipital and mastoid nodes passes to the superficial
cervical nodes along the external jugular vein.
• Drainage from the pre-auricular, parotid nodes, submandibular nodes, and
the submental nodes pass to the deep cervical nodes.
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 Lymph Drainage (Continued)
The deep cervical nodes eventually receive all lymphatic drainage from the head Figure 1
and neck either directly or through regional groups of nodes. From the deep
cervical nodes, lymphatic vessels form the right and left jugular trunks, which
empty into the right lymphatic duct on the right side or the thoracic duct on the
left side .

The deep cervical nodes are a collection of lymph nodes that form a chain along
the internal jugular vein.
• They are divided into upper and lower groups where the intermediate tendon
of the omohyoid muscle crosses the common carotid artery and the internal
jugular vein.
• The most superior node in the upper deep cervical group is
the jugulodigastric node . This large node is where the posterior belly of the
digastric muscle crosses the internal jugular vein and receives lymphatic
drainage from the tonsils and tonsillar region.
• Another large node, usually associated with the lower deep cervical group
because it is at or just inferior to the intermediate tendon of the omohyoid
muscle, is the jugulo-omohyoid node. This node receives lymphatic drainage
from the tongue.

Figure 2 33