7. Lymphatic Drainage of H/N Flashcards by J L

Lymphatic System: a passive, centripetal, vascular system

• Returns a portion of the extracellular (interstitial) fluid to the
systemic circulation through a thin-walled system of vessels.
• Arises from a network of highly permeable ____ arising blindly in tissues.
• With muscle contraction, fine filaments anchoring vessels to surrounding CT transfer tensional forces to endothelial cells, ____ spaces between cells allowing proteins and large particles present in the interstitial fluid to enter the lymphatic capillaries.
• Lymphatic capillaries collect this fluid from most parts of the body, after which it is passed through successively larger ____ and a network of nodes, trunks and ducts until it is returned to the ____ circulation at the base of the ____.
• The lymphatic system also absorbs and transports ____ and fats as dense and milky ____ from the ____ of the digestive system

lymphatic capillaries
opening
vasa lymphatica
venous
neck
fatty acids
chyle
lacteals

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Smaller vasa lymphatica act as tributaries which ultimately drain centrally to larger ____

Lymph nodes, ____ lymphoid organs of varying size,
lie at various points along this drainage system. The nodes present as round, oval or bean-shaped, usually featuring a depressed ____ on one side, through which ____ lymphatic vessels enter and ____ vessels emerge.

In the nodes:
• Pathologic cells, viruses, bacteria and cellular debris are filtered
from the clear, faintly yellow and slightly opalescent fluid; and
• B & T lymphocytes and APC’s initiate immune response to
foreign antigens

Though most trunks have ____ valves that prevent retrograde flow, these valves may become ____, thereby permitting
lymphatic flow and the spread of disease to occur ____.

Valvular incompetence is one potential cause of ____

lymphatic trunks
secondary
hilum
afferent
efferent

bicuspid
incompetent
centrifugally

lymphedema

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Lymphatic vessels from superficial tissues of the head usually drain
first to the following local groups of nodes:

Parotid:
drain the
- EAM &amp; auricle 
- \_\_\_\_
- Eyelids
- \_\_\_\_
- Soft palate
- \_\_\_\_

Superficial parotid nodes embedded in the gland are known nodes are aka ____ nodes

Mastoid (retro-auricular)
drain the ____ and auricle

Occipital
drain the ____

Buccal
-drain the
Buccal mucosa of the \_\_\_\_ vestibule
- Nose
- \_\_\_\_

middle ear
temple
posterior nasal cavity

preauricular

scalp

oral
upper lip

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Lymphatic vessels from superficial tissues of the head usually drain
first to the following local groups of nodes:

Superficial cervical

Lingual nodes:
lie on the superficial aspect of the ____

Submental nodes:
drain
- \_\_\_\_
- Chin
- \_\_\_\_
- Anterior
oral floor

Submandibular nodes:
drain
- \_\_\_\_
- Buccal &amp; Submental
nodes

Also: Anterior cervical

hyoglossus
lower lip
lingual apex

oral and perioral tissues

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Anterior Cervical (inconsistent)

____
____
____
____

infrahyoid
prelaryngeal
paratracheal
pretracheal

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These five groups of nodes are described collectively as comprising a ____ (____) at the junction of the head and neck

Parotid
Mastoid
Occipital
Submental
Submandibular

superficial ring

pericervical collar

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Ultimately, all lymphatics
of the head and neck drain to the ____ along the
carotid sheath, either ____ from tissues
or ____ through the aforementioned groups of outlying regional nodes

The “collecting” nodes along the internal jugular vein are referred to as ____ or ____ nodes

deep cervical lymph nodes
directly
indirectly

jugular
lateral deep cervical

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Submandibular nodes

are associated with the ____ gland and the ____ vessels as they course over the inferior border of the mandible

submandibular salivary

facial

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The submandibular salivary gland and lymph nodes are found in the ____ (____) triangle

submandibular

digastric

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Submandibular nodes
receive lymphatics which accompany the ____ vessels and drain the lower ____ and the lateral part of the ____

Submandibular nodes
also receive some of the drainage from the:
	• \_\_\_\_
	• \_\_\_\_; and
	• \_\_\_\_ nodes

facial
face
anterior tongue

buccal
submental
lingual

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Lymphatic drainage
of most of the
oral cavity is
directed toward the \_\_\_\_ nodes, specifically:
o \_\_\_\_ teeth,
o Vestibular gingivae of maxilla and mandible
o \_\_\_\_gingivae 
o Upper lip
o Lateral parts of \_\_\_\_
o Posterior floor of mouth
o Lateral body of \_\_\_\_

But there are some important exceptions…

submandibular
maxillary
mandibular lingual
lower lip
tongue

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BUT the mandibular incisors may drain directly to the ____ nodes

Mandibular teeth drain directly to ____ nodes

Lymphatic drainage
of the mucosa and gingivae of the hard palate
may be directed thru the ____ to the
____ and ____ nodes

submental
superior deep cervical
superior constrictor
retropharyngeal
superior deep cervical

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Embedded in the fascia between the posterior pharynx and vertebral column:

