SM_12b: Lymphatics of Head and Neck

Question 1

The head lymphatics include ____ and ____

Answer 1

The head lymphatics include superficial ring / chain of nodes surrounding the head / neck and deep ring (sheath) surrounding the visceral unit

(both send efferents to the jugular trunk around / within the carotid sheath)

Question 2

Superficial ring (collar chain nodes) receive ____

Answer 2

Superficial ring (collar chain nodes) receive all subcutaneous lymph in the head

Nodes: submental, submandibular, parotid, mastoid, and occipital

Question 3

Superficial ring (collar chain nodes) include the ___, ___, ___, ___, and ___ nodes

Answer 3

Superficial ring (collar chain nodes) include the submental, submandibular, parotid, mastoid, and occipital nodes

(receive all subcutaneous lymph in the head)

Question 4

Superficial ring (collar chain nodes) lymph converges on ____

Answer 4

Superficial ring (collar chain nodes) lymph converges on jugular nodes / trunk

Question 5

Jugular / carotid sheath nodes are part of the ____

Answer 5

Jugular / carotid sheath nodes are part of the deep cervical nodes

Question 6

In the deep ring / sheath, lymph flows from the ___ and ___ laterally to the ___

Answer 6

In the deep ring / sheath, lymph flows from the pharynx and larynx laterally to jugular nodes / lymphatics / trunk

(deep ring / sheath around the visceral unit)

Question 8

Other routes to the root of the neck include ____ and ____

Answer 8

Other routes to the root of the neck include

• Parallel posterior route along nerve XI then passing to transverse cervical nodes
• Nodes / lymphatics following anterior jugular veins

Question 9

Routes of lymphatics in the tongue are ____, ____, and ____

Answer 9

Routes of lymphatics in the tongue

• To the opposite side
• Anterior tongue to superficial ring -> jugular (deep cervical) nodes
• Posterior tongue to deep ring or directly to jugular (deep cervical nodes)

Question 10

Lymph in the maxilla flows ___

Answer 10

Lymph in the maxilla flows anteriorly out the infraorbital foramen to superficial ring

Question 11

Lymph in the mandible flows ___

Answer 11

Lymph in the mandible flows posteriorly out of the mandibular canal to deep cervical lymph

Question 12

Describe the ring of tonsils (lymph nodules) around the pharynx

Answer 12

Ring of tonsils (lymph nodules) around the pharynx

• Pharyngeal tonsils (adenoids) in the roof of nasopharynx
• Palatine tonsils between palatoglossal and palatopharyngeal arches
• Lingual tonsils in posterior 1/3 of tongue

(all part of upper deep ring: lymph goes directly to deep lymphatics in and around the carotid sheath)

Question 13

Jugulodigastric node is ___ and the primary node of ___ and ___ drainage

Answer 13

Jugulodigastric node is large / often palpable and the primary node of posterior tongue and tonsil drainage

Question 14

____ is the sentinel node often enlarged as the first sign of cancer

Answer 14

Jugulodigastric node is the sentinel node often enlarged as the first sign of cancer

Question 15

Head and neck lymph converges on ____

Answer 15

Head and neck lymph converges on jugular trunks

(thoracic duct only goes to the left)

Question 16

Describe clinical points about lymph nodes in the head and neck

Answer 16

Clinical points about lymph nodes in the head and neck

• Lymph nodes of a healthy individual are soft, mostly nonpalpable structures
• Infection, inflammation, and cancer of areas drained by nodes can cause them to become palpable, swollen, and hard
• Nodes that drain areas with cancer are removed: the number depends on the extent of the tumor and number of nodes that may be involved from metastasis
• Cancerous nodes attach to structures (muscles, carotid sheath, etc) so nodes and structures must be surgically removed

Question 17

Summarize the major concepts of lymphatics in the head and neck

Answer 17