Lymphatic System of the Head and Neck

Question 1

What is the role of the Lymphatic System?

Answer 1

• To remove excess fluid from the interstitial space
• Return small proteins and fluid that leaked from the capillaries back into the blood vessels
• As a key role in the immune defence and surveillance (1. Physical and Phagocytic barrier 2. Source of Lymphocytes)

Question 2

What is the Pathophysiology of Lymph Nodes and why do they swell?

Answer 2

How do Lymph Nodes Swell?:
1. Physical Filter
2. Phagocytic Filter
3. T+B Lymphocytes (Activate and proliferate in response to antigens)

Question 3

What are the specific regions where lymph nodes may be palpable?

Answer 3

• Neck (cervical)
• Armpit (axillary)
• Groin (femoral)

Question 4

What are the causes for an enlarged lymph node?

Answer 4

• Infection - tender/ mobile (most common)
• Malignancy - hard/ matted/ non-tender OR rubbery/ mobile/ fast-growing

Question 5

What is the drainage of Lymph Nodes?

Answer 5

• Superficial drain into the Deep lymph Nodes

Question 6

What are the Superficial Lymph Nodes draining the face, scalp and neck?

Answer 6

1. Sub-mental
2. Sub-mandibular
3. Pre-Auricular
4. Post-Auricular
5. Anterior Cervical
6. Superficial Cervical
7. Posterior Cervical
8. Occipital

Question 7

What are the Deep Lymph Nodes draining the face, neck and scalp?

Answer 7

• Jugulo-digastric
• Jugulo- omohyoid
• Supraclavicular lymph nodes

Question 8

Where are the Deep Lymph Nodes?

Answer 8

• Deep to the SCM
• Closely related to the IJV and the Carotid Sheath

Question 9

What is Waldeyer’s Ring?

Answer 9

• This is an Annular Collection of Lymphoid Tissue
• Pharyngeal tonsil
• Palatine tonsil
• Lingual tonsil
• Tubal tonsil

Question 10

What are the possible causes of neck lumps?

Answer 10

• Superficial - sebaceous cyst, dermoid cyst, lipoma, skin abscess
• Inflammatory/ Infective Lymph nodes - tonsillitis, mouth ulcer
• Congenital lesions - thyroglossal cysts, branchial cyst, laryngocoele, pharyngeal pouch
• Thyroid pathology
• Primary/ Secondary malignant disease
• Salivary gland pathology (calculus, infection and tumour)
• Other (chronic infection (TB, HIV, lymphadenopathy, carotid artery aneurysm)

Question 11

What neck lump will move on swallowing?

Answer 11

• Thyroglossal duct cyst

Question 12

What neck lump in midline and won’t move on swallowing?

Answer 12

• Dermoid Cysts

Question 13

What is a neck lump which