\_\_\_\_ nodes
Also drain lymph from:
- \_\_\_\_
- \_\_\_\_ 
- \_\_\_\_

Efferents drain to the ____ and ____ nodes

retropharyngeal
nasal cavity
soft palate
middle ear

jugulodigastric
superior deep cervical

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Submental lymph nodes

 Receive drainage from:
	• Anterior floor of the \_\_\_\_
	• Median \_\_\_\_
	• Apex of the \_\_\_\_
	• \_\_\_\_

mouth
lower lip
tongue
chin

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Submental nodes are found in the ____

submental triangle

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Submental lymph nodes

Lying superficial to the ____ muscles, these nodes are the most significant structures in the submental triangle these nodes, in turn, drain to the ____ nodes

mylohyoid

submandibular

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____ cell carcinoma of the lower lip, resulting from chronic sun exposure or a lifetime of pipe-smoking will metastasize to Submental nodes if ____
Submandibular nodes if ____

sqaumous
median (midline)
lateral (corners of mouth)

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The lymphatic plexus of the lingual mucosa is continuous with an ____ plexus

Posterior to the vallate papillae, the tongue is drained by ____ vessels draining to ____ nodes

With the exception of the apex, the anterior tongue is drained by :
• Marginal vessels to ____ nodes
• Median vessels to ____ nodes

intramuscular
dorsal lymph
superior deep cervical

submandibular
deep cervical

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Curiously,
vasa lymphatica draining each half of the tongue may cross the ____ and permit cancerous lesions arising on either lateral border of the tongue to metastasize to the ____ submental and submandibular nodes

midline

contralateral

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Submandibular nodes
in turn drain into the
____ nodes

Recall that the
deep lateral cervical nodes lie along the ____

superior deep lateral cervical

internal jugular vein

Enlargement of the jugulo-omohyoid node, a deep cervical node related to the ____ tendon of the ____ muscle, may be a sign of ____ carcinoma

intermediate
omohyoid
lingual

Aggregated lymphoid nodules or TONSILS guard the boundaries
between the ____ and ____ cavities and the ____

____-Associated Lymphoid Tissue (MALT)

These tonsils form ____

oral
nasal
pharynx
mucosa
waldeyer's ring

Waldeyer’s ring
a protective anulus of lymphoid tissue, arranged in \_\_\_\_ or follicles, is formed by four sets of tonsils:
- \_\_\_\_
- \_\_\_\_
- \_\_\_\_
- \_\_\_\_

As well as ____ in between

nodules

pharyngeal
tubal
palatine
lingual

minor masses

Pharyngeal tonsil in the pharyngeal recess (fossa of ____)

Enlargement of these tonsils: ____

may interfere with normal ____ breathing and impact ____

Rosenmuller
adenoids
nasal
salivation

Palatine tonsil in ____ (note the ____...)

tonsilar fossa | tonsilar crypts

Tonsilar crypts ...invaginations of tonsilar epithelium that dramatically increase ____ between environmental influences and lymphoid tissue. Chronic ____ or ____ drip may lead to formation of foul-smelling plugs of calcified mucus and bacteria known as… ____ - local inflammation

contact surface sinusitis postnasal tonsiloliths

PALATOPHARYNGEAL FOLD PALATOGLOSSAL FOLD Note the ____ resting in the fossa between the two arches Enlargement of the palatine tonsils with or without tonsiloliths may interfere with ____

deglutition

What about enlarged PALATINE TONSILS? “____ TONSILS” TONSILLECTOMY - risky procedure TONSILLITIS - Can heal ____ or w ____

kissing naturally antibiotics

Note how the | SUPERIOR PHARYNGEAL CONSTRICTOR contributes to the floor of the ____ FOSSA

tonsilar

Palatine tonsils Failure to resolve tonsilitis may lead to formation of a ____

parapharyngeal abscess

The parapharyngeal space connects to every other major fascial neck space. Infections in the parapharyngeal space usually originate in the ____ or ____, although local spread from ____ sources and lymph nodes may occur. Symptoms include fever, sore throat, ____ and swelling in the ____ down to the ____ bone. Diagnosis is by ____. Treatment is ____ and surgical ____.

tonsils pharynx ``` odynophagia neck hyoid CT antibiotics drainage ```

Anterior space abscesses cause ____ and ____ (thickening of tissues) along the angle of the mandible, with medial bulging of the ____ tonsil and ____ wall Posterior space abscesses cause more ____ swelling, may erode the ____ until rupture, and produce septic thrombosis of the ____ as well as ____ deficits

trismus induration palatine lateral pharyngeal posterior pharyngeal carotid artery IJV neurologic

