Fig. 63. Upper Triangle of Neck: Lymphatics. 



The Platysma is almost completely removed. The Cervico- Facial and Cervical 

 Nerves are cut short. The lymphatic glands have been drawn accurately from 

 the specimen (an old man), the lymphatic vessels with the aid of Stahr's 



investiga tions. 



Recent investigations have shewn that the number and the position of 

 the lymphatic glands in the submaxillary region do not vary as much as in the 

 other parts of the body (e. g. Axilla and Groin). There are usually only 3 glands, 

 which we call anterior, middle and posterior. They aU lie above the submaxillary 

 gland. The anterior is usually the smallest and lies next to the Submental Vein 

 on the Mylo-Hyoid Muscle; the middle is nearer the border of the jaw and 

 usually touches the Facial Artery : the posterior lies near the Facial Vein, either 

 immediately behind it, or nearer the angle of the jaw. 



A second group of glands lies between the anterior bellies of the Digastric 

 Muscles. Their number is less constant; but one can make out a superior set 

 (small glands, the upper submental glands) and an inferior set (the lower sub- 

 mental glands) often consisting of only one large gland (cf. Fig. 62). 



The efferent vessels from the upper submental set go partly to the lower 

 set, partly to the anterior submaxillary gland. F^rom the lower set the lymph 

 travels to the Anterior Submaxillary Gland and partly to the deep Cervical Glands. 

 The typical arrangement for the submaxillary lymphatics is as follows: lymph 

 goes from the anterior gland to the middle, thence to the posterior. Only in a 

 few cases, does it go directlj- to the deep cervical glands. Of the efferent vessels 

 from the posterior submaxillary gland, our figure shews the superficial channels 

 running to the cervical glands, but also one vessel going to an Inferior 

 Parotid Gland. 



A portion of the superior deep cervical glands along the Internal Jugular 

 Vein and the Carotid Artery is shewn in the figure. They receive lymph from 

 the Submental, Submaxillary, Lingual and Parotldean Glands, i. e. indirectly from 

 the whole Face, from the SkuU Cavity, Larynx, Pharynx and Thyreoid Gland; 

 this explains why they become enlarged so very frequently in disease. 



The lymphatics of the lips (cf. Fig. 115) are important, in consideration 

 of the frequent occurrence of epithelioma. We need to disting-uish between the 

 lymphatics of the skin, and the lymphatics of the mucous membrane. The vessels 

 from the mucous membrane of the lower lip (2 — 3 inches) usually go to the 

 middle submaxillary gland, into which the vessels from the upper lip (i to 

 2 Inches) frequently open, the latter may also pass to the posterior sub- 

 maxillary gland. 



The subcutaneous lymphatics vary more widely; these entered beyond the 

 middle line to a greater extent than the submucous vessels (2 — 4 subcutaneous 

 vessels go from the lower lip to the submental glands). The lymphatics of the upper 

 lip usually go to the middle submaxillary gland; in a few cases to an Inferior 

 parotid gland or even to a superficial cervical gland on the Sterno-Mastoid. As 

 epithelioma of the lip usually starts at the junction of the skin and mucous mem- 

 brane, and as the lymphatic areae meet here, aU glands and also those of the 

 opposite side demand consideration. 



