Session 3 - Lymphatic Drainage Of The Head And Neck

Question 1

Lymphatic vessels provide a route for the spread of what?

Answer 1

Infection

Malignancies

Question 2

The lymphatics is a low pressure system, what keeps lymph fluid moving?

Answer 2

Muscle contraction
Pulsation of arteries
Valves

Question 3

All lymph fluid eventually drains into one of what two main lymphatic ducts?

Answer 3

Right lymphatic duct

Thoracic duct

Question 4

The right lymphatic duct and thoracic duct drain into what veins?

Answer 4

Subclavian veins

Question 5

What is lymphoedema?

Answer 5

The abnormal collection of protein-rich fluid causing tissue swelling due to a compromised lymphatic system.

Question 6

Give some possible causes of lymphoedema.

Answer 6

Removal or enlargement of lymph nodes
Infections (e.g. certain parasites)
Damage to the lymphatic system (e.g. cancer treatments)
Lack of limb movement 
Congenital (e.g. Milroy’s syndrome)

Question 7

How do lymph nodes act as a defence against infection?

Answer 7

Physical filter
Phagocytic filter
Full of lymphocytes - activate and proliferate in response to antigens

Question 8

What is lymphadenopathy?

Answer 8

Enlarged lymph nodes

Question 9

What are the two main causes of lymphadenopathy?

Answer 9

Infection (most common)

Malignancy

Question 10

How does lymphadenopathy caused by infection differ to lymphadenopathy caused by malignancy?

Answer 10

Infection - lymphadenopathy is tender, mobile

Malignancy - lymphadenopathy is hard, matted, non-tender

Question 11

Give examples of conditions that present with cervical lymphadenopathy.

Answer 11

Upper respiratory tract infection
Glandular fever
Stomach cancer
Lung cancer
Laryngeal cancer
Lymphoma

Question 12

What is the difference between a terminal and regional lymph node?

Answer 12

Regional - superficial, drain specific areas

Terminal - deep, receive drainage from a number of regional lymph nodes

Question 13

In the neck, superficial (regional) and deep (terminal) lymph nodes are separated by what layer of cervical fascia?

Answer 13

Investing layer of deep cervical fascia

Question 14

In the neck, most deep lymph nodes are associated with what blood vessel?

Answer 14

Internal jugular vein

Question 15

Name the superficial (regional) lymph nodes of the head.

Answer 15

Submental
Submandibular
Pre-auricular 
Post-auricular
Occipital

Question 16

Name the superficial (regional) cervical lymph nodes and the blood vessels they are associated with.

Answer 16

Superficial - external jugular vein
Posterior - external jugular vein
Anterior - anterior jugular vein

Question 17

What is Waldeyer’s ring?

Answer 17

Collection of lymphatic tissue (nodules) surrounding the entrance to the aerodigestive tracts. Consists of the tonsils.

Question 18

Name the tonsils.

Answer 18

Pharyngeal tonsils (adenoids)
Tubal tonsils
Palatine tonsils
Lingual tonsils

Question 19

Which tonsil of Waldeyer’s ring can you most readily view when examining a patient’s oropharynx?

Answer 19

Palatine

Question 20

Name the deep cervical lymph nodes.

Answer 20

Jugulo-digastric
Jugulo-omohyoid
Supraclavicular

Question 21

Which tonsil do you see as enlarged in tonsillitis?

Answer 21

Palatine

Question 22

The jugulo-digastric node receives lymph drainage from where?

Answer 22

Palatine tonsil, oral cavity and the tongue.

Question 23

The jugulo-omohyoid node mainly receives lymph drainage from where?

Answer 23

Tongue, oral cavity, trachea, oesophagus and thyroid gland.

Question 24

Which deep cervical lymph node enlarges in tonsillitis?

Answer 24

Jugulo-digastric

Question 25

The supraclavicular lymph nodes receive lymph drainage from where?

Answer 25

Abdomen and thorax

Question 26

What does Virchow’s node refer to?

Answer 26

An enlarged left supraclavicular lymph node, which may not necessarily be pathogenic.

Question 27

What does Trosier’s sign refer to?

Answer 27

An enlarged, hard left supraclavicular lymph node secondary to a metastatic abdominal malignancy.

Question 28

Give some clinical manifestations of disease involving the lymphatic system.

Answer 28

Lymphoedema
Swollen lymph nodes
Cervical lymphadenopathy

Question 29

Summarise the key roles of the lymphatic system.

Answer 29

Remove excess fluid from interstitial space.
Return small proteins and fluid to circulation.
Immune defence and immune surveillance:
- physical and phagocytic barrier
- lymphocytes