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SA head and neck > S3) Lymphatic Drainage of the Head and Neck > Flashcards

S3) Lymphatic Drainage of the Head and Neck Flashcards

1
Q

What does the lymphatic system consist of?

A
  • Lymph nodes
  • Lymphatics
  • Lymph fluid
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2
Q

What is the purpose of the lympathic system?

A
  • Continuous removal of residual tissue fluid from the extracellular space to be returned back to blood circulation
  • return small proteins and fluid that has leaked from capillaries
  • immune defence and surveillance
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3
Q

Lymph is just tissue fluid which has entered the lymphatic capillary.

Identify some of the contents of lymph

A
  • Lipids (chylomicrons from gut lymphatics)
  • Small proteins
  • Damaged cells
  • Tissue fluid
  • Bacteria
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4
Q

How much lymph does the body produce a day?

A

3 ‐ 4 L of lymphatic fluid produced per day

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5
Q

What clinical manifestations are associated with the lymphatic vessels?

A
  • lymphoedema = fluid accumulation (upper and lower limbs)
  • lymphadenopathy = enlarged lymph nodes that are palpable due to infection or malignancy
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6
Q

Illustrate how uni-directional flow occurs in the lymphatic system

A

Tissue fluid → lympathic capillary → lymphatic vessels → lymphatic nodes → lymphatic vessels → lymphatic trunks → lymphatic ducts → subclavian veins

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7
Q

The lymphatic system is a low pressure system with no central pump.

How does the lymph flow?

A
  • Valves: passive and intrinsic constriction
  • Pulsation of an artery (close association)
  • Muscle contraction
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8
Q

Where in the venous circulation does the lymph drain?

A

Lymphatic system ends in two main lymphatic ducts which drain into subclavian veins

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9
Q

What is lymphoedema?

A

Lymphoedema is the abnormal collection of protein‐rich fluid causing tissue swelling due to compromised lymphatic system

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10
Q

Lymphoedema is a chronic condition.

Identify 5 of its causes

A
  • Removal / enlargement of lymph nodes
  • Infections e.g. certain parasites
  • Damage to lymphatic system e.g. cancer treatments
  • Lack of limb movement
  • Congenital
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11
Q

Provide 3 examples of lymphoid organs in the body

A
  • Spleen
  • Tonsils (Waldeyer’s ring)
  • Thymus
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12
Q

Describe the structure of lymph nodes

A

Connective tissue structures:

  • Tough fibrous outer capsule
  • Reticular connective tissue inside
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13
Q

Describe, briefly, how lymph nodes provide defence against infection

A
  • Physical filter
  • Phagocytic filter
  • Lymphocytes (T and B) : activate and proliferate in response to antigens

all can cause it to enlarge

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14
Q

Enlarged lymph nodes is a very common patient presentation.

Which two underlying conditions cause this?

A

Lymphadenopathy:

  • Reactive due to an Infection – most common, tender, mobile (can move around with finger)
  • Cancer: - hard, irregular, stuck
  • Metastasis - it has spread from somewhere to this lymph node. “hard and tethered, painless to palpate”
  • lymphoma - rubbery, fast growing, painless to palpate
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15
Q

What should one do when a patient presents with enlarged lymph nodes?

A
  • Comprehensive history
  • Examine the area of tissue it drains
  • Examine other lymph nodes and body systems (if malignancy is suspected)
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16
Q

Lymph nodes in the head and neck can be classified into two groups.

Identify them and describe their function

A
  • Regional: receive drainage from scalp, face and neck (ring)
  • Terminal: receive drainage from regional nodes (vertical)
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17
Q

Describe the relative depth of terminal and regional lymph nodes

A
  • Regional = superficial
  • Terminal = deep
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18
Q

Identify the 5 regions in body where collections of lymph nodes may be palpable

A
  • neck
  • auxilla
  • groin
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19
Q

How many lymph nodes are in the body?

Of those, how many can be found in the neck?

A
  • 800 lymph nodes in the body
  • 300 lymph nodes in the neck (equal amount on both sides)
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20
Q

Where are regional lymph nodes located?

A

Superficial to the investing layer of deep cervical fascia

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21
Q

Where are the terminal lymph nodes located?

A
  • Deep to the investing layer of deep cervical fascia
  • Most are associated with IJV (in carotid sheath)
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22
Q

Identify the following superficial lymph nodes 1-5:

A

1) Submental (under chin)
2) Submandibular (under jaw)
3) Pre-auricular (behind the ear)
4) Post-auricular (in front of the ear)
5) Occipital

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23
Q

Identify the following cervical lymph nodes 6-8:

A

6) Superficial: EJV
7) Posterior: EJV
8) Anterior: AJV

24
Q

Identify the following deep lymph nodes 9-11:

A

9) Jugulo‐digastric (tonsillar node)
10) Jugulo‐omohyoid
11) Supraclavicular lymph nodes

25
Q

What do supraclavicular lymph nodes do?

A

Supraclavicular lymph nodes oversee transport of lymph from thoracic cavity and abdomen

  • if it is palpable then it is a sign of gastric cancer
  • found in the posterior triangle
26
Q

Where are supraclavicular lymph nodes located?

A

Supraclavicular nodes are found in the root of the neck on either side

27
Q

What is Virchow’s node?

A

Virchow’s node is a lymph node in the left supraclavicular fossa

28
Q

What is Trosier’s sign?

