Lecture 07. Lymphatic's of Head & Neck. By: Dr Farooq Amanullah Khan PMC

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1 Lecture 07 Lymphatic's of Head & Neck By: Dr Farooq Amanullah Khan PMC Dated:

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3 Lymphatic Vessels Of the 800 lymph nodes in the human body, 300 are in the Head & neck region. The lymphatic vessels of the head and neck can be divided into two major groups: Superficial Vessels The superficial vessels drain lymph from the scalp, face and neck into the superficial ring of lymph nodes at the junction of the neck and head. Deep Vessels The deep lymphatic vessels arise from the deep cervical lymph nodes. They converge to form the left and right jugular lymphatic trunks: Left jugular lymphatic trunk joins the thoracic duct at the root of the neck. Right jugular lymphatic trunk empties into the right lymphatic duct at the root of the neck.

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5 Lymph Nodes The lymph nodes of the head and neck can be divided into two groups; Superficial ring of lymph nodes, and a Vertical group of deep lymph nodes. Superficial Lymph Nodes They are arranged in a ring shape; extending from underneath the chin, to the posterior aspect of the head. They ultimately drain into the deep lymph nodes. Following are the superficial group of LNs. Ocipital. Mastoid (Retroauricular/ Post. auricular.). Parotid (Pre auricular)] Submandibular. Submental. Facial and Superficial cervical LNs.

6 Superficial Lymph Nodes 1. Occipital: There are usually between 1-3 occipital lymph nodes. They are located in the back of the head at the lateral border of the trapezius muscle and collect lymph from the occipital area of the scalp. 2. Mastoid: There are usually 2 mastoid lymph nodes, which are also called the post-auricular lymph nodes. They are located posterior to the ear and lie on the insertion of the sternocleidomastoid muscle into the mastoid process. They collect lymph from the posterior neck, upper ear and the back of the external auditory meatus (the ear canal).

7 Superficial Lymph nodes..con t 3. Pre-auricular: There are usually between 1-3 pre-auricular lymph nodes. They are located anterior to the auricle of the ear, and collect lymph from the superficial areas of the face and temporal region 4. Parotid: The parotid lymph nodes are a small group of nodes located superficially to the parotid gland. They collect lymph from the nose, the nasal cavity, the external acoustic meatus, the tympanic cavity and the lateral borders of the orbit. There are also parotid lymph nodes deep to the parotid gland that drain the nasal cavities and the nasopharynx.

8 superficial lymph nodes..con t Submental: These lymph nodes are located superficially to the mylohoid muscle. They collect lymph from the central lower lip, the floor of the mouth and the apex of the tongue. Submandibular: There are usually between 3-6 submandibular nodes. They are located below the mandible in the submandibular triangle and collect lymph from the cheeks, the lateral aspects of the nose, upper lip, lateral parts of the lower lip, gums and the anterior tongue. They also receive lymph from the submental and facial lymph nodes.

9 superficial lymph nodes..con t Facial: The facial lymph nodes comprise three groups: (a) Infraorbital or maxillary, scattered over the Infraorbital region from the groove between the nose and cheek to the zygomatic arch; (b) Buccinators, one or more placed on the buccinators muscle opposite the angle of the mouth; (c) Supramandibular, on the outer surface of the mandible, in front of the masseter and in contact with the external maxillary artery and anterior facial vein. Their afferent vessels drain the eyelids, the conjunctiva, and the skin and mucous membrane of the nose and cheek; their efferents pass to the submandibular glands.

10 superficial lymph nodes..con t Superficial Cervical Lymph Nodes: The superficial cervical lymph nodes are the collection of lymph nodes along the external jugular vein on the superficial surface of the sternocleidomastoid muscle. They primarily receive lymphatic's from the posterior and posterolateral regions of the scalp through the occipital and mastoid node They send the lymphatic in the direction of the deep cervical lymph nodes.

11 The Deep Lymph Glands of the Neck (Vertical) The deep lymph glands of the neck are the collection along the internal jugular vein. Thet are following groups: Central Lateral. The above two are also termed as Vertical groups of LNs. The other groups are. Submaxillary. Supraclavicular.

12 Deep central Group of LNs. Prelaryngeal lymph nodes: They are lymph nodes located anterior to the larynx. One such node is the Delphian node situated above the isthmus of the thyroid gland. This LN may be removed at the time of a thyroidectomy as a sentinel lymph node in order to identify risks of cancer spread. Paratracheal Lymph Nodes: The right and left paratracheal lymph nodes (or paratracheal chains) are groups of lymph nodes located in the throat. Pretracheal Lymph Nodes: 02 to 03 in number. Located anterior to the trachea.

13 Deep LATERAL Group of LNs. Jugulodiagastric Nodes: The jugulodigastric lymph node is a large node found in the proximity of where the posterior belly of the digastric muscle crosses the internal jugular vein. It is the most superior node in gthe upper deep cervical group. Receive lymphatic drainage from the Tonsils and tonsillar region. Juguloomohyoid lymph node (tongue node) It is related to the intermediate tendon of the omohyoid muscle. As it is associated with the lymph drainage of the tongue if enlarged, it can be a sign of a tongue carcinoma.

14 Supraclavicular Lymph nodes: The supraclavicular lymph nodes are a set of lymph nodes found just above the clavicle or collarbone, toward the hollow of the neck. The most notable supraclavicular lymph node is Virchow's node. Virchow's node (or signal node) It is a lymph node in the left supraclavicular fossa. It takes its supply from lymph vessels in the abdominal cavity. The finding of an enlarged, hard node (also referred to as Troisier's sign) has long been regarded as strongly indicative of the presence of cancer in the abdomen, specifically gastric cancer, that has spread through the lymph vessels. It is sometimes called the signal node or sentinel node for the same reason.

15 Submaxillary Lymph glands: Three to six in number, are placed beneath the body of the mandible in the submaxillary triangle, and rest on the superficial surface of the submaxillary salivary gland. One gland, the middle gland of Stahr, which lies on the external maxillary artery as it turns over the mandible. It is the most constant of the series. The afferents of the submaxillary glands drain the medial palpebral commissure, the cheek, the side of the nose, the upper lip, the lateral part of the lower lip, the gums, and the anterior part of the margin of the tongue. Its efferent vessels are from the facial and submental glands also enter the submaxillary glands. Their efferent vessels pass to the superior deep cervical glands.

16 The Waldyer s Ring: The ring consists of the following four sets of tonsils. 1. Pharyngeal Tonsils: Also called as Nasopharyngeal/ Adenoids tonsils. 2. Tubal tonsil: 3. Palatine Tonsils: Commonly called the *Tonsil*. Less commonly called as faucial tonsils, located in oropharynx. 4. Lingual Tonsils: Located on the posterior tongue.

17 The skin of Head & Neck Drainage The Scalp drains into the occipital, Mastoid and parotid nodes. The Lower eye lid and anterior cheek drains into buccal nodes. The cheek drains in to the parotid, buccal and submandibular nodes. While the middle third of the lower lip drains into the submental nodes. The skin of the neck drains in to the cervical nodes.

18 The drainage of the ORAL structures The Gingiva drains in to the submandibular, submental and upper deep cervical nodes. The Palate drains via the lymphatic's passing through the pharyngeal wall to the upper deep cervical nodes. Anterior part of the mouth floor drains into submental and upper deep cervical nodes. While posterior part into submandibular and upper deep cervical nodes.

19 Clinical Relevance Palpation of the Lymph Nodes

20 Palpation of the Lymph Nodes

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26 Have a bless Day Ahead.

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