The deeper fascial structures of the head and neck drain either directly into the deep cervical lymph nodes or through the superficial system first and then into the deep system. These superficial nodes have already been described. The deep cervical lymph nodes proper (Figure 13.1) consist of the junctional nodes, the upper, middle, and lower cervical nodal groups which are situated along the internal jugular vein, the spinal accessory group which accompanies the accessory nerve in the posterior triangle, the nuchal nodes, the visceral nodes in the midline of the neck, and nodes in the upper mediastinum. The junctional nodes represent the confluence of nodes at the junction of the posterior part of the submandibular triangle with the retropharyngeal nodes where they meet at the junction of the upper and middle deep cervical nodes.
Figure 13.1 The Deep Cervical Lymph Nodes. (From Watkinson JC,Gaze MN and Wilson JA. Stell & Maran's Head & Neck Surgery, page 200, Butterworth Heinemann 2000. Reproduced by permission of Hodder Arnold.)
In general, the passage of lymph within these systems has been well documented using lymphography and follows a sequential pattern from superficial to deep, and from the upper to lower parts of the neck . These lower confluent vessels form into a jugular trunk which on the right side ends at the junction of the jugular vein, the brachiocephalic vein or joins the right lymphatic duct. On the left side, the trunk will usually join the thoracic duct as it arches behind the lower part of the carotid sheath and in front of the subclavian artery to enter the junction of the internal jugular vein with the brachiocephalic vein.
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