12. Lymphatics in H&N

Question 1

What are the 4 functions of lymph?

Answer 1

1. Drain excess fluid from body
2. Recirculate proteins from blood capillaries
3. Absorb emulsified fat from lacteals in intestinal villi
4. Defense (B Cells = antibody; T Cells = cell mediated immunity)

Question 2

Review:
What are the 3 main lymphatic trunks that enter the same junction?
Where is this junction?
What structure collects all lower lymph?
Where does lymph from heart and lungs drain?

Answer 2

Jugular Trunks, Subclavian Trunks (drain sup + deep arms), Bronchomediastinal Trunks
Junction at subclavian veins and internal jugular vein

Cysterna chyli: below diaphragm, drains into thoracic duct = to left side junction

Heart/Lungs drain into bronchomediastinal trunk, can pass over to opposite sides

Question 3

What are the 2 big routes for H+N lymph? What do they drain and where do they drain to?

Answer 3

1. Superficial Ring/Chain of Nodes (Collar Chain): receives all subQ lymph in head, drains to deep lymphatics on carotid sheath = jugular nodes + jugular trunk
2. Deep Ring/Sheath surrounding visceral unit of neck: includes jugular/carotid sheath nodes, deep to SCM/deep fascia, drains pharynx/larynx lymph (laterally outward flow), drains to Jugular trunk

Question 4

Describe the routes of the parallel posterior route and front of neck

Answer 4

Parallel Posterior Route: Nodes/Vessels deep to SCM (follow CN XI) = Transverse Cervical Nodes = Jugular Trunk

Nodes/Lymphatics following Anterior Jugular Veins drain to jugular lymphatics

Question 5

What are the 3 main drainage routes of the tongue?

Answer 5

1. From L to R and R to L
2. Ant 2/3: to superficial ring = Jugular Nodes
3. Post 1/3: to Deep Ring or Direct to Jugular Nodes

Question 6

Where do the Maxilla, Mandible, and Tonsils in Pharynx drain? What is unique about where the tonsils drain?

Answer 6

Maxilla: drains anteriorly out infraorbital foramen to Sup Ring
Mandible: drains posteriorly out mandibular canal to Deep Ring

All tonsils (adenoids, palatine, lingual) drain to deep cervical lymph via JD node

JD node: jugulodigastric, in b/w post belly of digastric and jugular vein - large and palpable - “sentinel node” - enlarged as first sign of cancer

Question 7

What changes occur to lymph nodes when they become cancerous? How do we treat cancer in nodes?

Answer 7

Nodes attach to structures when cancerous (muscles, carotid sheath)

Tx: surgically remove nodes and their attached structures (also consider neighboring node)
Nodes are organized by levels of resection - will usually remove all nodes of a level if one is found to be cancerous