Lymphatics of the Head and Neck

Question 1

What is the lymphatic system?

Answer 1

A network of drainage vessels

Question 2

What does the lymphatic system consist of?

Answer 2

• Fluid - lymph
• Drainage vessels
• Lymphatic tissues

Question 3

What are the lymphatic tissues?

Answer 3

Lymph nodes, a type of lymphoid organ

Question 4

How many lymph nodes are there in the body?

Answer 4

800

Question 5

How many lymph nodes are there in the neck?

Answer 5

300

Question 6

Describe the structure of lymph nodes

Answer 6

Connective tissue structures, with a tough, fibrous outer capsule, and reticular connective tissue inside

Question 7

What do lymph nodes contain?

Answer 7

Large collections of lymphocytes and macrophages

Question 8

Where do lymph nodes play a key role?

Answer 8

In immune defence

Question 9

What do all substances transported in lymph pass through?

Answer 9

1 or more lymph nodes

Question 10

What immune defences do lymph nodes have?

Answer 10

• Physical filter
• Phagocytic filter
• Full of lymphocytes

Question 11

What happens to the lymphocytes in lymph nodes?

Answer 11

They activate and proliferate in response to antigens

Question 12

Where are the specific regions in the body where lymph nodes may be palpable?

Answer 12

• Neck (cervical)
• Armpit (axillary)
• Diaphragm
• Spleen
• Abdominal
• Pelvic
• Groin (femoral)

Question 13

What may lymph draining into lymph nodes contain?

Answer 13

Pathogens

Question 14

What are the lymphoid organs?

Answer 14

• Spleen
• Thymus
• Tonsils

Question 15

What happens to the lymph fluid?

Answer 15

It returns to the blood circulation

Question 16

Where are lymph vessels found?

Answer 16

Throughout the body, with a few exceptions

Question 17

What parts of the body do not have a lymphatic circulation?

Answer 17

• Eyeball
  
  • Cornea
  • Lens
• Inner ear
• Cartilage
• CNS

Question 18

Why is there debate regarding the lymphatic circulation of the CNS?

Answer 18

Recent research has identified small lymphatic vessels lining the dura

Question 19

How can lymph nodes be organised?

Answer 19

Into regional (or superficial) and terminal (or deep) groups

Question 20

How are regional and terminal lymph nodes seperated?

Answer 20

By investing layer of deep cervical fascia in the neck

Question 21

What are the regional groups of lymph nodes found in the area of the head and neck?

Answer 21

• Occipital
• Pre- and post- auricular
• Submandibular
• Sternocleidomastoid
• Submental

Question 22

What do regional lymph nodes do?

Answer 22

Drain specific areas

Question 23

Where do regional lymph nodes in the neck lie?

Answer 23

Superficially within superficial cervical fascia

Question 24

What is the result of regional lymph nodes lying superficially within superficial cervical fascia?

Answer 24

They can be readily palpated, especially when enlarged

Question 25

Where does lymph from superficial lymph nodes drain?

Answer 25

Into the deep lymph nodes

Question 26

Where does the submandibular node drain?

Answer 26

* Upper lip and teeth * Lateral lower part of lip * Most of face * Anterior nasal cavity * Tongue (middle) * Submandibular and sublingual glands

Question 27

Where does the submental node drain?

Answer 27

* Lower lip/teeth (central) * Anterior chin * Tip of tongue * Floor of mouth

Question 28

Where does the pre-auricular node drain?

Answer 28

* Scalp * Anterior part of ear (auricle) * Parotid gland * *Some sources indicate conjunctiva and eyelids*

Question 29

Where does the post-auricular (mastoid) lymph node drain?

Answer 29

* Scalp * Posterior part of ear (auricle) * Ear canal

Question 30

Where does the occipital lymph node drain?

Answer 30

Occipital area of scalp and neck

Question 31

Where do the superficial cervical lymph nodes drain?

Answer 31

Skin of neck

Question 32

What are the deep cervical lymph nodes of the head and neck?

