Superficial lymph nodes of the head and neck and their drainage areas
The superficial lymph nodes form a ring where the head meets the neck, and a swollen node usually points to the area that is infected or diseased.
Remember
Lymph (the clear fluid that carries immune cells) from the face and scalp is filtered first by the superficial nodes, then passes to the deep cervical nodes (a chain receiving drainage from the whole head and neck). A swollen node in the head and neck usually points to disease in the area that drains to it.
The superficial ring is a collar of lymph nodes where the head meets the neck, running under the chin and round to the back of the head. Its groups include the submental (under the chin), submandibular (below the jaw), pre-auricular (in front of the ear), post-auricular (behind the ear) and occipital (at the back of the head). Because they sit just under the skin, they are easy to feel.
The submental nodes take lymph from the tip of the tongue, the central lower lip and the floor of the mouth (formed by a muscle sheet called the mylohyoid). The submandibular nodes drain the gums, the cheeks, the front of the tongue, the upper lip and the outer parts of the lower lip. As a simple rule, the jaw nodes take the side of the mouth and the chin nodes take the middle of the lower lip, the tip of the tongue and the floor of the mouth. The pre-auricular nodes drain the temple and nearby facial skin, the post-auricular nodes drain the upper ear and the back of the ear canal, and the occipital nodes drain the back of the scalp.
From the ring, lymph flows on to the deep cervical nodes, a vertical chain of nodes lying beside the internal jugular vein (the main vein draining blood from the head). These receive drainage from the whole head and neck. So lymph from the central lower lip passes to the submental nodes first, then the submandibular nodes, then the deep cervical chain.
The swollen node gives a clue to which area is infected or diseased, so look at the area that drains to it. When an area is infected, the nodes that drain it can enlarge. A hard, fixed, painless node should make you consider cancer.
Key facts
- Superficial ring
- includes the submental, submandibular, pre-auricular, post-auricular and occipital nodes.
- Submental nodes
- lymph from the tip of the tongue, the central lower lip and the floor of the mouth drains to them first.
- Submandibular nodes
- gum and side-of-mouth infections drain to them first.
- Pre-auricular nodes
- they lie in front of the ear and drain the temple and nearby facial skin.
- Occipital nodes
- these drain the back of the scalp.
- Next stage
- the superficial nodes drain into the deep cervical nodes.
- Other name
- the ring is often called the superficial cervical group, but some textbooks use that name for a narrower set, the nodes along the external jugular vein.
Exam traps
- The submandibular nodes do not come first for the central lower lip, because they also receive lymph from the submental nodes and so come second.
- The deep cervical nodes are not the first to receive lymph from the face and scalp, because they receive it second, after the superficial nodes.
- The jugulodigastric node is not part of the superficial ring, because it is a deep cervical node in the chain beside the internal jugular vein.
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