19 - Lymphatics of the head and neck

Question 1

What is the function of the lymphatic system?

Answer 1

• drainage of surplus tissue fluid
• removal of debris from cell breakdown or immune response
• important to indicate infection
• facilitates malignancy spread

Question 2

Describe the general lymphatic drainage of the head and neck.

Answer 2

• nodes within the face drain into superior deep cervical nodes
• deep cervical nodes and occipital nodes drain into inferior deep cervical nodes
• all nodes drain into left or right subclavian vein

Question 3

Which nodes drain into the superior deep cervical nodes?

Answer 3

• facial nodes
• anterior and posterior auricular nodes
• superficial parotid nodes
• deep parotid nodes
• retropharyngeal nodes

Question 4

Where is the thoracic duct located?

Answer 4

Left subclavian vein

Question 5

What does the thoracic duct drain?

Answer 5

All lymph from body except upper right quadrant

Question 6

Where is the right lymphatic duct located?

Answer 6

Right subclavian vein

Question 7

What does the right lymphatic duct drain?

Answer 7

Upper right quadrant

Question 8

What are the superficial nodes of the head?

Answer 8

• facial
• superficial parotid
• posterior auricular
• anterior auricular
• occipital

Question 9

How many superficial parotid nodes are there?

Answer 9

10

Question 10

How many posterior auricular nodes are there?

Answer 10

1-3

Question 11

How many anterior auricular nodes are there?

Answer 11

1-3

Question 12

How many occipital nodes are there?

Answer 12

1-3

Question 13

What do the superficial parotid and posterior and anterior auricular nodes drain?

Answer 13

• area of external ear
• lacrimal glands
• adjacent skin of scalp and face

Question 14

How many facial nodes are there?

Answer 14

12

Question 15

Where are the facial nodes located?

Answer 15

Along facial vein

Question 16

Where are the superficial parotid nodes located?

Answer 16

Superficial to the parotid gland

Question 17

Where are the anterior auricular nodes located?

Answer 17

Anterior to the external acoustic meatus

Question 18

Where are the posterior auricular nodes located?

Answer 18

Posterior to the external acoustic meatus

Question 19

Where are the occipital nodes located?

Answer 19

Over the occipital region of the head

Question 20

What are the subdivisions of the facial nodes?

Answer 20

• infraorbital
• nasolabial
• buccal
• mandibular

Question 21

What do the facial nodes drain?

Answer 21

Skin and mucosa in the area, superior to inferior

Question 22

What are the deep lymph nodes of the head?

Answer 22

• deep parotid
• retropharyngeal

Question 23

How many deep parotid nodes are there?

Answer 23

10

Question 24

How many retropharyngeal nodes are there?

Answer 24

0, usually disappear by ages 4-5

Question 25

What do the deep parotid nodes drain?

Answer 25

- middle ear - auditory tube - parotid gland

Question 26

What do the retropharyngeal nodes drain?

Answer 26

- palate - pharynx - paranasal sinuses - oral cavity

Question 27

What are the superficial cervical nodes?

Answer 27

- submandibular - submental - anterior jugular - external jugular

Question 28

How many submandibular nodes are there?

Answer 28

3-6

Question 29

How many submental nodes are there?

Answer 29

2-3

Question 30

Where are the submandibular nodes located?

Answer 30

in the region of the angle of the mandible

Question 31

Where are the submental nodes located?

Answer 31

Under the chin

Question 32

Where are the anterior jugular nodes located?

Answer 32

Along the anterior jugular vein

Question 33

Where are the external jugular nodes located?

Answer 33

Along the external jugular vein

Question 34

What do the submandibular nodes drain?

Answer 34

- cheek - upper lip - body of tongue - anterior hard palate - majority of teeth, PDLs and gingiva (except lower incisors and upper 8s)

Question 35

What do the sublingual nodes drain?

Answer 35

- drain tissue bilaterally - lower lip - chin - floor of mouth - apex of tongue - mandibular incisors, PDLs and gingiva

Question 36

What are the deep cervical nodes?

Answer 36

- jugulodigastric - jugulo-omohyoid - accessory - supraclavicular

Question 37

How many deep cervical nodes are there?

Answer 37

15-30 along each IJV

Question 38

What do the jugulodigastric nodes drain?

Answer 38

- palate - tonsils

Question 39

What do the jugulo-omohyoid nodes drain?

Answer 39

- tongue - submental triangle

Question 40

What do the accessory and supraclavicular nodes drain?

Answer 40

Lateral triangles of the head

Question 41

How are the deep cervical nodes separated into superior and inferior?

Answer 41

Where the omohyoid crosses the IJV

Question 42

What do the superior deep cervical nodes drain?

Answer 42

- posterior nasal cavity - posterior hard palate and soft palate - base of tongue (bilateral) - maxillary 8s - TMJ - oesophagus - trachea - thyroid gland

Question 43

What do the inferior deep cervical nodes drain?

Answer 43

- posterior scalp and neck - superior pectoral region - part of the arm

Question 44

How does infection and inflammation in the lymph node present?

Answer 44

Swollen and tender lymph nodes

Question 45

How does malignancy present in lymph nodes?

Answer 45

Hard and painless lumps

Question 46

What does swelling in the submandibular lymph nodes indicate?

Answer 46

Disease or malignancy in the oral cavity, face, nasal cavity or maxillary sinus

Question 47

What does swelling in the supraclavicular lymph nodes indicate?

Answer 47

Disease or malignancy in the thorax or abdomen