Lymphatics of the head and neck Flashcards
what is the function of the lymphatic system?
- drainage of surplis tissue fluid and leaked plasma proteins to the bloodstream
- removal of debris from cellular decomposition and infection
what lymphatic structure is found at the left venous angle?
the thoracic duct
where does most of the bodies lymph re-enter the vascular system? what area is the exception?
- the thoracic duct
- the exception is the right superior quadrant
what structures drain into the right lymphatic duct?
- right upper limb
- right side of head & neck
- right side of thorax
how can the lymph nodes of the head be described?
paired lymph nodes (either superficial or deep)
what are the 5 groups of paired superficial lymph nodes located in the head?
- occipital
- posterior auricular
- anterior auricular
- superficial parotid
- facial
In a healthy patient, how would lymph nodes present?
usually small, soft and free/mobile in the surrounding tissue
In a pathological/malignant setting, how would lymph nodes present?
- enlarged
- tender
- hard
how many superficial parotid nodes are there?
up to 10
What area of the face does the posterior auricular, anterior auricular and superficial parotid nodes drain?
- external ear
- lacrimal gland
- adjacent regions of scalp & face
what do the occipital nodes drain?
the scalp of the occipital region
where
where do the superficial lymph nodes of the face empty into?
deep cervical nodes
where are the facial lymph nodes located?
located along the facial vein & split into four subgroups:
- the malar region
- nasolabial
- buccal
- mandibular
What may result in the enlargement of a facial lymph node?
infections of the teeth
what are the deep lymph nodes of the head?
- deep parotid nodes
- retropharyngeal nodes
where are the retropharyngeal nodes located? what do they drain?
located & drain posterior to palate, pharynx, paranasal sinus & nasal cavity
Nodes of the neck/cervical lymph nodes are paired and unilaterally drain either the right of left tissues… what is the exception?
the midline submental nodes
- drain tissue in the submental triangle bilaterally
what are the four groups of superficial cervical lymph nodes?
- submental
- submandibular
- external jugular
- anterior jugular
what structures do they submental lymph nodes drain?
- lower lip
- both sides of chin
- floor of mouth
- apex of tongue
- mandibular incisors (with associated periodontium & gingiva)
what are examples of infections that can cause swelling of the submental nodes?
- Epstein-Barr virus
- Cytomegalovirus
- Dental infections including peridontitis **
How many submandibular lymph nodes are there? where are these nodes located?
Approx. 3 to 6 nodes
- located in the submandibular triangle at the inferior border of the mandibular ramus
- just superficial to the submandibular salivary gland
what structures do the submandibular nodes drain?
- cheeks
- upper lip
- body of the tongue
- anterior hard palate
- most of the teeth & associated periodontium/gingiva
what lymph nodes drain the maxillary third molars?
superior deep cervical lymph nodes
where do all of the superficial cervical lymph nodes drain to?
the deep cervical lymph nodes
where are the deep cervical lymph nodes located?
approx. 15 to 30 located along the length of the internal jugular vein on each side of neck (deep to the SCM muscle)
what structures do the superior deep cervical nodes drain?
- posterior nasal cavity
- posterior hard palate
- soft palate
- base of tongue
- maxillary third molars
- TMJ
- oesophagus
- trachea
- thyroid gland
Why is the drainage of the posterior of the tongue interesting?
Drainage is bilateral, so pathological may appear in the lymph nodes on either side as opposed to just the affected side
Where is the jugulodigastric node? what does it drain?
Located posterior to the angle of the mandible & inferior to the posterior belly of digastric
- drains the palatine tonsils
what do the inferior deep cervical nodes drain?
- posterior part of the scalp & neck
- superficial pectoral region
- part of the arm
where is the jugulo-omohyoid lymph node located? what does it drain?
Located at the angle where the omohyoid crosses the internal jugular vein
- receives lymph from submental triangle
what cancer are the inferior deep cervical lymph nodes at risk of helping to spread?
breast cancer
- these nodes communicate the axillary lymph nodes that drain the breast region
Why are the supraclavicular lymph nodes particularly at risk for involving the spread of cancer?
Lie very close to the thoracic duct
What may enlargened lymph nodes indicate?
A current or recent past pathology/area of immune activity
- can point to systemic or local disease
what occurs in lymphogenous spread of cancer?
cancer cells travel via lymphatics, are filtered & trapped in lymph nodes, which become secondary cancer sites
If lymph nodes are swollen & tender, what does this suggest?
Inflammation/infection
If lymph nodes are hard & painless nodes, what does this indicate?
Malignancy
If the submandibular lymph nodes are swollen, where is the relevant malignancy/pathology going to be?
- oral cavity
- face
- nasal cavity
- maxillary sinus
If the supraclavicular lymph nodes are swollen, where is the relevant malignancy/pathology going to be?
Thorax & abdomen
if the submandibular lymph nodes are enlarged, where might the infection be?
- oral cavity
- face
- nasal cavity
- maxillary sinus
