Variations in the lymphatic drainage pattern of the head and neck: Further anatomic studies and clinical implications

Background: There is an increasing clinical need for accurate evaluation of the lymphatic anatomy of the head and neck. Methods: Fourteen halves of the superficial tissues of the head and neck and six specimens of the anterior superficial neck tissue from 13 unembalmed human cadavers were studied. Six percent hydrogen peroxide was used to detect the lymphatic vessels by using a surgical microscope. These vessels were then injected with a radio-opaque lead oxide mixture. Each specimen was dissected, photographed, and radiographed to demonstrate lymphatic vessels in the tissue. The final results were then transferred to the computer for analysis. Results: Lymph-collecting vessels were found in three regions of the superficial tissue of the head and neck: the scalp, face, and cervical region. They were dense in the scalp and lateral neck area but sparse in the facial, anterior, and posterior neck. Most vessels in the lateral neck were internodal lymphatics. Two layers of lymphatic vessels were found in the anterior superficial neck tissue coursing in different directions. Conclusions: An actual and accurate lymphatic map of the head and neck lymphatic drainage patterns is presented to upgrade our anatomical knowledge. This map will be of benefit for the clinical management of trauma and malignancies in this region.