Answer 32

* Jugulo-digastric *(also called tonsillar node)* * Jugulo-omohyoid * Supraclavicular

Question 33

Which deep cervical lymph node is most frequently enlarged?

Answer 33

Jugulo-digastric

Question 34

Where is the jugulo-digastric node located?

Answer 34

Just below and behind the angle of the mandible

Question 35

What does the jugulo-digastric lymph node drain?

Answer 35

* Palatine tonsil * Oral cavity * Posterior 1/3 of tongue * Pharynx * Larynx

Question 36

What is the jugulo-omohyoid lymph node mainly associated with?

Answer 36

Lymph drainage of; * Tongue * Oral cavity * Trachea * Oesophagus * Thyroid gland

Question 37

Where are the supraclavicular lymph nodes found?

Answer 37

In root of neck on either side

Question 38

Where do the supraclavicular lymph nodes recieve lymph from?

Answer 38

The abdomen and thorax

Question 39

What happens to the lymph drained from the abdomen and thorax to the supraclavicular node?

Answer 39

It drains via the thoracic duct into venous circulation

Question 40

What is the left supraclavicular node known as?

Answer 40

Virchow's node

Question 41

What does Virchow's node drain?

Answer 41

Abdomen and thorax

Question 42

What does the right supraclavicular node drain?

Answer 42

* Mid section chest * Oesophagus * Lungs

Question 43

Where do terminal lymph nodes lie within the neck?

Answer 43

Deep to the investing layer of cervical fascia

Question 44

What do the terminal lymph nodes of the head and neck recieve?

Answer 44

All lymph of the head and neck, *either directly or indirectly from regional groups*

Question 45

What are the terminal lymph nodes of the head and neck closely related to?

Answer 45

The carotid sheath, in particular the jugular vein

Question 46

Describe the path of lymph in the head and neck

Answer 46

Head and neck superficial lymph nodes drain into deep cervica lymph nodes, which surround the IJV before draining via the thoracic duct into the subclavian vein

Question 47

What is the most common cause of swelling in the neck?

Answer 47

Enlarged cervical lymph nodes

Question 48

What may an enlarged lymph node signal?

Answer 48

Disease in the area it drains

Question 49

What diseases can be indicated by an enlarged cervical lymph node?

Answer 49

* Infection *(most common)* * Malignancy

Question 50

How do enlarged lymph nodes feel in infection?

Answer 50

* Tender * Mobile

Question 51

How do enlarged lymph nodes feel in malignancy?

Answer 51

* Hard * Matted * Non-tender

Question 52

What should be done if a lymph node is found to be enlarged?

Answer 52

* Comprehensive history * Examine area of tissue it drains * If malignancy is supsected, examine other lymph nodes and body systems

Question 53

What is lymphodema?

Answer 53

An abnormal collection of protein-rich fluid causing tissue swelling due to compromised lymphatic system

Question 54

What can cause lymphodema?

Answer 54

* Removal or enlargement of lymph nodes * Infections * Damage to lymphatic system * Lack of limb movement * Congenital

Question 55

What kind of infections may cause lymphodema?

Answer 55

Certain parasites

Question 56

How may the lymphatic system be damaged?

Answer 56

Cancer treatments

Question 57

Why can lack of limb movement cause lymphodema?

Answer 57

Muscle contraction assists movement of lymph fluid

Question 58

Give an example of a congenital condition that can cause lymphoedema?

Answer 58

Milroy's syndrome

Question 59

When is the jugulo-digastric node swollen and tender?

Answer 59

In tonsillitis

Question 60

When may the jugulo-omohyoid node be enlarged?

Answer 60

In infection or disease of tongue, oral cavity, trachea, oesophagus, or thyroid gland

Question 61

When may supraclavicular lymph nodes be enlarged?

Answer 61

In late stages of malignancies of abdomen and thorax

Question 62

Is an enlarged left supraclavicular lymph node always pathological?

Answer 62

No

Question 63

What is Trosier's sign?

Answer 63

An enlarged, hard, left supraclavicular lymph node

Question 64

What is Trosier's sign considered a sign of?

Answer 64

A sign of metastatic abdominal malignancy