Lymphatic Drainage of the Head and Neck Flashcards
Give 3 functions of the immune system
1) Protection from pathogens
2) Cleans up
3) Recognizes and removes abnormal cells
What defines the primary immune system?
What organs are part of this?
Organs where lymphocytes are formed and mature. They provide an environment for stem cells to divide and mature into B- and T- cells:
Organs:
- Bone Marrow: B cell maturation
- Thymus: T cell maturation
What defines the secondary immune system?
What organs are part of this?
Site where lymphocytes are activated.
Tissues that filter and monitor extracellular fluids:
- Spleen
- Tonsils
- Peyer’s patches
- Lymphatic system (nodes, fluid, vessels)
- MALT tissues
and salivary glands, lung, stomach, appendix
What makes up the lymphatic system?
Lymph Fluid
Lymph Nodes
Lymph Vessels
Define Lymph
Tissue fluid & plasma proteins that drains via network of vessels (valves).
Lymph drainage largely follows the route of arterial supply
What are Lymph nodes?
Filters with immune function
How does Lymphoid tissue appear in the body?
Lymphoid tissue forms aggregations at body entrances
How does most of the body drain lymphatics?
What is the exception?
Most of the body drains via the THORACIC DUCT into the left subclavian vein at junction of LSV and IJV
Grey region is the exception: this regions drains to the right lymphatic duct
Describe the structure of lymphatic vessels?
List 2 things that aid return of lymph?
Similar to veins: they are thin-walled and most contain valves (they develop with the vascular system)
1) arterial pulsation compresses lymph vessels aiding venous return
2) valves stop lymph fluid going backwards, allowing for right direction movement.
How can lymph nodes within the body be classified?
Regional (superficial): drain specific areas
Terminal (deep): receive drainage from number of regional nodes)
Both found in head and neck but Regional are more readily palpable, and drain into deep nodes
What is the most common cause of swelling in the neck?
Enlarged cervical lymph node
Many nodes sit along this line, what is it known as?
What are the nodes labeled 1-6 and state waht each drains
The peri- craniocervical line
1) submental: drains lower lip, tip of tongue
2) submandibular: drains lip, lateral body of tongue, nose, face
3) parotid (preauricular): drains temporal scalp and eye
4) mastoid: drains EAM and pinna
5) occipital drains occipital scalp region to vertex
6) superficial cervical (run with EJV, over SCM) drains rest of skin
Eventually all nodes drain into the deep nodes via what?
All deep lymph nodes sit with what vessel?
All head and neck lymphatics drain via deep cervical lymph nodes into the thoracic duct or right lymphatic trunk
Deep (Terminal) Lymph Nodes sit with internal jugular vein
What are the 3 deep nodes in the image and what does each drain?
7) Jugulo-digastric: drains tonsil, pharynx, posterior tongue
8) deep cervical chain: drains superficial node groups
9) Jugulo-omohyoid: drains superficial node groups and central tongue
What is the LEFT supraclavicular node known as?
What structures does this drain? (Hint: NOT head and neck)
Virchow’s node
Stomach
Kidney
Ovary
What structures does the RIGHT supraclavicular node drain? (Hint: NOT head and neck)
- Intrathoracic structures
- Oesophagus
- Lung
- Mediastinum
What may you ask the patient to do to better examin isolated supraclavicular lymphadenopathy?
Ask patient to carry out valsava manoeuvre to aid examination
Helps lymph nodes stand out
What lymph nodes run down the SCM?
What lymph node is located in the posterior triangle?
2, 3 and 4 run down the SCM
5 is located in the posterior triangle
What is the general direction of node drainage?
Nodes drain from superficial to deep and from superior to inferior
Give 4 potential causes of neck lumps
State which is the MOST common
1) Tumour metastasis or primary
2) Lymphadenopathy
3) Infection (most common!!)
4) Branchial cyst
Give 2 nerves that may be compressed in cervical lymphadenopathy?
Give 4 focal signs/symptoms
Can compress phrenic, vagus or sympathetic chain
Signs/symptoms:
Where is tonsillar (lymphoid) tissue located?
Sits in the entrance to the pharynx
Most pathogens can come through nose and mouth so lots of lymphoid tissue in mouth and nose
Label the image below and state what these are?
What are the 4 structures collectively known as?
The structures labels are several different tonsils and each is lymphoid tissue
Collectively known as Waldeyers ring of lymphoid tissue
What are the consequences of an increase in size of the lymphoid tissue masses?
Swollen lymph nodes might cause difficulty breathing, and also blocks tube going to ear. This causes negative pressure in middle of the ear which wont be able to equalise. This Obstruction can lead to nose and ear problems
a) Which tonsil is located at the back of the nose?
b) Which tonsil is joins the eustachian tube of the ear?
a) Pharyngeal (adenoid)
b) Tubal
Label the image and state what is shown below?
Waldeyers ring
*** study second image
a) Where does the Lingual tonsil drain?
b) Where does the Palantine tonsil drain?
a) cervical nodes
b) jugulodigastric nodes
How would you know if a swollen lymph node is Infection or a Malignancy?
Infection (most common): Tender, firm, mobile
Malignancy: Hard, matted, non-tender
If an enlarged lymph node is found, what 3 steps would be taken next?
1) comprehensive history
2) examine the area of tissue it drains
3) If malignancy suspected examine other lymph nodes/body systems
Give 4 infectious causes of an enlarged lymph node
- Strep throat
- HIV
- Skin or wound infections, such as cellulitis
- Measles
- Ear infections
- Infected (abscessed) tooth
- Mononucleosis
List 4 features a patient would present with that suggest Infection
1) Swollen, painful lymph nodes
2) Sore throat
3) Fatigue
4) Fever
What is a cancer of the lymphatic system known as and where does it originate
How does it present and what is the main treatment?
Give 2 specific types
Lymphoma (5th most common cancer in the UK): originates in lymph nodes
Often presents with a swollen lymph node(s)
Treatment: Chemo/radiotherapy
Types eg. Hodgkin vs. Non-Hodgkin
How is lymph formed and how does it flow around the body?
Blood flows into capillary bed ➞ veins ➞ heart
Stuff is squeezed out of capillary bed into ECF ➞ picked up by lymph vessels ➞ gets to lymph node (filters pathogens and activates WBC to fight any pathogens) ➞ drains back into the venous system
