The face, oral tissues and tongue possess many lymphatic channels and display a variable pattern of lymphatic drainage. In general, the tissues of the anterior face and lips drain to lymph nodes in the submental and submandibular regions. The tissues of the lateral face, eyelids and anterior portion of the scalp and external ear drain to lymph nodes around the parotid region. The tissues of the posterior scalp and behind the ear tend to drain to retroauricular and suboccipital lymph nodes. These superficial lymph node groups ultimately drain to lymph nodes in the deep cervical chain situated around the internal jugular vein (Figure 19.1).
Within the oral cavity, the tissues of the palatal gingiva, hard palate and soft palate drain to retropharyngeal lymph nodes or directly to lymph nodes in the deep cervical chain. The tissues of the floor of the mouth and those of the lingual gingiva drain to nodes in the submental and submandibular regions, and ultimately to lymph nodes in the deep cervical chain.
There is much subregional variability in the lymphatic drainage of the tongue influenced by the presence of the median septum. Malignant tumour drains to ipsilateral lymph nodes in the deep cervical chain but contralateral node involvement should be considered with lesions at the tip of the tongue, lesions that cross the midline or involve the median fibrous septum and lesions in the posterior one-third.
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