Lymphatics of the head and neck

Question 1

what is the function of the lymphatic system?

Answer 1

• drainage of surplis tissue fluid and leaked plasma proteins to the bloodstream
• removal of debris from cellular decomposition and infection

Question 2

what lymphatic structure is found at the left venous angle?

Answer 2

the thoracic duct

Question 3

where does most of the bodies lymph re-enter the vascular system? what area is the exception?

Answer 3

• the thoracic duct
• the exception is the right superior quadrant

Question 4

what structures drain into the right lymphatic duct?

Answer 4

• right upper limb
• right side of head & neck
• right side of thorax

Question 5

how can the lymph nodes of the head be described?

Answer 5

paired lymph nodes (either superficial or deep)

Question 6

what are the 5 groups of paired superficial lymph nodes located in the head?

Answer 6

• occipital
• posterior auricular
• anterior auricular
• superficial parotid
• facial

Question 7

In a healthy patient, how would lymph nodes present?

Answer 7

usually small, soft and free/mobile in the surrounding tissue

Question 8

In a pathological/malignant setting, how would lymph nodes present?

Answer 8

• enlarged
• tender
• hard

Question 9

how many superficial parotid nodes are there?

Answer 9

up to 10

Question 10

What area of the face does the posterior auricular, anterior auricular and superficial parotid nodes drain?

Answer 10

• external ear
• lacrimal gland
• adjacent regions of scalp & face

Question 11

what do the occipital nodes drain?

Answer 11

the scalp of the occipital region

Question 12

where

Question 13

where do the superficial lymph nodes of the face empty into?

Answer 13

deep cervical nodes

Question 14

where are the facial lymph nodes located?

Answer 14

located along the facial vein & split into four subgroups:
- the malar region
- nasolabial
- buccal
- mandibular

Question 15

What may result in the enlargement of a facial lymph node?

Answer 15

infections of the teeth

Question 16

what are the deep lymph nodes of the head?

Answer 16

• deep parotid nodes
• retropharyngeal nodes

Question 17

where are the retropharyngeal nodes located? what do they drain?

Answer 17

located & drain posterior to palate, pharynx, paranasal sinus & nasal cavity

Question 18

Nodes of the neck/cervical lymph nodes are paired and unilaterally drain either the right of left tissues… what is the exception?

Answer 18

the midline submental nodes
- drain tissue in the submental triangle bilaterally

Question 19

what are the four groups of superficial cervical lymph nodes?

Answer 19

• submental
• submandibular
• external jugular
• anterior jugular

Question 20

what structures do they submental lymph nodes drain?

Answer 20

• lower lip
• both sides of chin
• floor of mouth
• apex of tongue
• mandibular incisors (with associated periodontium & gingiva)

Question 21

what are examples of infections that can cause swelling of the submental nodes?

Answer 21

1. Epstein-Barr virus
2. Cytomegalovirus
3. Dental infections including peridontitis **

Question 22

How many submandibular lymph nodes are there? where are these nodes located?

Answer 22

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

Question 23

what structures do the submandibular nodes drain?

Answer 23

• cheeks
• upper lip
• body of the tongue
• anterior hard palate
• most of the teeth & associated periodontium/gingiva

Question 24

what lymph nodes drain the maxillary third molars?

Answer 24

superior deep cervical lymph nodes

Question 25

where do all of the superficial cervical lymph nodes drain to?

Answer 25

the deep cervical lymph nodes

Question 26

where are the deep cervical lymph nodes located?

Answer 26

approx. 15 to 30 located along the length of the internal jugular vein on each side of neck (deep to the SCM muscle)

Question 27

what structures do the superior deep cervical nodes drain?

Answer 27

- posterior nasal cavity - posterior hard palate - soft palate - base of tongue - maxillary third molars - TMJ - oesophagus - trachea - thyroid gland

Question 28

Why is the drainage of the posterior of the tongue interesting?

Answer 28

Drainage is bilateral, so pathological may appear in the lymph nodes on either side as opposed to just the affected side

Question 29

Where is the jugulodigastric node? what does it drain?

Answer 29

Located posterior to the angle of the mandible & inferior to the posterior belly of digastric - drains the palatine tonsils

Question 30

what do the inferior deep cervical nodes drain?

Answer 30

- posterior part of the scalp & neck - superficial pectoral region - part of the arm

Question 31

where is the jugulo-omohyoid lymph node located? what does it drain?

Answer 31

Located at the angle where the omohyoid crosses the internal jugular vein - receives lymph from submental triangle

Question 32

what cancer are the inferior deep cervical lymph nodes at risk of helping to spread?

Answer 32

breast cancer - these nodes communicate the axillary lymph nodes that drain the breast region

Question 33

Why are the supraclavicular lymph nodes particularly at risk for involving the spread of cancer?

Answer 33

Lie very close to the thoracic duct

Question 34

What may enlargened lymph nodes indicate?

Answer 34

A current or recent past pathology/area of immune activity - can point to systemic or local disease

Question 35

what occurs in lymphogenous spread of cancer?

Answer 35

cancer cells travel via lymphatics, are filtered & trapped in lymph nodes, which become secondary cancer sites

Question 36

If lymph nodes are swollen & tender, what does this suggest?

Answer 36

Inflammation/infection

Question 37

If lymph nodes are hard & painless nodes, what does this indicate?

Answer 37

Malignancy

Question 38

If the submandibular lymph nodes are swollen, where is the relevant malignancy/pathology going to be?

Answer 38

- oral cavity - face - nasal cavity - maxillary sinus

Question 39

If the supraclavicular lymph nodes are swollen, where is the relevant malignancy/pathology going to be?

Answer 39

Thorax & abdomen

Question 40

if the submandibular lymph nodes are enlarged, where might the infection be?

Answer 40

- oral cavity - face - nasal cavity - maxillary sinus