Lymphatic Drainage of the Head and Neck

Question 1

What percentage of interstitial fluid enters the lymphatic system?

Answer 1

20%

Question 2

Where do the upper deep cervical nodes drain from?

Answer 2

Superficial nodes
Tongue
Tonsil

Question 3

Which lymph node is enlarged in tonsilitis?

Answer 3

Jugulodigastric

Question 4

Where do the lower deep cervical nodes drain from?

Answer 4

Back of scalp and neck
Superficial pectoral region/part of arm
Tongue
Superficial deep cervical glands

Question 5

Name a large lymph node that is a lower deep cervical node

Answer 5

Juguloomohyoid

Question 6

Where do the submental nodes drain from?

Answer 6

Floor of mouth
Incisor and gum
Central lower lip
Chin

Question 7

Where do the submental and buccal nodes drain to?

Answer 7

Submandibular nodes

Question 8

Where do the buccal nodes drain from?

Answer 8

Lower eyelid
Cheek and buccinator
Facial vein

Question 9

Which structures do the parotid nodes drain from?

Answer 9

Eyelid
Nose
External acoustic meatus
Part of nasopharynx

Question 10

Which structures do the mastoid nodes drain from?

Answer 10

Strip of scalp above auricle

Posterior external auditory meatus

Question 11

Where do the occipital nodes drain from?

Answer 11

Back of scalp

Question 12

Where do the superficial cervical nodes drain from?

Answer 12

Skin over jaw angle
Parotid apex
Lobule of ear

Question 13

Where do all the superficial nodes in the neck eventually drain to?

Answer 13

Deep cervical nodes

Question 14

Where do the retropharyngeal nodes drain from?

Answer 14

Pharynx
Auditory tube
Palate
Nasal cavity

Question 15

What is the name of the first node in drainage of the nasopharynx?

Answer 15

Node of Rouviere

Question 16

What is the Delphian node?

Answer 16

Prelaryngeal node that is associated with poor prognosis in thyroid cancer

Question 17

Where does the thyroid drain to?

Answer 17

Directly to pretracheal/ prelaryngeal nodes

Question 18

Where does the back of the tongue drain?

Answer 18

Superior deep cervical nodes

Question 19

What is unique about the lymph drainage of the tongue and why is it clinically significantly?

Answer 19

Lymph crosses over midline with significant drainage to both sides of neck
Tongue lesions can spread to nodes on both sides so much check bilaterally for enlarged nodes

Question 20

Where do the lateral surfaces of the tongue drain?

Answer 20

Inferior deep cervical nodes

Submandibular nodes

Question 21

Where does the tip of the tongue drain?

Answer 21

Submental nodes

Question 22

Describe the characteristics of tongue cancer

Answer 22

Squamous cell carcinoma most common

Contralateral lymph node metastasis - poor prognosis

Question 23

What is virchow’s node?

Answer 23

Supraclavicular node
Enlarged, hard left node
If enlarged known as Troisier’s sign - indicative of tumour in the abdomen (especially stomach)

Question 24

What is Waldeyer’s ring?

Answer 24

An interrupted circle of protected lymph tissue around the respiratory tract opening

Question 25

Name the 4 tonsils in Waldeyer’s ring?

Answer 25

Pharyngeal
Palatine
Tubal
Lingual

Question 26

How can you label draining lymph nodes?

Answer 26

Dye marker - isosulfan blue
Fluorescence marker
Lymphosyntigraphy

Question 27

What is perineural spread?

Answer 27

Spread of cancer along a nerve

Question 28

Which nerves are involved in perineural spread of head and neck cancer?

Answer 28

Trigeminal
Facial
Hypoglossal

Question 29

Where is a crossroad for perineural and perivascular spread?

Answer 29

Pterygopalatine fossa