Lecture 2- Cervical lymph nodes and neck lumps

Question 1

The lymphatic system functions

Answer 1

to drain tissue fluid, plasma proteins and other cellular debris back into the blood stream, and is also involved in immune defence

Question 2

Once this collection of substances enters the lymphatic vessels, it is known

Answer 2

as lymph. Lymph is subsequently filtered by lymph nodes and directed into the venous system.

Question 3

Lymph is subsequently

Answer 3

filtered by lymph nodes and directed into the venous system.

Question 4

The lymphatic vessels of the head and neck can be divided into two major groups

Answer 4

superficial vessels and deep vessels.

Question 5

superficial vessel

Answer 5

drain lymph from the scalp, face and neck into the superficial ring of lymph nodes at the junction of the neck and head.

Question 6

Deep Vessels

Answer 6

The deep lymphatic vessels of the head and neck arise from the deep cervical lymph nodes.

Question 7

deep lympathic vessels converge to form the

Answer 7

left and right jugular lymphatic trunks

Question 8

Left jugular lymphatic trunk

Answer 8

– combines with the thoracic duct at the root of the neck. This empties into the venous system via the left subclavian vein.

Question 9

Right jugular lymphatic trunk

Answer 9

– forms the right lymphatic duct at the root of the neck. This empties into the venous system via the right subclavian vein.

Question 10

lymph nodes can be divided into

Answer 10

superifical ring of lymph nodes

vertical group of deep lymph nodes

Question 11

name the superficial lymph nodes

Answer 11

• occipital
• mastoid
• pre-auricular
• parotid
• submental
• submandibular
• facial
• superficvial cervical

Question 12

Occipital

Answer 12

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.

Question 13

Mastoid

Answer 13

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).

Question 14

Pre-auricular

Answer 14

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.

Question 15

Parotid

Answer 15

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.

Question 16

Submental

Answer 16

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.

Question 17

Submandibular

Answer 17

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.

Question 18

Facial

Answer 18

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.

Question 19

superficial cervical

Answer 19

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.

Question 21

The deep (cervical) lymph nodes receive

Answer 21

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.

Question 22

deep lymph nodes can be divided into

Answer 22

superior and inferior

Question 23

deep lymph nodes include

Answer 23

prelaryngeal, pretracheal, paratracheal, retropharyngeal, infrahyoid, jugulodigastric (tonsilar), jugulo-omohyoid and supraclavicular nodes.

Question 24

Waldeyer’s tonsillar ring refers to

Answer 24

the collection of lymphatic tissue surrounding the superior pharynx. This lymphatic tissue responds to pathogens that may be ingested or inhaled. T

Question 25

which tonsils make up waldeyers ring

Answer 25

lingual tonsil

palatine

tonisls

tbual tonisls

pharyngeal tonsil

Question 26

Pharyngeal tonsil

Answer 26

– 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

Question 27

palatine tonsils

Answer 27

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.

Question 28

Tubal tonsils

Answer 28

– these are located where each Eustachian tube opens into the nasopharynx and form the lateral part of the ring.

• not readily visible

Question 29

Lingual tonsil

Answer 29

– located on the posterior base of the tongue to form the antero-inferior part of the ring.

• cannot be seen

Question 30

clinical manifestations of disease involving the lympathic system

Answer 30

lymphoedema

lymphadenopathy (swollen lymph nodes due to ifnectio or malignancy- primary and secondary

Question 31

Lymphadenopathy is very common case for neck lumps. They can be caused due to:

Answer 31

1. Infection (most common
   
   • Tender and mobile
2. Malignancy
   
   • Hard, matted, non0tender

Or rubbery, moviel and fast

Question 32

Superficial lymph nodes draining the face, scalp and neck are..

*

Answer 32

Readily palpable, sometimes in healthy people

Question 33

deep lymph nodes lie below the

Answer 33

SCM

Question 34

• Jugulo-digastric lymph node drains the

Answer 34

• posterior tongue and pharyngeal tonsils (very large 1-2cm)
  
  • Tonsillitis will cause this to be palpable

Question 35

• Jugulo- omohyoid lymph nodes drains

Answer 35

the posterior parts of the tongue and oral cavity and aerodigestive tract. (structures found beneath the hyoid bone)

Question 36

• Supraclavicular lymph nodes (within supraclavicular fossa) drains

Answer 36

part of the thorax and abdomen

Question 37

Sometimes DLN can be enlarged due to

Answer 37

swellings in structures below or due to excess drainage from superficial lymph nodes

Question 38

Clincical correlates

Mouth Ulcer (inner surface of the lower lip)-

Answer 38

submental lymph node may be enlarged

Question 39

Tongue Ulcer ( tip of tongue)

Answer 39

• submental

Question 40

*any lump under chin

Answer 40

look in the mouth*

Question 41

Conjunctivitis –

Answer 41

Preauricular lymph nodes

Question 42

Tonsilitis-

Answer 42

deep cervical lymph nodes (jugulodigastric)

Question 43

Cancer of the lateral posterior tongue –

Answer 43

submandibular and deep cervical lymph nodes

Question 44

approaching neck lumps

Answer 44

Question 45

when assessing neck lumps it is important to determine

Answer 45

midline or larteral lump?

Question 46

possible midline lumps

Answer 46

• Dermoid cyst (congenital)
• Thyroglossal duct cysts (moves on tongue protrusion- congenital cause of a neck lump)
• Thyroid pathology (lump would move with swallowing)

Question 47

possible lateral lumps

Answer 47

• Submandibular pathology
• Bronchial cyst (congenital)

Question 48

possible causes of neck lump: superficial, within superifical fascia

Answer 48

sebaceous cycst, dermoid cyst, lipoma, skin abscess

Question 49

possible causes of neck lump: inflammatory/ infective lymph node

Answer 49

tonsilitis, mouth ulcer

Question 50

possible causes of neck lump

congenital lesions

Answer 50

thyroglossal cysts

branchial cyst

laryngocoele

pharyngeal pouch

Question 51

possible causes of neck lump thyroid pathology

Answer 51

malignant or benign

Question 52

possible causes of neck lump; primary (e.g. lymphoma) or secondary (metastatic) disease involving a lymph nodes

Answer 52

supraclabicular lymph nodes drain thorax/abdomen too

Question 53

possible causes of neck lump salivary gland pathology

Answer 53

calculus, infection, tumour

Question 54

red flags for lymphadenopathy

Answer 54

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

Question 55