Lecture 2- Cervical lymph nodes and neck lumps Flashcards
The lymphatic system functions
to drain tissue fluid, plasma proteins and other cellular debris back into the blood stream, and is also involved in immune defence
Once this collection of substances enters the lymphatic vessels, it is known
as lymph. Lymph is subsequently filtered by lymph nodes and directed into the venous system.
Lymph is subsequently
filtered by lymph nodes and directed into the venous system.
The lymphatic vessels of the head and neck can be divided into two major groups
superficial vessels and deep vessels.
superficial vessel
drain lymph from the scalp, face and neck into the superficial ring of lymph nodes at the junction of the neck and head.
Deep Vessels
The deep lymphatic vessels of the head and neck arise from the deep cervical lymph nodes.
deep lympathic vessels converge to form the
left and right jugular lymphatic trunks
Left jugular lymphatic trunk
– combines with the thoracic duct at the root of the neck. This empties into the venous system via the left subclavian vein.
Right jugular lymphatic trunk
– forms the right lymphatic duct at the root of the neck. This empties into the venous system via the right subclavian vein.
lymph nodes can be divided into
superifical ring of lymph nodes
vertical group of deep lymph nodes
name the superficial lymph nodes
- occipital
- mastoid
- pre-auricular
- parotid
- submental
- submandibular
- facial
- superficvial cervical
Occipital
There are usually between 1-3 occipital lymph nodes. They are located in the back of the head at the lateral border of the trapezius muscle and collect lymph from the occipital area of the scalp.
Mastoid
There are usually 2 mastoid lymph nodes, which are also called the post-auricular lymph nodes. They are located posterior to the ear and lie on the insertion of the sternocleidomastoid muscle into the mastoid process. They collect lymph from the posterior neck, upper ear and the back of the external auditory meatus (the ear canal).
Pre-auricular
There are usually between 1-3 pre-auricular lymph nodes. They are located anterior to the auricle of the ear, and collect lymph from the superficial areas of the face and temporal region.
Parotid
The parotid lymph nodes are a small group of nodes located superficially to the parotid gland. They collect lymph from the nose, the nasal cavity, the external acoustic meatus, the tympanic cavity and the lateral borders of the orbit. There are also parotid lymph nodes deep to the parotid gland that drain the nasal cavities and the nasopharynx.
Submental
These lymph nodes are located superficially to the mylohoid muscle. They collect lymph from the central lower lip, the floor of the mouth and the apex of the tongue.
Submandibular
There are usually between 3-6 submandibular nodes. They are located below the mandible in the submandibular triangle and collect lymph from the cheeks, the lateral aspects of the nose, upper lip, lateral parts of the lower lip, gums and the anterior tongue. They also receive lymph from the submental and facial lymph nodes.
Facial
This group comprises the maxillary/infraorbital, buccinator and supramandibular lymph nodes. They collect lymph from the mucous membranes of the nose and cheek, eyelids and conjunctiva.
superficial cervical
The superficial cervical lymph nodes can be divided into the superficial anterior cervical nodes and the posterior lateral superficial cervical lymph nodes. The anterior nodes lie close to the anterior jugular vein and collect lymph from the superficial surfaces of the anterior neck. The posterior lateral nodes lie close to the external jugular vein and collect lymph from superficial surfaces of the neck.
The deep (cervical) lymph nodes receive
all of the lymph from the head and neck – either directly or indirectly via the superficial lymph nodes. They are organised into a vertical chain, located within close proximity to the internal jugular vein within the carotid sheath. The efferent vessels from the deep cervical lymph nodes converge to form the jugular lymphatic trunks.
deep lymph nodes can be divided into
superior and inferior
deep lymph nodes include
prelaryngeal, pretracheal, paratracheal, retropharyngeal, infrahyoid, jugulodigastric (tonsilar), jugulo-omohyoid and supraclavicular nodes.
