NODES OF THE UPPER LIMB 719 



The lymphatics of the larynx. — ^The larynx is, for the most part, drained by 

 the deep cervical nodes, although its lymph may also pass through certain out- 

 lying nodes situated upon its ventral surface. The mucous membrane is divided 

 into two zones by the ventricular folds, the mucous membrane of these structures 

 possessing but a scanty lymphatic plexus. The vessels from the upper part of the 

 larynx, four or five in number, pass to the nodes of the superior deep cervical chain, 

 situated near the digastric muscle; those from the lower part pass to the lower 

 nodes of the same chain, some even descending as far as the supra-clavicular nodes. 

 The lymphatics of the trachea pass, on each side, to the paratracheal and inferior 

 deep cervical nodes. 



The lymphatics of the thyreoid body. — The lymphatics of the thyreoid body 

 pass either to the small nodes situated in front of the larynx and trachea, or to 

 nodes of the deep cervical chain, a part of them ascending and a part descending. 



It will thus have been seen that the lymphatics of the mucous membrane of 

 the head and neck all end in the deep cervical chain of nodes or in the outlying 

 nodes from it. Some of the vessels pass by the outlying nodes, but since the nodes 

 of the chain are so closely connected, the lymph must pass through several nodes 

 before entering the veins. The main tonsils, the numerous lingual and pharyngeal 

 tonsils, together with small lymph-follicles in the submucosa of the respiratory 

 tract, represent lymph-nodes in the capillary zone. 



B. THE LYMPHATICS OF THE UPPER EXTREMITY 

 1. THE LYMPHATIC NODES OF THE UPPER EXTREMITY 



The lymph-nodes of the arm lie, for the most part, in the axilla, where there is 

 a large group of nodes which receive almost the entire drainage of the arm and 

 the thoracic wall. In addition, there is in the arm a set of outlying superficial 

 nodes, the superficial cubital (supra-trochlear), while small isolated nodes are often 

 intercalated along the course of the deep lymphatic vessels which accompany the 

 radial, ulnar, anterior interosseus and brachial arteries, the cephalic vein, and the 

 deep cubital vessels. 



(1) The antibrachial nodes are very small, pin-head sized nodes which are 

 intercalated along the deep lymphatics which accompany the radial, ulnar, ante- 

 rior and posterior interosseus arteries. 



(2) The deep cubital nodes [Igl. cubitales profundae] are also very small 

 nodes, one or two in number, intercalated along the ducts, near the deep vessels 

 at the bend of the elbow. 



(3) The superficial cubital node [Igl. cubitales superficiales] (or supratrochlear) 

 is situated three or four centimetres above the medial epicondyle of the humerus. 

 It lies in the superficial fascia on the medial side of the basilic vein near the place 

 where it passes through the deep fascia. It is usually single, but may be absent 

 or represented by a chain of from two to five nodes. Its efferents follow the 

 basilic vein. 



(4) The delto-pectoral nodes are very small intercalated nodes from one to 

 three in number, and are situated in the groove between the deltoid and pectoral 

 muscles. Their vessels follow the cephalic vein. 



(5) The axillary nodes [Igl. axillares], from twelve to thirty-six in number, 

 may be divided into groups according to the areas which they drain (fig. 566). 

 In addition to the upper extremity, they receive lymphatic drainage from the 

 thoracic walls, including dorsal, lateral and ventral (mammary) regions. 



(1) The subclavian group consists of four or five nodes, situated in the apex of the axillary 

 fossa. They receive the efferent vessels of all the other groups, and their efferent vessels in turn 

 unite to form a single trunk, the subclavian, which empties into the thoracic duct on the left 

 side and on the right side either into the vein directly or else after uniting with the jugular 

 trunk. (See pp. 726-728.) 



(2) The central group. A little lower along the axillary artery is a group of three to five 

 nodes, which makes a second centre for the vessels of the other groups, and sends its efferents 

 to the subclavian group. It will be clear from the figure that the separation of groups 1 and 2 

 is arbitrary. 



(3) The brachial group.- — This consists of four or five nodes, and, as its position toward 

 the junction of the axillary and brachial arteries indicates, is the main station for the lymphatics 

 of the arm proper. It receives almost all the superficial and deep lymphatics of the arm, and 

 its efferents pass to the central and subclavian groups, although a few pass directly to the 



