Lymphatic drainage of Head and Neck Flashcards
Name the primary and secondary organs of the immune system
Primary: bone marrow and thumbs
Secondary: spleen, tonsils, peyer’s patches, MALT tissues, lymphatic system (nodes, fluid, vessels)
What happens in the primary immune system organs?
Lymphocytes (stem cells) are formed and can mature into either …
Bone marrow: B cell maturation
Thymus: T cell maturation
What happens in the secondary immune system organs?What do these tissues do?
Lymphocytes are activated, tissues filter and monitor extra cellular fluids
Name four structures where MALT (mucosa associated lymphatic tissue) is found
Salivary glands, lung, stomach, appendix
What is the function of lymph nodes?
Filters through the lymph with immune function
What composes lymph?
Tissue fluid and plasma proteins
Where do lymphoid tissues form aggregations?
At body entrances
Where does the majority and the minority of lymph drain?
Majority: Thoracic duct -> L subclavian vein (at its junction with the IJV)
Minority: drains to the R lymphatic duct -> R subclavian vein
Describe the structure of lymphatic vessels, which vessel type are they most structurally similar to?
Thin walled and most contain valves (to keep it going in the right direction), structurally similar to veins
Which vessel influences venous return and how?
Arterial pulsation compresses lymph vessels and aid venous return
Which system does the lymphatic system develop with?
The vascular system
What are the two major groups of lymph nodes and how do they interact? Which is more palpable?
Regional nodes are superficial and therefore more palpable, they drain specific areas -> a number of regional nodes will drain into a terminal deep node
How many lymph nodes are there in the body and how many are there in the neck?
800 in the body
300 in the neck
What is the most common cause of swelling in the neck?
Enlarged cervical lymph nodes
List the 6 groups of regional lymph nodes from anterior-> posterior, where can many of them be found?
Many can be found on the pericraniocervical line
- Submental
- Submandibular
- Parotid (preauricular)
- Mastoid
- Occipital
- Superficial cervical
Which vessel does the superficial cervical lymph nodes run with? (+ which muscle does it cross over)
Runs with EJV and crosses over sternocleidomastoid
What do the submental lymph nodes drain?
Lower lip and tip of tongue
What do the submandibular lymph nodes drain?
Lip, lateral body of tongue, nose and face
What do the parotid (preauricular) lymph nodes drain?
Temporal scalp and eye
What do the mastoid lymph nodes drain?
External Auditory meatus (EAM) and pinna (external ear)
What do the occipital lymph nodes drain?
Occipital scalp region to vertex
What are the three major deep (terminal) lymph nodes and what do they drain?
- Jugulo-digastric: tonsil, pharynx, posterior tongue
- Deep cervical chain: superficial node groups
- Jugulo-omohyoid: superficial node groups draining oral cavity, trachea, esophagus, thyroid and central tongue
Which type of lymphadenopathy is almost always suspicious?
Isolated supraclavicular lymphadenopathy (since they drain structures inferior to them)
Which structures are drained by the R supraclavicular nodes?
Intrathoracic structures
Esophagus
Lung
Mediastinum
Which structures are drained by the L supraclavicular nodes?
Virchow’s node
Stomach
Kidney
Ovary
What is an enlarged virchow’s node indicative of?
Gastric carcinoma
What is a valsava maneuver and why might it be done?
Breath out through mouth and pinch nose, this creates a forceful strain that can slow HR back into normal rhythm and cause enlarged lymph nodes to stand out
Which direction do nodes drain in?
Superior -> inferior
And superficial -> deep
What might regional lymph node enlargements indicate?
Systemic problems - so need to look elsewhere on the body for signs!
Which nerves might be affected by a cervical lymphadenopathy?
A cervical lymphadenopathy can compress the phrenic, vagus and sympathetic chain
Name the four groups of tonsillar lymphoid tissue from superior-inferior
- Pharyngeal (Adenoid)
- Tubal
- Palatine
- Lingual
What does Waldeyer’s ring of lymphoid tissue refer to?
