8. Lymphatic drainage of the head and neck.pdf Flashcards
Where does lymphatic drainage end?
RHS: Right lymphatic duct
LHS: Thoracic duct
What main lymphatic vessels receive output of head and neck lymphatic drainage?
Right jugular trunk –> Right subclavian trunk –> Right lymphatic trunk
Left jugular trunk –> Join thoracic duct and left subclavian trunk –> Left subclavian vein
Multiple layers of lymph nodes can be arranged in _____. This occurs in the head and neck
Multiple layers of lymph nodes can be arranged in chains. This occurs in the head and neck
What comprises of the efferents and afferents of the upper group of the deep cervical nodes?
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
Which node is enlarged in tonsilltis
JUGULODIGASTRIC NODE
Enlarged in tonsillitis (the “tonsillar node”)
Posterior belly digastric crossing IJV
Part of upper group of deep cervical nodes
What comprises of the efferents and afferents lower group of the deep cervical nodes?
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
Which node drains anterior 2/3 of tongue?
Juguloomohyoid node
Large and constant member of inferior group (omohyoid crossing IJV) Drains anterior 2/3 tongue
Lymph drainage of the face
Superficial nodes
into deep cervical nodes
Most drain into SUP CERVICAL nodes then to INF CERVICAL nodes
Submental nodes:
Receives?
Drain to?
Floor mouth beneath tongue tip, incisor+gum, central lower lip, chin skin
-> Submandibular nodes (juguloomohyoid nodes)
Buccal nodes:
Receives?
Drain to?
Lower eyelid, cheek buccinator, facial vein->
-> Submandibular nodes
Submandibular nodes:
Receives?
Drain to?
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
Parotid nodes:
Receives?
Drain to?
Eyelid, nose, external acoustic meatus, tympanic cav.
Parts of nasal pharynx
-> Superior deep cervical
Mastoid nodes:
Receives?
Drain to?
Strip of scalp above auricle and posterior external auditory meatus
-> Superior deep cervical nodes
Occipital nodes:
Receives?
Drain to?
Back of the scalp
-> Deep cervical nodes
Superficial cervical node:
Receives?
Drain to?
Skin over jaw angle, parotid apex and lobule of ear
-> Deep cervical
Superficial tissue drainage of head to which nodes?
Superficial cervical node Occipital nodes: Parotid nodes: Mastoid nodes: Submandibular nodes: Buccal nodes: Submental nodes
What are the deep lymph nodes of neck?
Retropharyngeal nodes: Drains Pharynx, Auditory tube, soft palate, hard palate, nose (cavities)
Paratracheal nodes: Drains neighbouring structures, thyroid
Pretracheal
Prelaryngeal
First node of nasopharynx lymph drainage?
Node of Rouvierre
Thyroid lymph drainage
via pretracheal/partracheal or prelaryngeal to deep cervical nodes
Pretracheal lymph node also known as….
Delphian
NOTE: on cricothyroid membrane enlargement associated with poor prognosis in thyroid cancer
Lymph drainage of upper and lower lip?
Lower (mixed drainage): to submental or directly to submandibular
Upper: Submandibular
Tongue lymph drainage?
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
90% of all oral cancers are …
Squamous cell carcinoma
floor of mouth and tongue 90% of all oral cancers
3% of all malignancy though
Prognosis of oral caner depends o.
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)
What is Vrichow’s node?
Indicates..
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)
Role of tonsils
Made of lymphoid nodules of invaginated epithelium.
-Increases contact with ingested organisms
– increases exposure and destruction
- facilitates development immunity
What is Waldeyer’s tonsillar ring?
An interrupted circle of protective lymph tissue - upper ends of alimentary respiratory tracts
Name the 4 tonsils/
Lingual
Palatine
Pharynfeal
Tubul
Ways to label draining lymph nodes>
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
What is the sentinal node?
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.
Which nerves are involved in the perineural spread of tumours in head and neck?
Trigeminal, facial and hypoglossal nerves are important routes (e.g. lingual from tongue, maxillary/facial from face etc)
How is lymph drained from brain?
• 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
