3. Lymphatics of H&N

Question 1

What is Waldeyer’s Ring?

Answer 1

annular collection of lymphatic tissue/tonsils surrounding the superior pharynx - responds to pathogens that are inhaled or ingested

Question 2

Name and describe the location of the tonsils in Waldeyer’s Ring.

Answer 2

1. Pharyngeal tonsil (adenoids): roof of nasopharynx, behind uvula (postero-superior part of ring)
2. Tubal tonsils: posterior to opening of Eustachian tubes (lateral part of ring)
3. Palatine tonsils: between palatoglossal and glossopharyngeal arches (lateral part of ring)
4. Lingual tonsils: posterior base of tongue (anteroinferior part of ring)

Question 3

Which part of Waldeyer’s ring can be seen when performing routine examination?

Answer 3

palatine tonsils

Question 4

Which tonsils are enlarged in tonsillitis?

Answer 4

palatine tonsils

Question 5

Inflammation of which tonsils might cause middle ear problems and why?

Answer 5

Pharyngeal tonsil as located close to opening on Eustachian tube to middle ear (can cause infection or fluid build-up in middle ear).

Question 6

What are the 2 types of lymph node and where are these found in the H&N?

Answer 6

• REGIONAL (superficial): in superficial cervical fascia

- TERMINAL (deep): deep to investing layer of cervical fascia - closely related to carotid sheath, esp. IJV

Question 7

Where do the superficial lymph nodes drain to?

Answer 7

deep/terminal nodes

Question 8

What structures do the superficial lymph nodes/vessels drain?

Answer 8

scalp, face and neck

Question 9

What structures do the deep lymph nodes/vessels drain?

Answer 9

all the head and neck, either directly or indirectly from regional groups

Question 10

Name and describe the location of the main lymph nodes in the head, as well as the regions they drain.

Answer 10

1. submental
   - inferior to mental process
   - lymph from central lower lip, floor of mouth and tongue apex
2. submandibular
   - inferior to mandible
   - lymph from cheeks, lateral nose, upper lip, lateral lower lip, gums and anterior tongue (+submental LNs)
3. preauricular
   - anterior to ear auricle
   - lymph from superficial area of face and temporal region
4. postauricular
   - posterior to ear at insertion of SCM on mastoid process
   - lymph from posterior neck, upper ear and back of external auditory meatus
5. occipital
   - back of head at lateral border of trapezius
   - lymph from occipital area of scalp

Question 11

Name and describe the location of the main lymph nodes in the neck, as well as the regions they drain.

Answer 11

Superficial cervical lymph nodes:
- superficial to EJV 
- posterior to EJV
- anterior to EJV
Collect lymph from superficial neck

Question 12

Which deep cervical lymph node is enlarged in tonsillitis?

Answer 12

jugulo-digastric

Question 13

Which deep cervical lymph nodes can be enlarged in tongue cancer?

Answer 13

jugulo-digastric and jugulo-omohyoid

Question 14

Which structures do the jugulo-digastric nodes drain and where are they located?

Answer 14

• located below angle of mandible

- drains palatine tonsil, oral cavity and tongue

Question 15

Which structures do the jugulo-omohyoid nodes drain and where are they located?

Answer 15

• located near intermediate tendon of omohyoid

- drains tongue, oral cavity, trachea, oesophagus and thryroid gland

Question 16

What is Virchow’s node?

Answer 16

enlarged left supraclavicular LN

Question 17

What is Trosier’s sign?

Answer 17

enlarged, hard, left supraclavicular LN secondary to metastatic abdominal malignancy

Question 18

Where are the supraclavicular nodes found and what structures do they drain?

Answer 18

• located in supraclavicular fossae

- receive lymph from abdomen and thorax (left node) or mid-section of chest, oesophagus and lungs (right node)

Question 19

What do the deep cervical lymphatic vessels drain into?

Answer 19

Converge to form the L and R jugular lymphatic trunks:

• L trunk joins thoracic duct at root of neck
• R trunk empties into R lymphatic duct at root of neck