19 - Lymphatics of the head and neck Flashcards
What is the function of the lymphatic system?
- drainage of surplus tissue fluid
- removal of debris from cell breakdown or immune response
- important to indicate infection
- facilitates malignancy spread
Describe the general lymphatic drainage of the head and neck.
- nodes within the face drain into superior deep cervical nodes
- deep cervical nodes and occipital nodes drain into inferior deep cervical nodes
- all nodes drain into left or right subclavian vein
Which nodes drain into the superior deep cervical nodes?
- facial nodes
- anterior and posterior auricular nodes
- superficial parotid nodes
- deep parotid nodes
- retropharyngeal nodes
Where is the thoracic duct located?
Left subclavian vein
What does the thoracic duct drain?
All lymph from body except upper right quadrant
Where is the right lymphatic duct located?
Right subclavian vein
What does the right lymphatic duct drain?
Upper right quadrant
What are the superficial nodes of the head?
- facial
- superficial parotid
- posterior auricular
- anterior auricular
- occipital
How many superficial parotid nodes are there?
10
How many posterior auricular nodes are there?
1-3
How many anterior auricular nodes are there?
1-3
How many occipital nodes are there?
1-3
What do the superficial parotid and posterior and anterior auricular nodes drain?
- area of external ear
- lacrimal glands
- adjacent skin of scalp and face
How many facial nodes are there?
12
Where are the facial nodes located?
Along facial vein
Where are the superficial parotid nodes located?
Superficial to the parotid gland
Where are the anterior auricular nodes located?
Anterior to the external acoustic meatus
Where are the posterior auricular nodes located?
Posterior to the external acoustic meatus
Where are the occipital nodes located?
Over the occipital region of the head
What are the subdivisions of the facial nodes?
- infraorbital
- nasolabial
- buccal
- mandibular
What do the facial nodes drain?
Skin and mucosa in the area, superior to inferior
What are the deep lymph nodes of the head?
- deep parotid
- retropharyngeal
How many deep parotid nodes are there?
10
How many retropharyngeal nodes are there?
0, usually disappear by ages 4-5
What do the deep parotid nodes drain?
- middle ear
- auditory tube
- parotid gland
What do the retropharyngeal nodes drain?
- palate
- pharynx
- paranasal sinuses
- oral cavity
What are the superficial cervical nodes?
- submandibular
- submental
- anterior jugular
- external jugular
How many submandibular nodes are there?
3-6
How many submental nodes are there?
2-3
Where are the submandibular nodes located?
in the region of the angle of the mandible
Where are the submental nodes located?
Under the chin
Where are the anterior jugular nodes located?
Along the anterior jugular vein
Where are the external jugular nodes located?
Along the external jugular vein
What do the submandibular nodes drain?
- cheek
- upper lip
- body of tongue
- anterior hard palate
- majority of teeth, PDLs and gingiva (except lower incisors and upper 8s)
What do the sublingual nodes drain?
- drain tissue bilaterally
- lower lip
- chin
- floor of mouth
- apex of tongue
- mandibular incisors, PDLs and gingiva
What are the deep cervical nodes?
- jugulodigastric
- jugulo-omohyoid
- accessory
- supraclavicular
How many deep cervical nodes are there?
15-30 along each IJV
What do the jugulodigastric nodes drain?
- palate
- tonsils
What do the jugulo-omohyoid nodes drain?
- tongue
- submental triangle
What do the accessory and supraclavicular nodes drain?
Lateral triangles of the head
How are the deep cervical nodes separated into superior and inferior?
Where the omohyoid crosses the IJV
What do the superior deep cervical nodes drain?
- posterior nasal cavity
- posterior hard palate and soft palate
- base of tongue (bilateral)
- maxillary 8s
- TMJ
- oesophagus
- trachea
- thyroid gland
What do the inferior deep cervical nodes drain?
- posterior scalp and neck
- superior pectoral region
- part of the arm
How does infection and inflammation in the lymph node present?
Swollen and tender lymph nodes
How does malignancy present in lymph nodes?
Hard and painless lumps
What does swelling in the submandibular lymph nodes indicate?
Disease or malignancy in the oral cavity, face, nasal cavity or maxillary sinus
What does swelling in the supraclavicular lymph nodes indicate?
Disease or malignancy in the thorax or abdomen
