H&N lymphatics Flashcards
directions of lymph flow
- superior to inferior
- superficial to deep
- anterior to posterior
superficial lymph nodes
1 retroauricular 2 occipital 3 superficial parotid 4 mastoid 5 anterior superficial cervical 6 lateral superficial cervical
retroauricular lymph nodes
- drains posterolateral scalp
* located posterior to auricle
occipital lymph nodes
- drains occipital scalp
superficial parotid lymph nodes
- drains lateral face, scalp, EAM, buccal mucosa
* located on top of fascia covering parotid gland
mastoid lymph nodes
- drains posterolateral scalp and posterior ear
* located on top of mastoid process
anterior superficial cervical lymph nodes
- drains anterior neck
* located anterior SCM
lateral superficial cervical lymph nodes
- drains posterolateral neck
* located posterior-ish SCM
deep parotid nodes are DEEP
- drains EAM, auditory tube, middle ear
* embedded IN or deep to parotid tissue
name the 6 cervical node quadrants
1) submental and submandibular -SF
2) jugulodigastric -deep
3) juxtavisceral -deep
4) jugulo-omohyoid -deep
5) posterior triangle nodes -SF
6) anterior jugular (cervical) nodes -SF
1) submental and submandibular
submental= chin, anterior gingiva, tip of tongue, anterior floor of mouth, medial lower lip and MD INCISORS
submandibular= uppier lip, lateral lower lip,cheeck, teeth, sublingual and submandibular glands… BULK of oral cavity except MD incisors
submental nodes drain into?
submandibular nodes before they drain into jugulodigastric
maybe deep anterior jugular (cervical) nodes
5) posterior triangle nodes
within posterior triangle
*posterior neck
6) anterior jugular (cervical) nodes
skin and muscles of the anterior infrahyoid region
2) jugulodigastric -deep
- *all of head
- junction of jugulars along posterior line of digastric
- upper deep cervical nodes, all oral cavity/pharynx, tonsils, all superior superficial nodes
3) juxtavisceral -deep
- unique to viscera, collects from 2
* esophagus, larynx, trachea, thyroid gland
4) jugulo-omohyoid -deep
head and neck above this level
- most inferior
- no new drainage
what are the internal nodes?
tonsils!
1) pharyngeal tonsil
2) tubal tonsil
3) palatine tonsil
4) lingual tonsil
what is waldeyers lymphatic rings?
simply refers to internal ring of tonsils that are collecting all of the lymph from deep within
what are tonsils?
mounds od lymph tissue that eventually drain into jugular chain of nodes OR directly into retropharengeal or jugular digastirc nodes
outer and inner ring or ‘waldeyer’s lymphatic rings’?
Inner
1) pharyngeal tonsil
2) tubal tonsil
3) palatine tonsil
4) lingual tonsil
Outer
1) retropharyngeal node -deep
2) jugulodigastric node- deep
3) jugular chain of nodes -deep
4) submandibular nodes
5) submental nodes
jugulofacial venous juntion
where common facial and jugular vein meet
the internal jugular and subclavian v meet to form?
the venous angle and brachiocehalic vein
jugulosubclavian venous junction
thoracic duct on left
lymphatic duct on right
***where lymph drainage meets venous angle
drainage of the ear
- anterior
- posterior
- inferior
- anterior (ear canal)= to parotid, superficial
- posterior= drains into mastoid nodes
- inferior (lobule)= drains directly into jugulo-digastirc deep nodes
MD incisors drain into?
submental nodes in submental triangle (and apex of tongue)
all teeth except MD incisors drain into?
submandibular nodes
3rd molars can drain directly into?
deep cervical nodes
*so can spread infections faster and deeper; biggest prob
apex of tongue (anterior part) drains into?
submental
rest of tongue (exlcusing apex and root) drain into?
submandibular
root of tongue drains in?
deep cervical nodes (upper group) and jugulodigastric nodes
drainage order of tongue
submental > submandibular >deep cervical nodes > jugulofacial venous junctions > jugular nodes
why is extensive metastasis of cancer/lesions of tongue a big deal?
both ipsilateral AND contralateral drainage! easy to spread due to large overlap
venous angle is the junction of?
internal jugular and subclavian
Right lymphatic duct empties at?
juntion of right internal jugular and right subclavian
thoracic duct empties into?
junction of left internal jugular and left subclavian veins
cisterna chyli?
most inferior part of thoracic duct at T12
what region is drained by the right lymphatic duct?
right head and neck; upper right quadrant (right arm)
what region is drained by the left lymphatic duct?
left head and neck, upper left quadrant; everything below cisterna chyli at T12
heathy adults may have palpable nodes up to?
2cm
generalozed lymphadenopathy is involvemnt of? caused by?
3+ noncontiguous lymph node areas
*caused by infectious mononucleosis (EBV), lupes (SLE), leukemias, lymphomas or viruses or autoimmune disease
physical exams for lymphadenopathy?
- localized vs generalized
- size of nodes
- texture
- nodal tenderness/inflammation
- splenomegaly
- CBC= complete blood count
things to consider for fascial abscesses
- dental infection (periapcial abscess) to subperiosteal/periodontal abscess to potatntal space
- cellulitis and braod abscess within space
- lymph nodes involved by defealt but not palpebal
- SOURCE is easily localized; 60-70% from MD molars
- treatment= incision, drainage, bone removal, ANTIBIOTICS
things to consider for swollen nodes
- recently sick
- palpable INCLUDING borders
- usually NOT painful
- past/current diagnosis of cancer
- source not localized
- lethargy, rapid weight loss, night weats
- TREATMENT- need biopsy, removal last resort bc is causes lymphedema
lymphedema
need lymph system to you don’t swell up with excess fluid, removal of lymph nodes causes lymphedema