The four groups of tonsillar lymphoid tissues at the entrance to the pharynx
What is the most common cause of a swollen lymph node?
Infection
How would you differentiate a lymph node caused by infection vs malignancy? What should you do if you suspect a malignancy?
Infection: node is tender, firm and mobile
Malignancy: node is hard, matted and non-tender
*if malignancy suspected must examine other lymph nodes/body systems
What would an infected lymph node present with?
- Swollen painful lymph nodes
- Sore throat
- Fatigue
- Fever
Name seven common causes for an infection of the lymph nodes
- Strep throat
- Measles
- Ear infections
- Infected (abscessed) tooth; collection of pus caused by bacterial infection
- Skin or wound infections like cellulitis
- HIV
- Mononucleosis (mono!!)
What is a lymphoma?
Cancer of lymphatic system
How common are lymphomas in the UK and how are they mainly treated?
5th most common cancer in UK, mainly treated with chemo/radiotherapy
What is the difference between a Hodgkin and non-Hodgkin lymphoma? Which tends to be more treatable?
Non-hodgkin means can arise in lymph nodes anywhere in the body
Hodgkin tends to arise in upper body (such as neck, chest or armpits) and is usually diagnosed at an earlier stage so is therefore more treatable
Which structure and vessel is closely related with the deep cervical nodes?
Carotid sheath and IJV
Where is the jugulo-digastric node (also called tonsillar node)
Below and behind the angle of the mandible
Which nerve may be removed by a malignancy in the neck and why?
Accessory nerve as it is closely related to the few deep cervical nodes which extend into the posterior triangle of the neck and lie along the nerve’s course
Which ‘region’ of nodes enlarges in the late stages of malignancies in the thorax and abdomen?
Supraclavicular
What is a block dissection of the cervical nodes and when is it performed?
Done when there is cervical metastasis and involves the removal of the IJV, fascia, lymph nodes and submandibular salivary gland to remove all lymph tissues one the affected side of the neck
What do efferent lymph vessels from the deep cervical nodes join to form?
Jugular lymph trunks
What may occur as a result of an enlarged adenoid lymph nodes/tonsils?
Blocked nasal passages and Eustachian tube
What may occur as a result of enlarged palatine lymph nodes/tonsils?
Snoring and sometimes problems with swallowing
Describe the drainage of lymph in the following tonsils
A) Pharyngeal (adenoid) tonsil
B) Palatine tonsils
C) lingual tonsils
A) upper deep cervical and retropharyngeal nodes
B) Jugulodigastric lymph nodes
C) Deep cervical (spinal accessory) lymph nodes
How should the supraclavicular lymph nodes be palpated?
*bonus: how are enlarged supraclavicular nodes best felt?
Examiner stands behind patient and places fingers into medial supraclavicular fossae. Ask patient to take deep breath while pressing deeply in and behind the clavicle, any supraclavicular nodes that are enlarged will be felt as the patient inhales.
What is most likely if there is associated pain with a mass in the neck?
Acute infection
What does a mass that has been present for a long period of time without any change in size often turn out to be?
Benign or congenital
What symptom might be caused by a mass that blocks the salivary gland?
The mass may change in size as the patient eats
Between what ages is a neck mass most likely to be thyroid disease? What is a neck mass most likely to be in a patient under 20 years old?
Most likely to be thyroid disease between ages of 20-40
A neck mass in <20 is most likely an enlarged tonsillar lymph node or congenital mass
How does the location of a neck mass influence its likely diagnosis?
Midline mass: more likely to be benign or dermoid cysts
Lateral masses: more likely to be neoplastic
-upper lateral: metastatic lesions from tumours of head and neck
-lower lateral: metastatic from tumours of breast, lung and stomach
How might neck pain be related to headaches?
Neck stiffness is often caused by a spasm of cervical muscles and is commonly the cause of tension headaches.
What pathologies may cause referred neck pain?
Can be from the chest; patients with angina or MI may have neck pain