Waldeyer’s tonsillar ring refers to
the collection of lymphatic tissue surrounding the superior pharynx. This lymphatic tissue responds to pathogens that may be ingested or inhaled. T
which tonsils make up waldeyers ring
lingual tonsil
palatine
tonisls
tbual tonisls
pharyngeal tonsil
Pharyngeal tonsil
– also called the nasopharyngeal/adenoid tonsil, located in the roof of the nasopharynx, behind the uvulva and forms the postero-superior part of the ring.
- cannot be seen. ut if enlarged can cause nasal obsturction and also in close proximity to the gestation tube–> cause hearing problems
palatine tonsils
x2
*palatine tonsils affected by tonsilitis- visiblen part of waldeyers ring**palatine tonsils affected by tonsilitis- visiblen part of waldeyers ring*
located on each side between the palatoglossal and palatopharyngeal arches. These are the common ‘tonsils’ that can be seen within the oral cavity.
Tubal tonsils
– these are located where each Eustachian tube opens into the nasopharynx and form the lateral part of the ring.
- not readily visible
Lingual tonsil
– located on the posterior base of the tongue to form the antero-inferior part of the ring.
- cannot be seen
clinical manifestations of disease involving the lympathic system
lymphoedema
lymphadenopathy (swollen lymph nodes due to ifnectio or malignancy- primary and secondary
Lymphadenopathy is very common case for neck lumps. They can be caused due to:
- Infection (most common
- Tender and mobile
- Malignancy
- Hard, matted, non0tender
Or rubbery, moviel and fast
Superficial lymph nodes draining the face, scalp and neck are..
*
Readily palpable, sometimes in healthy people
deep lymph nodes lie below the
SCM
- Jugulo-digastric lymph node drains the
- posterior tongue and pharyngeal tonsils (very large 1-2cm)
- Tonsillitis will cause this to be palpable
- Jugulo- omohyoid lymph nodes drains
the posterior parts of the tongue and oral cavity and aerodigestive tract. (structures found beneath the hyoid bone)
- Supraclavicular lymph nodes (within supraclavicular fossa) drains
part of the thorax and abdomen
Sometimes DLN can be enlarged due to
swellings in structures below or due to excess drainage from superficial lymph nodes
Clincical correlates
Mouth Ulcer (inner surface of the lower lip)-
submental lymph node may be enlarged
Tongue Ulcer ( tip of tongue)
- submental
*any lump under chin
look in the mouth*
Conjunctivitis –
Preauricular lymph nodes
Tonsilitis-
deep cervical lymph nodes (jugulodigastric)
Cancer of the lateral posterior tongue –
submandibular and deep cervical lymph nodes
approaching neck lumps
when assessing neck lumps it is important to determine
midline or larteral lump?
possible midline lumps
- Dermoid cyst (congenital)
- Thyroglossal duct cysts (moves on tongue protrusion- congenital cause of a neck lump)
- Thyroid pathology (lump would move with swallowing)
possible lateral lumps
- Submandibular pathology
- Bronchial cyst (congenital)
possible causes of neck lump: superficial, within superifical fascia
sebaceous cycst, dermoid cyst, lipoma, skin abscess
possible causes of neck lump: inflammatory/ infective lymph node
tonsilitis, mouth ulcer
possible causes of neck lump
congenital lesions
thyroglossal cysts
branchial cyst
laryngocoele
pharyngeal pouch
possible causes of neck lump thyroid pathology
malignant or benign
possible causes of neck lump; primary (e.g. lymphoma) or secondary (metastatic) disease involving a lymph nodes
supraclabicular lymph nodes drain thorax/abdomen too
possible causes of neck lump salivary gland pathology
calculus, infection, tumour
red flags for lymphadenopathy
Lymphadenopathy is not a diagnosis in itself, it is a sign of underlying disease
- Persisting >6 weeks
- Fixed, hard and irregular
- Rapidly growing in size
- Associated with generalised lymphadenopathy
- Enlarged lymph nodes in other parts of the body (lymphoma and HIV)
- Associated systemic signs/symptoms such as weight loss, night sweats
- Associated with a persistent (unexplained) change in vice, hoarseness or difficulty swallowing