A dense of plexus of lymphatic vessels surrounds each follicle; Efferent vessels arise from the plexus and pass to the superior deep cervical nodes, especially the ____ group

jugulodigastric

Jugulodigastric node One of the ____ nodes Drainage: 1. ____ tonsil 2. ____ tonsil Q: sentinel node? A: Since it receives afferent flow from regions which may be hard to assess on ____ exam, enlargement warns the DMD that further investigation is necessary

superior deep lateral cervical pharyngeal palatine oral

Lymph nodes and vessels of the cervical region are divided into superficial and deep groups • Superficial cervical nodes, previously introduced, receive afferent lymphatic vessels from the ____, ____, and ____. These nodes lie superficial to the investing layer of ____ fascia * External jugular and anterior jugular groups follow the superficial veins of the same name before draining into the ____ group of nodes * An occasional member of the superficial lymph nodes of the neck, chronically enlarged by past infection, may be ____ in the normal neck

scalp face superficial neck cervical deep cervical palpable

Some superficial cervical nodes accompany the ____ vertically across the superficial surface of ____, while others lie along the ____ in the root of the neck

external jugular vein SCM anterior jugular veins

Lymph nodes and vessels of the cervical region are divided into ____ and ____ groups Deep lateral cervical nodes lie along the ____vein. They drain all ____ head and neck structures. These head and neck areas drained by the deep lateral cervical nodes are prone to ____ and ____ – SUPERIOR deep lateral cervical nodes, which lie along the ____ vein, should be sought superiorly along the anterior border of the ____. – INFERIOR deep lateral cervical nodes Are sometimes called the ____ or ____ NODES because of their position above the clavicle and upon the surface of the scalene muscles. These nodes may also interrupt any of the major ____ draining into the large veins at the base of the neck... Thus they may serve as a final ____ for tumor cells spreading thru the lymphatic system arising from either ____ or ____ sites

``` superficial deep internal jugular vein ipsilateral infection carcinoma ``` internal jugular sternocleidomastoid supraclavicular scalene lymphatic trunks filter near distant

SUPERIOR Deep lateral cervical nodes INFERIOR Deep lateral cervical nodes These nodes have therapeutic as well as diagnostic importance - Therapeutically, the surgical procedure of ____ for head and neck carcinoma is designed to remove all of these nodes in a "block" which also includes the ____, the ____ gland, and the major ____ to insure as complete a lymph node extirpation as possible

radical neck dissection sternocleidomastoid submandibular veins

One of the ____ nodes, the specifically named Jugulodigastric node... ... drains the posterior ____ and ____ tonsils. It is commonly enlarged and can be located at the level of the greater horn of the ____ bone in a triangle formed by the posterior belly of the ____ muscle and the ____ and ____ veins

tongue palatine hyoid digastric facial internal jugular

The Jugular Lymphatic Trunks * Jugular lymphatic trunks are formed by efferents from the ____ cervical nodes on each side, transmitting the lymphatic drainage of the ipsilateral head and neck. * On the right side, the jugular trunk may join with the ____ trunk draining the ____ upper limb and the ____ trunk draining the right side of the thorax, to commonly form a right ____ duct. These lymphatics empty into the junction of the right ____ and ____ veins as they form the right ____ vein. On the left, ____, ____ and ____ trunks commonly join the thoracic duct

``` inferior deep lateral subclavian right bronchomediastinal lymphatic subclavian internal jugular brachiocephalic ``` jugular subclavian bronchomediastinal

The ____ transmits the lymphatic drainage of three-quarters of the body to the venous system at the root of the neck

thoracic duct

Thoracic duct arises from the ____, a lymphatic reservoir located just below the aortic ____ which receives the drainage of the ____ of the body and all ____ viscera The duct ascends thru the posterior mediastinum, gradually crossing from right to left until it passes thru the ____ aperture

cisterna chyli hiatus lower half abdomino-pelvic superior thoracic

Before draining into the venous system, the thoracic duct receives drainage of the ____ wall and the ____ trunk

left thoracic | left broncho-mediastinal

Each broncho- mediastinal trunk receives the drainage of the ____ and ____ nodes among others These nodes are implicated in the metastasis of ____

bronchopulmonary tracheobronchial primary lung carcinomas

THORACIC DUCT | The duct ascends out of the thorax and loops up behind the ____ before emptying into junction of the ____ and ____ veins

carotid sheath left subclavian internal jugular

Palpation of the supraclavicular fossa ____ Node aka "The Seat of the Devil"

virchow's

The inferior deep lateral nodes are also called ____ nodes since their enlargement on the right side should send the physician looking for a primary tumor site in the ____ quadrant of the body and their enlargement on the left indicates a primary site in the ____ or ____ quadrant of the body. Therefore, lymph from the right upper quadrant of the body, i.e., the right side of head and thorax and the right upper limb, drains into the great veins at the ____ of the base of the neck. However, lymph from the lower half of the body and the left upper quadrant drains into the great veins on the ____ of the base of the neck. ____ are present in the the terminal parts of these lymphatic ducts to prevent venous reflux.

sentinel right upper lower half left upper right side left side valves

The THYMUS and the bone marrow are ____ organs and will be discussed in BS VI

primary lymphoid

Sloan Kettering Nomenclature Level I ____ and ____ nodes. Level II ____ jugular nodes Level III ____ jugular nodes Level IV ____ Jugular nodes between the ____ and the ____ Level V Posterior ____ nodes Level VI Anterior ____ nodes

submental submandibular upper middle lower omohyoid clavicle triangle cervical