558 THE LYMPHATICS OF THE HEAD AND NECK. 



most of these vessels, however, pass with the deep lymphatics of this region to the 

 sternal glands ; they may traverse a small and inconstant epigastric gland near 

 the linea alba (Mascagni). 



The superficial lymphatics of the back converge to the axillary glands from 

 its various regions ; from the lower part of the neck over the surface of the trapezius 

 muscle, from the hinder part of the deltoid, and from the whole thoracic region ; the 

 branches communicate inferiorly with vessels leading to the inguinal glands, and 

 likewise across the middle line with branches of the opposite side. 



LYMPHATICS OF THE HEAD AND NECK. 



The lymphatic glands of the head are comparatively few and small ; those of the 

 neck are, on the contrary, large and numerous. The following groups of glands, 

 with their associated vessels, are distinguished : 



1. One or two suboccipital glands are placed beneath the skin, over the upper 

 end of the complexus muscle, and receive the lymphatics from the hindmost part of 

 the scalp ; their efferent vessels join the superficial cervical glands. 



2. The mastoid glands are two or three in number, and lie over the inser- 

 tion of the sterno-mastoid muscle ; they receive lymphatics which descend from the 

 scalp behind the ear, and their efferent vessels enter the superficial cervical glands. 



3. The parotid lymphatic glands, three or four of small size, lie beneath the 

 parotid fascia, and are frequently more or less embedded in the substance of the 

 parotid gland ; one, larger than the others, is situated immediately in front of 

 the tragus of the ear. They receive the superficial lymphatics descending from the 

 temporal region, and their efferent vessels pass to the submaxillary and superficial 

 cervical glands. 



4. The internal maxillary glands are placed deeply beneath the ramus of the 

 lower jaw, one or two with the internal maxillary artery, others on the hinder part 

 of the buccinator muscle and the side wall of the pharynx. Their afferent vessels 

 are derived from the temporal, zygomatic and orbital fossae, as well as the roof 

 of the mouth and the soft palate ; their efferent vessels enter the superior deep 

 cervical glands. 



5. The submaxillary lymphatic glands, from eight to ten or more in number, 

 lie beneath the base of the inferior maxilla, and receive the superficial lymphatics of 

 the face, the lymphatics of the floor of the mouth, and of the submaxillary and sub- 

 lingual salivary glands, as well as most of the vessels emerging from the parotid 

 lymphatic glands. Their efferent vessels pass to both superficial and deep cervical 

 glands. There are frequently also one or two small suprahyoid glands (Sappey) placed 

 in the centre of the neck between the anterior bellies of the two digastric muscles, 

 and connected with the lymphatics descending from the lower lip. 



6. The superficial cervical glands, from four to six, lie along the external 

 jugular vein, between the platysma myoides and the deep fascia. They are joined 

 by the lymphatics of the external ear, and of the integument of the neck, by the 

 vessels issuing from the suboccipital and mastoid glands, and by some of those from 

 the parotid and submaxillary lymphatic glands. Their efferent ducts enter the 

 inferior deep cervical glands. One or two small glands are sometimes found near 

 the middle line of the front of the neck between the hyoid bone and the sternum, 

 less frequently at the back of the neck over the trapezius muscle. 



7. The deep cervical glands are very numerous (twenty to thirty), and are 

 subdivided into superior and inferior. The superior extend from the bifurcation of 

 the common carotid artery to the base of the skul], lying for the most part along the 

 internal jugular vein. They receive the efferent vessels of the internal maxillary 



