Lymphatic Drainage of Tongue

Lymphatic Drainage of the Tongue

Lymphatic drainage of the tongue is a clinically important and often confusing topic, particularly due to its complex patterns and implications in the spread of carcinoma.

The region of the tongue involved determines the drainage pathway and lymph node involvement, which in turn affects cancer staging.

🔄 Overview of Drainage

The lymphatic drainage of the tongue consists of:

• Intramuscular and submucosal plexuses

• These are arranged into four sets:

  • Apical
  • Marginal
  • Central
  • Dorsal (Basal)

1️⃣ Apical Set

🟡 Drains: Tip of tongue & frenulum linguae

🟡 Pathways:

• Pierces mylohyoid → Submental nodes (Level Ia)
• Some pass anterior to hyoid → Jugular mylohyoid nodes
• Others pierce mylohyoid → Submandibular nodes (Level Ib)
• A few pass deep to mylohyoid → Jugulodigastric or Juguloomohyoid nodes

2️⃣ Marginal Set

🟢 Drains: Side of the tongue anterior to the sulcus terminalis

🟢 Pathways:

• Pierces mylohyoid → Submandibular nodes
• Passes deep to mylohyoid → Jugulodigastric or Jugulo-omohyoid nodes

3️⃣ Central Set

🔵 Drains: Dorsal surface of anterior two-thirds (in front of vallate papillae)

🔵 Pathways:

• Descends between genioglossus muscles
  • Some → Jugulodigastric or Juguloomohyoid nodes
  • Some pierce mylohyoid → Submandibular nodes

4️⃣ Dorsal (Basal) Set

🟣 Drains: Posterior one-third of the tongue (including vallate papillae)

🟣 Pathways:

• Majority drain bilaterally → Jugulodigastric nodes (after piercing pharyngeal wall)
• Some pass downward behind tongue & hyoid → pierce thyrohyoid membrane → Jugulo-omohyoid nodes