Among the lymph nodes of the neck, superficial and deep are distinguished, and the latter, in turn, are divided into front and side.
Superficial lymph nodes of the neck are located on the external fascia. The anterior ones (1-3) lie along the external jugular vein, and the lateral ones lie along the posterior edge of the sternocleidomastoid muscle and partly along its outer surface. These groups of lymph nodes take lymph from the skin of the anterior and lateral surfaces of the neck and their efferent vessels go to the deep lymph nodes.
The deep lymph nodes of the neck include the pretracheal, right and left paratracheal groups.
The pretracheal lymph nodes are inconsistent and located on the front surface of the trachea. Paratracheal nodes are adjacent to the lateral surfaces of the trachea on the right and are usually a continuation of the same groups of lymph nodes of the mediastinum. Their number reaches from 2 to 10. Like the nodes of the pretracheal group, they receive lymph from the organs of the neck and partially from the lungs. The efferent vessels of the anterior deep groups of lymph nodes reach the deep lymph nodes of the lateral surfaces of the neck or participate in the formation of the jugular lymph trunks.
Deep lymph nodes of the lateral surfaces of the neck are most numerous and well developed. They are located in the area of supraclavicular fascial cases and, in turn, are divided into external and internal. Lymph nodes located throughout the internal jugular vein are called internal jugular. The number of lymph nodes in this group is quite large and can reach up to 30 on each side. Throughout the chain of internal jugular lymph nodes, three main groups, in turn, are distinguished: superior, middle, and lower — in relation to the internal jugular vein and external carotid artery, as well as the common carotid artery and scapular-hyoid muscle. In the group of lower deep jugular lymph nodes, one, the largest, located at the confluence of the internal jugular and subclavian veins, is often isolated. He received his own name – ” node Troisier . ” Through the Troisier node, lymph is drained from several collectors, which include the mediastinal. The carrying out lymphatic vessels of the deep jugular lymph nodes, combining, form the jugular trunk. The jugular lymphatic trunk either flows directly into the venous channel in the region of the right or left venous corners, respectively, or flows first from the right into the right lymphatic trunk, or from the left into the thoracic lymphatic duct.
External deep lymph nodes of the lateral surfaces of the neck are less numerous and are named according to the anatomical formations near which they are grouped: nodes of the accessory nerve, lymph nodes of the transverse neck artery. The efferent lymphatic vessels of both of these groups of nodes widely anastomose between themselves and with the vessels of the internal jugular group, and their efferent vessels carry lymph to the “Troisier node”, or to the jugular trunk or veins of the venous angle region.
The connections between the lymphatic collectors of the neck and mediastinum are particularly stable and numerous. With regular constancy, lymphatic vessels from the prevenous and pre-aortocarotid lymph nodes are observed, which reach the supraclavicular collectors and jugular lymph trunks of the right and left sides, respectively. The bulk of the efferent vessels of the right and left upper divisions of the paratracheal groups of the mediastinal nodes also ends in the region of venous angles or in the nodes of the deep jugular lymphatic chain. Connections between bifurcation and supraclavicular lymph nodes were also noted.
All of the above gave reason to attribute the deep lymph nodes of the neck — the supraclavicular region — to one of the final stages of the outflow of lymph from the lungs . Thus, the intrapulmonary, root, mediastinal and supraclavicular groups of lymph nodes represent a single system and are interconnected by numerous lymphatic vessels, through which lymph is drained from the lungs into the venous bed. Lymphatic drainage from the lungs has a number of peculiar features, which, taking into account the structural features and functions, are largely observed in other organs. According to the so-called “ Moskany law”, it is generally accepted that each lymphatic vessel, from its organ to the venous bed, passes through at least one lymph node. Most often for the first time this happens near the source: inside the lung, in the area of its root. Often this can be observed at a considerable distance from the lung — in the mediastinum. Direct connections have also been established — when lymphatic vessels do not meet a single lymph node from their origins and into the bloodstream, which can affect the spread of tumor metastases, but this is more likely an exception to the general rule. The most typical and usual in the construction of the lymphatic system of the lungs is a sequential, phased flow of lymph from one group of lymph nodes to another. From the deep lymphatic network of the lung, the bulk of the lymphatic vessels reaches the intrapulmonary groups of regional nodes, and then located in the root region. Here, widely anastomosing with the outgoing vessels of the deep lymphatic network, the lymphatic vessels of the superficial network of the lung are sent. With the greatest constancy, regional lymphatic collectors within the lung are located on the upper anterior surface of the lobar bronchi.
In the region of the lung root, part of the lymphatic vessels from the lower lobes is located in the pulmonary ligaments, passing through the lymph nodes located here. Often on the front or back surface can detect lung root lymph vessels extending obliquely in the transverse direction lenii which constitute interlacing efferent vessels of the upper lobe of the following description to nodes mediastinum.