The Anatomy of superficial lymphatics of the head and neck: an anatomical study and clinical application

Introduction: Current knowledge of the anatomy of the lymphatic system does not match nor explain some of the unexpected clinical and lymphoscintigrapic findings seen in head and neck cancer patients 1. There is a need, therefore, to re-map the lymphatic network of the superficial tissues of the head and neck region. Methods: The lymphatic vessels in the scalp, face and neck of seven fresh human cadavers were identified using 6% hydrogen peroxide with and without India ink, then injected with a lead oxide, milk powder and water mixture under the surgical microscope2. The specimens were photographed, radiographed and analyzed. Results: The lymph capillaries arise from both the skin and galea layers. Unusual ‘‘ampullae’’ structures and inactive lymph nodes were observed along their course. We found a lymphaticvenous shunt in the occipital region, as well as lymphatic bypass routes. On average the lymphatic collecting vessels were found to be 0.2 mm in diameter. The lymphatic vessels were color coded in accordance with their respective lymph nodes. The patterns were found to be different in each specimen. Even each side of the same head showed considerable variation. We were able to compare the anatomical relationship of the lymphatic and venous systems. Lymphatic pathways of the anterior neck were found to lie in the tissue above the platysma and course horizontally and obliquely. Conclusion: This study will provide an actual anatomical superficial lymphatic image of the head and neck and help surgeons to plan the treatment of the trauma, infection, lymphoedema and cancer.