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MD4001 Week 5 > 8. Lymphatic drainage of the head and neck.pdf > Flashcards

8. Lymphatic drainage of the head and neck.pdf Flashcards

1
Q

Where does lymphatic drainage end?

A

RHS: Right lymphatic duct
LHS: Thoracic duct

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2
Q

What main lymphatic vessels receive output of head and neck lymphatic drainage?

A

Right jugular trunk –> Right subclavian trunk –> Right lymphatic trunk
Left jugular trunk –> Join thoracic duct and left subclavian trunk –> Left subclavian vein

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3
Q

Multiple layers of lymph nodes can be arranged in _____. This occurs in the head and neck

A

Multiple layers of lymph nodes can be arranged in chains. This occurs in the head and neck

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4
Q

What comprises of the efferents and afferents of the upper group of the deep cervical nodes?

A

Afferent (input)
Receive afferents from superficial lymph node groups
From deeper structures tongue and tonsil
(nasal cavity, nasopharynx, palate, oesophagus)

Efferents -> lower deep nodes and jugular trunk

Jugulodiagastric is a key node

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5
Q

Which node is enlarged in tonsilltis

A

JUGULODIGASTRIC NODE

Enlarged in tonsillitis (the “tonsillar node”)
Posterior belly digastric crossing IJV
Part of upper group of deep cervical nodes

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6
Q

What comprises of the efferents and afferents lower group of the deep cervical nodes?

A 
Afferent: 
Directly back of the scalp and neck
Superficial pectoral region/ part of arm
Tongue
Superficial deep cervical glands

Efferent:
-> lower deep nodes and jugular trunk

Juguloomohyoid is a key node

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7
Q

Which node drains anterior 2/3 of tongue?

A

Juguloomohyoid node

Large and constant member of inferior group (omohyoid crossing IJV) Drains anterior 2/3 tongue

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8
Q

Lymph drainage of the face

A

Superficial nodes
into deep cervical nodes

Most drain into SUP CERVICAL nodes then to INF CERVICAL nodes

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9
Q

Submental nodes:
Receives?
Drain to?

A

Floor mouth beneath tongue tip, incisor+gum, central lower lip, chin skin

-> Submandibular nodes (juguloomohyoid nodes)

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10
Q

Buccal nodes:
Receives?
Drain to?

A

Lower eyelid, cheek buccinator, facial vein->

-> Submandibular nodes

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11
Q

Submandibular nodes:
Receives?
Drain to?

A

Nose, cheek, lower lip, frontal/max/ethmoidal sinuses,
Upper/lower teeth (except lower incisor), ant 2/3 tongue (except tip/centre) - floor mouth, vestibule gums

-> Deep cervical nodes

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12
Q

Parotid nodes:
Receives?
Drain to?

A

Eyelid, nose, external acoustic meatus, tympanic cav.
Parts of nasal pharynx

-> Superior deep cervical

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13
Q

Mastoid nodes:
Receives?
Drain to?

A

Strip of scalp above auricle and posterior external auditory meatus

-> Superior deep cervical nodes

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14
Q

Occipital nodes:
Receives?
Drain to?

A

Back of the scalp

-> Deep cervical nodes

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15
Q

Superficial cervical node:
Receives?
Drain to?

A

Skin over jaw angle, parotid apex and lobule of ear

-> Deep cervical

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16
Q

Superficial tissue drainage of head to which nodes?

A 
Superficial cervical node
Occipital nodes:
Parotid nodes:
Mastoid nodes:
Submandibular nodes:
Buccal nodes:
Submental nodes
17
Q

What are the deep lymph nodes of neck?

A

Retropharyngeal nodes: Drains Pharynx, Auditory tube, soft palate, hard palate, nose (cavities)

Paratracheal nodes: Drains neighbouring structures, thyroid

Pretracheal

Prelaryngeal

18
Q

First node of nasopharynx lymph drainage?

A

Node of Rouvierre

19
Q

Thyroid lymph drainage

A

via pretracheal/partracheal or prelaryngeal to deep cervical nodes

20
Q

Pretracheal lymph node also known as….

A

Delphian

NOTE: on cricothyroid membrane enlargement associated with poor prognosis in thyroid cancer

21
Q

Lymph drainage of upper and lower lip?

A

Lower (mixed drainage): to submental or directly to submandibular
Upper: Submandibular

22
Q

Tongue lymph drainage?

A

anterior: Submental

Middle: Crosses at midline. To the inferior deep cercical inc jugulo-omohyoid + to submandublar

Posterior: Superior deep cervical nodes incl jugulodigastric

NOTE: Significant drainage to both sides of the neck so……. TONGUE LESIONS CAN SPREAD TO NODES ON BOTH SIDES

23
Q

90% of all oral cancers are …

A

Squamous cell carcinoma
floor of mouth and tongue 90% of all oral cancers
3% of all malignancy though

24
Q

Prognosis of oral caner depends o.

A

Prognosis depends strongly on whether detectable
metastasis in cervical lymph nodes

Contralateral lymph node metastasis – poor prognosis

More mets from tumours thart arise from floor of mouth and tongue base (vs tongue tip and oropharynx)

25
Q

What is Vrichow’s node?

Indicates..

A

Enlarged hard left supraclavicular node (supraclavicular nodes on both sides can bear tumour from other sites)
aka Toisier’s sign

Indicates: ABDOMINAL tumour (esp stomach)

26
Q

Role of tonsils

A

Made of lymphoid nodules of invaginated epithelium.
-Increases contact with ingested organisms
– increases exposure and destruction
- facilitates development immunity

27
Q

What is Waldeyer’s tonsillar ring?

A

An interrupted circle of protective lymph tissue - upper ends of alimentary respiratory tracts

28
Q

Name the 4 tonsils/

A

Lingual
Palatine
Pharynfeal
Tubul

29
Q

Ways to label draining lymph nodes>

A

Dye marker (e.g. isosulfan blue)

Lymphosyntigraphy (e.g. colloidal sulphur radioactive)

Fluoresence marker (iodocyanine green near infrared imaging)

Note: Combined imaging or lymphosyntigraphy alone preferred

30
Q

What is the sentinal node?

A

Sentinel node biopsy is a surgical procedure used to determine if cancer has spread beyond a primary tumor into your lymphatic system. Sentinel node biopsy is used most commonly in evaluating breast cancer and melanoma. The sentinel nodes are the first few lymph nodes into which a tumor drains.

31
Q

Which nerves are involved in the perineural spread of tumours in head and neck?

A

Trigeminal, facial and hypoglossal nerves are important routes (e.g. lingual from tongue, maxillary/facial from face etc)

32
Q

How is lymph drained from brain?

A

• CSF is a specialised interstitial fluid of the brain

How does interstitial fluid get out of the brain?
• Previously suggested interstitial fluid filtered from blood vessels in brain either to CSF or could drain via the sheath of the olfactory nerve to nasal mucosa
• Newer study shows lymphatics run alongside dural sinuses and dye injected into the subarachnoid space stains deep cervical nodes

MD4001 Week 5 (11 decks)

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