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Head and Neck Anatomy > Lecture 5 Lymphatic System > Flashcards

Lecture 5 Lymphatic System Flashcards

1
Q

What does lymphatic system consist of?

A

Lymph vessels, lymphatic organs, diffuse lymphatic tissue

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2
Q

Function of lymph vessels?

A
  • collection of tissue fluid and its return to the systemic circulation.
  • Transport of lymphocytes and other cells.
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3
Q

What is tissue fluid in lymph vessels?

A

Tissue fluid is basically plasma (water, proteins, lipids extruded from blood capillaries into the connective tissue matrix. 20% (approx) of this fluid (lymph) is returned to the main systemic circulation via lymph vessels (80% approx. is removed blood capillaries, perspiration). If fluid/protein return is compromised then lymphoedema results.

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4
Q

Describe the return of lymph to venous system

A

Majority of return occurs in two places - at junctions of subclavian and internal jugular veins (usual pattern). There are additional connections into the venous system in the inferior vena cava and renal, suprarenal, azygous and iliac veins. The extent and location of these are variable and not fully documented but they are important if the usual lymph channels are blocked or damaged. Conversely they are also involved in the spread of malignancy or infection.

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5
Q

Describe general features of lymph vessels

A
  • Lymph capillaries arise as blindly ending tubes in connective tissue which are initially a plexus then anastomose to form larger vessels.
  • Particularly permeable, more so than blood capillaries
  • Always small - largest - thoracic duct - is a few mm in diameter. All very thin walled.
  • Many anastomoses
  • Transport of fluid is slow. Mechanism similar to veins (muscle in walls, external pressures, gravity, lots of valves)
  • May form plexuses on larger blood vessels
  • Not found in cartilage and healthy non-inflamed human corneas.
  • often but not always associated with lymph nodes
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6
Q

Function of lymph nodes

A
  • Immunosurveillance of lymph

- production of lymphocytes and other immune cells

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7
Q

Describe general features of lymph nodes

A
  • Organs 1-25mm long. Many are tiny. Lymph node enlargement is called lymphadenopathy and is the result of infection or a tumour.
  • Nodes are always associated with lymph vessels.
  • Contains proliferative structures - lymph nodules which produce lymphocytes and other immune cells, immunosurveillance of lymph.
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8
Q

Describe lymph nodules and their locations

A
  • 300-400 nodes with most in neck, thorax, abdomen, pelvis, groin. Relatively few in limbs. However most medium to large lymph vessels pass through at least one node on their way back to the circulation (some exceptions - e.g. thoracic duct).
  • Named according to whether they are superficial or deep and on the basis of associated structures.
  • Other lymph organs include spleen, thymus and tonsils - only tonsils form part of this course.
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9
Q

List the trunks and branches of left side and lower body

A
  • Thoracic duct
  • 2 Lumbar trunks
  • 1 Gastrointestinal trunk
  • 2 descending intercostal (thoracic) trunks
  • Left subclavian trunk
  • Left jugular
  • Left bronchomediastinal
  • Cysterna chyli
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10
Q

Describe thoracic duct

A

Commonly formed by the confluence of 5 major tributaries in the posterior abdomen. Cysterna chyli may be present at confluence.

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11
Q

2 Lumbar trunks drains?

A

Drains lower abdominal and pelvic walls, lower limbs, pelvic viscera and parts of large intestine, kidneys and suprarenals.

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12
Q

1 Gastrointestinal trunk drains?

A

Drains liver, spleen, pancreas, stomach, small intestine and much of large intestine.

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13
Q

2 descending intercostal (thoracic) trunks drains?

A

Drains lower thoracic regions on both sides. These trunks pass down through diaphragm to the start of the thoracic duct.

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14
Q

The thoracic duct also receives lymph from ?

A

From a range of lymph vessels in the thorax.

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15
Q

In the neck, the thoracic duct has the following main tributaries:

A
  • left subclavian trunk
  • left jugular
  • left bronchomediastinal
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16
Q

Left subclavian trunk drains from?

A

From left upper limb

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17
Q

Left jugular drains from?

A

From left head and neck

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18
Q

Left bronchomediastinal drains from?

A

Upper left thorax

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19
Q

Termination of thoracic duct is at?

A

Left jugulosubclavian junction

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20
Q

Right jugular, subclavian, bronchiomediastinal trunks drain from?

A

Right arm, right half of head and neck, upper right thorax.

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21
Q

Right subclavian, jugular and bronchomediastinal trunks drain?

A

Similar territories as on the left.

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22
Q

In about 20% of individuals, right subclavian, jugular and bronchomediastinal trunks converge to form?

A

Right lymphatic duct (approx 1 cm long) which drains into the right jugulosubclavian junction.

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23
Q

The thoracic duct and the right lymphatic duct have bicuspid valves at their terminations at the jugulosubclavian junctions which prevents or reduces regurgitation of blood in life.

A

True

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24
Q

The valve is still functional after death so regurgitation of blood then occurs.

A

False, it is non-functional.

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25
Q

Subclavian, jugular trunk and bronchomediastinal trunks have valves at their terminations.

A

False, only jugular trunk doesn’t have it.

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26
Q

Pattern of drainage from head and neck?

