THE LYMPHATICS OF THE HEAD. 



951 



directions ; it must be recognized, however, that this classification of the stems into 

 three groups does not imply a corresponding division of the net-work into distinct 

 areas, since there is a considerable overlapping of the areas drained by the various 

 stems, and, indeed, stems from the same region may pass in some cases with one of 

 the group, and in others with another. From the outer (anterior) surface the 

 stems pass mainly to the anterior auricular nodes, a few bending backward over the 

 helix and terminating in the posterior auricular nodes. From the upper part of the 

 posterior surface (Fig. 801 j the stems pass mainly to the posterior auricular nodes, 

 some, however, continuing past them to terminate in the external jugular nodes. 

 From the lower part of the pinna, including the lobule, a number of stems pass to 

 the parotid nodes. 



The Nasal Region. — The lymphatic vessels of the integument of the nose 

 (Fig. 802) form numerous anastomoses with those of the mucous membrane, especially 

 with those of the middle and inferior meatuses, and those of the one side of the nose 

 are also continuous with those of the other side. Some of the vessels which drain 

 the upper portion of 



the nasal integument Fig. 802. 



pass almost directly 

 backward to the 

 parotid nodes, but 

 the principal path, 

 followed by vessels 

 from all parts of the 

 nasal integument, 

 is downwards and 

 backwards across 

 the cheek, in com- 

 pany with the facial 

 blood - vessels. In 

 their course some of 

 them traverse some 

 of the facial nodes, 

 which appear as if 

 intercalated in their 

 course, but the ma- 

 jority pass directly 

 to the submaxillary 

 nodes. 



A rich 1 y m- 

 phatic net-work lies 

 beneath the mucous 

 membrane of the 



nasal cavities, and from it vessels pass in two directions. Those of the anterior and 

 lower portions of the fossae pass forward and, partly at the external nares and partly by 

 passing between 'the nasal bones and the cartilages, communicate with the superficial 

 nasal lymphatics. The majority of the vessels, however, take a backward course, 

 terminating in different node groups. Some join the vessels draining the palate and 

 tonsils to pass to the superior deep cervical nodes and especially to that one which is 

 situated in the angle formed by the union of the facial and internal jugular veins, 

 while the rest unite to form from two to four stems which pass over the lateral surface 

 of the pharynx and terminate in the retropharyngeal nodes. 



The lymphatics of the sinuses which open into the nasal cavities follow, in part 

 at least, the same courses as those of the nasal mucous membrane, their principal 

 termination being in the larger retropharyngeal nodes. 



The Cheeks, Lips, Gums, and Teeth. — The lymphatics from the more 

 posterior portions of the cheeks empty into the parotid nodes ; those from the 

 more anterior portions pass to the submaxillary nodes, and the deeper ones 

 communicate with the facial nodes. 



* Beiti'age f. klin. Chirurgie, Bd. x.xv., 1899. 



Superficial 



cervical 



node 



or deep 

 al node 



Lymphatics of nose and cheek, {h'uttner.*) 



