Carcinoma of buccal mucosa commonly drain to the which of the following lymph nodes

Carcinoma Buccal Mucosa Buccal mucosa covers a large area. It extends from the meeting point of lips in front to the pterygomandibular raphe behind and from upper gingivobuccal sulcus to the lower one. Site of origin: Most common site is the angle of mouth or the line of occlusion of upper and lower teeth. It may also arise from the buccal sulcus where "pan" or tobacco quid is kept. As the whole of buccal mucosa is "condemned," carcinoma may be multicentric. Gross appearance: Lesion may be exophytic or ulceroinfil trative; the latter may infiltrate deeply. Exophytic type may be associated with erythroleukoplakia. Buccal mucosa is also the most common site for verrucous carcinoma which is a white papillary growth with considerable keratinization. Local spread: From its site of origin, the lesion may spread deeply involving submucosa - muscle - subcutaneous fat - skin. Involvement of buccinator muscle or anterior masseter causes trismus. Tumour may spread radially from its site of origin and involve angle of the mouth and lip anteriorly, retromolar trigone and medial pterygoid posteriorly, upper gingivobuccal sulcus and maxilla superiorly, lower gingivobuccal sulcus and alveolar ridge and gums inferiorly. Lymphatic spread: Nodal involvement occurs in about 50% of cases. Submandibular and later the upper jugular nodes may get involved. Upper jugular nodes may also be involved, directly skipping the submandibular group. Ref:- Dhingra; pg num:-226