A
  • Lymph from superficial tissues drain into superficial groups of nodes and then into deep nodes. Alternatively, some drainage may be into deep nodes directly e.g. some o the drainage of the tongue.
  • Deep chain of vessels and nodes eventually drain into the jugular lymph trunk
27
Q

List superficial nodes of head

A
  • Occipital
  • Retroauricular
  • Parotid
  • Buccal
28
Q

Parotid nodes are located on:

A

Both on parotid sheath and within gland

29
Q

Skin and superficial tissues are drained by?

A

Roughly vertically disposed vessels to the nodes inferior to the tissues in question. For example, temporal region and lateral forehead drain into parotid nodes.

30
Q

List deep nodes in the head

A
  • Lingual nodes

- Retropharyngeal nodes

31
Q

Location of lingual nodes

A

Root of the tongue

32
Q

Location of retropharyngeal nodes

A

Between upper pharynx and longus capitus (a prevertebral muscle) ultimately drain to upper deep cervical nodes.

33
Q

Lingual nodes are sometimes classified as deep cervical nodes rather than nodes of the head.

A

True

34
Q

List superficial nodes of the neck

A
  • Superficial cervical
  • Submandibular
  • Submental
  • Anterior cervical
35
Q

Location of superficial cervical lymph nodes

A

Over lateral surface sternocleidomastoid (SCM)

36
Q

Location of submandibular lymph nodes

A

Between mandible and submandibular salivary gland

37
Q

Location of submental lymph nodes

A

Overlies mylohyoid muscle

38
Q

Location of anterior cervical lymph nodes

A

Over thyroid, larynx, trachea

39
Q

Deep nodes of neck are best seen if?

A

If sternocleidomastoid is removed.

40
Q

Deep nodes overlie and are located and divided where?

A

Many overlie carotid sheath and internal jugular. Arbitrarily divided into superior and inferior by a line marked by omohyoid muscle.

41
Q

Superior/upper deep cervical nodes includes:

A

Jugulodigastric and retropharyngeal posterior to pharynx

42
Q

Inferior/lower deep nodes includes?

A

Includes jugulo-omohyoid group

43
Q

Jugulodigastric nodes are located where? Also describe?

A
  • Located in a triangular region bounded by posterior belly of digastric, facial vein and internal jugular
  • Usually has one large and several small nodes
  • The jugulodigastric nodes are 1-2cm below the angle of the mandible and are easily palpable especially when inflamed.
44
Q

Describe properties and location of jugulo-omohyoid node

A
  • Included int he lower deep cervical group
  • Overlies the intermediate tendon of omohyoid
  • Not readily palpable in adults unless enlarged (may enlarge when lymph is redirected from its normal path in cancers of thoracic structures or stomach).
45
Q

Lymph drainage of tongue and tonsils are concerned with?

A

Both jugulodigastric and jugulo-omohyoid nodes.

46
Q

Describe jugular lymph trunks

A

Lymph from efferents of the deep nodes enter the jugular lymph trunks - THUS ALL LYMPH from head and neck eventually drains into these trunks.

47
Q

Much of the lymph from floor of mouth and mandibular teeth and gingiva drains into?

A

Submandibular and submental nodes and from there into the deep cervical nodes. Also some direct deep drainage.

48
Q

Hard and soft palate and maxillary teeth and gingiva drain into ?

A

Retropharyngeal nodes and also some direct deep drainage.

49
Q

Tongue contains a plexus of lymph vessels with a wide distribution of drainage into ?

A

Submental and submandibular nodes or to both upper and lower deep nodes.

50
Q

Virchow’s node - supraclavicular/anterior scalene nodes are located where?

A

Lowest of the deep cervical group of nodes. Located in supraclavicular fossa, just lateral to clavicular head of SCM.

Consists of groups of nodes closest to the jugular trunk.

51
Q

Left supraclavicular/anterior scalene nodes were known historically as Virchow’s node (singular is used despite them being actually being multiple).

A

True

52
Q

Left supraclavicular/anterior scalene nodes are particularly prone to metastasis from malignancies in many other parts of the body.

A

True

53
Q

List the tonsils

A
  • Pharyngeal tonsil
  • Lingual tonsil
  • Palatine tonsils (x2)
54
Q

Describe lingual tonsils’ location

A

A collections of lymph nodules in posterior or pharangeal part of the tongue

55
Q

Describe palatine tonsils’ location

A
  • on lateral sides of the oropharynx just behind the oral cavity
  • Located in the tonsilar fossa between palatoglossal and palatopharangeal folds.
56
Q

Describe pharyngeal tonsil location

A

Beneath nasopharangeal mucosa in posterior wall of nasopharynx. In children prominent around opening of auditory tube.

Enlarged pharangeal tonsils are called adenoids - mouth breathing.

57
Q

The tonsils are sometimes collectively called ??

A

Waldeyer’s ring

58
Q

Possible metastases in Virchow’s nodes can occur from?

A

Lungs, bronchi, breast, upper limb, stomach, intestines, prostate, testis, etc.

59
Q

Retrograde backflow at the venous termination of the thoracic duct is prevented by?

A

Valve

60
Q

Jugular trunk drains into ?

A

Thoracic duct, which in turn receives lymph from most of the body.

61
Q

Subclavian and bronchomediastinal trunks also have valves at their junction with the thoracic duct.

A

True

62
Q

Jugular trunk appears to lack?

A

Valves

63
Q

Lack of valves in jugular trunk predisposes retrograde flow from the thoracic duct specifically into the jugular trunk and from there to the first group of lymph nodes encountered namely the?

A

Left supraclavicular/anterior scalene group.

Head and Neck Anatomy (13 decks)

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