The lymphatics of the neck are both superficial and deep. The superficial nodes communicate freely with and end in the deep ones. For the sake of convenience we may divide them into a transverse set, embracing the submental, submaxillary, superficial upper cervical (behind the angle of the jaw), posterior auricular, and occipital nodes; and two longitudinal sets, one along the great vessels and another, a posterior set, in the posterior cervical triangle.

The Transverse Lymphatics

The submental nodes, also called the suprahyoid, lie beneath the chin and drain the region of the lower lip and chin and anterior part of the floor of the mouth. These will be enlarged in children with ulcerative skin affections of these regions. They may also be involved in carcinoma of the lower lip, especially if near the median line. That the submental nodes drain the tissues of the anterior portion of the mouth and probably the tongue itself is shown by Henry T. Butlin ("Surgery of Malignant Disease," p. 153), who states that the submental nodes are frequently affected in carcinoma of the tongue when its tip is involved.

The submaxillary nodes are beneath the body of the mandible in the submaxillary triangle. They drain the lips, nose, floor of the mouth, gums, anterior portion of the tongue and side of the face. These are the nodes most frequently affected in carcinomatous affections of the lips and anterior portion of the tongue. Henry T. Butlin ("Surgery of Malignant Disease," p. 153) calls attention to the fact that in malignant disease of one side of the anterior portion of the tongue the lymphatics of the opposite side may also be involved, thus showing that the lymphatics of the two sides of the tongue freely anastomose. This is contrary to what exists as regards the arteries, which anastomose hardly at all across the median line. He also states that one or more of the lymphatic nodes is frequently imbedded in the substance of the submaxillary gland. Therefore the submaxillary gland is excised at the same time as the affected lymphatic nodes.

The superficial upper cervical (subparotid) nodes are just below the parotid lymphatics and behind the angle of the jaw. They drain the region embraced by the masseter muscle as far back as the ear. They may be enlarged in affections of the skin and scalp above. Therefore in children with enlargement of these nodes the source of infection should be sought in those regions.

The posterior auricular nodes are behind the ear on the mastoid process and insertion of the sternomastoid muscle. In practice they are encountered as small (1 cm.), round swellings behind the ear, which are usually quite tender to the touch. This is probably due to their being placed on a hard, bony base. When enlarged they are often the subject of operations.

The superficial occipital nodes are just below the superior curved line of the occiput or a little lower down in the hollow below the occiput between the posterior edge of the sternomastoid and anterior edge of the trapezius muscles, resting on the splenitis. These are the nodes that are enlarged in syphilis and are to be searched for in endeavoring to establish a diagnosis.