A

Trosier’s sign is the enlargement of the left supraclavicular node (Virchow’s node) secondary to metastatic abdominal malignancy

29
Q

Where is the jugulo-digastric node located and what does it do?

A

The jugulo-digastric node is located just below and behind the angle of the mandible and is concerned with lymph drainage of the palatine tonsil, oral cavity and the tongue

30
Q

What does the jugolo-omohyoid lymph node do?

A

The jugulo-omohyoid node is mainly associated with the lymph drainage of the tongue, oral cavity, trachea, oesophagus and the thyroid gland

31
Q

Where do deep lymph nodes drain?

A

Deep cervical lymph nodes eventually drain via the thoracic duct (or right lymphatic duct) into the subclavian vein

32
Q

The deep lymphatic vessels converge to form left and right jugular lymphatic trunks.

Describe their location

A
  • Left jugular lymphatic trunk: joins thoracic duct at root of neck
  • Right jugular lymphatic trunk: empties into right lymphatic duct at root of neck
33
Q

Why do some diseases involve both regional and terminal cervical lymph nodes?

A

Many structures of the head and neck drain via superficial lymph nodes into the deep cervical lymph nodes

34
Q

What is Waldeyer’s ring?

A

Waldeyer’s ring is an annular collection of lymphatic tissue (NOT nodes) surrounding the entrance to the aerodigestive tracts

  • tough outer capsule
35
Q

Identify the tonsils which form Waldeyer’s ring

A
  • Lingual tonsil (opening of mouth *)
  • Palatine tonsils
  • Tubal tonsils
  • Pharyngeal tonsils (opening of nose *)
  • *in a good spot to fight immediate infection**
36
Q

Which tonsils are affected by tonsillitis?

A

Palatine tonsils

37
Q

Which of the lymphoid tissue in Waldeyer’s ring can one most readily view when examining a patient?

A

Palatine tonsils - the ones that get swollen at the back of the mouth

38
Q

Which tonsils of Waldeyer’s ring are also called the adenoids?

Where are they located?

A

Pharyngeal tonsils – located in the roof of the nasopharynx (behind the uvula)

39
Q

Why might an enlargement of the adenoids cause middle ear problems?

A
  • An enlarged adenoid (enlarged lymphoid tissue) can block the Eustachian tube
  • Mucus cannot drain properly and accumulates
  • Infection easily spreads into middle ear
  • also leads to obstruction of nasal breathing so they snore / breath through mouth
40
Q

what are some red flags when examining an enlarge lymph node?

A
  • persisting > 6 weeks
  • hard, fixed, irregular
  • rapidly growing in size
  • associated With generalised lymphadenopathy (other lymphs are enlarged too)
  • weight loss, night sweats
  • change in voice
41
Q

label this diagram that outlines the organisation of cervical lymph nodes and explain what is happening

A
  1. superficial cervical lymph nodes drain into deep cervical lymph nodes
42
Q

what is the superficial cervical fascia continuous with?

A
  • fascia of the face
  • just beneath the skin, draining lymphatic tissue
  • you can palpate these lymph nodes
43
Q

what is the cervical lymph nodes continuous with?

A
  • drain into the deep tissues within neck
44
Q

what part of the head does the superficial occipital lymph nodes drain?

A

posterior scalp

45
Q

what part of the head does the superficial post - auricular lymph nodes drain?

A

posterolateral half of scalp

46
Q

what part of the head does the pre - auricular and parotid lymph nodes drain

A

anterolateral scalp

upper half of face and eyelids

cheeks

47
Q

what part of the head does the superficial submental nodes drain?

A
  • inferior and posterior chin
  • floor of mouth
  • tip tongue
  • lower incisor teeth and gums
48
Q

what part of the head does the superficial submandibular lymph nodes drain?

A
  • centre of face and cheek
  • teeth and gingivae (gums)
  • parts of the anterior lounge
49
Q

when approaching neck lumps what must you check

A
  • location - midline or lateral (anterior or posterior triangle)
  • movement while swallowing (indicates a thyroid gland)
  • movement while stick out tongue
50
Q

if there is movement while sticking out tongue what malignancy does it suggest

A
  • thyroglossal duct cyst (lump in midline)
51
Q

what does a lump in the neck always have as a potential cause

A
  • lymphadenopathy
52
Q

what imaging technique should you use to investigate a neck lump

A
  • ultrasound
53
Q

name neck lumps that can be found anteriorly

A
  • salivary gland pathology
  • carotid body tumour
  • thyroglossal (more midline)
54
Q

thyroglossal duct malignancies

A

normally this duct should disappear when a fetus but if it remains then cysts can develop => thyroglossal duct cysts

  • these cysts are found midline below the hyoid
  • sign: if the cyst moves up when you stick tongue out and swallow
55
Q

how can you distinguish between goitre and throglossal duct cyst

A
  • transilluminate as cyst is full of fluid
  • if there is no movement when the tongue sticks out then this is a sign of a goitre as there is no thyroglossal duct connecting tongue and the ‘cyst’
  • aka thyroglossal cyst move with movement of the Tongue and goitre is to do with swallowing
56
Q

hyoid bone moving up when swallowing

A

due to the suprahyoid muscles

to do with the pre tracheal fascia?

57
Q

what defines lymphadenopathy

A

lymph that are greater than 1cm, can be localised or generalised

SA head and neck (18 decks)

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