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LYMPHATIC DRAINAGE OF HEAD AND NECK REGION.

Presented By Dr Fatema Yusuf.

IntroductionFunctionsClinical significancePalpation of lymph nodesDevelopment of lymphoid tissueLymphatic system and organizationLymphoid tissue• Primary lymphoid organs • Secondary lymphoid organs• Lymph nodes

Lymphatic drainage of head and neckDiseases of lymphatic systemConclusionReferences

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Introduction• The lymphatic system is the part of the immune system comprising a

network of conduits called lymphatic vessels that carry a clear fluid called lymph ( Latin lympha -"water) unidirectionally toward the heart.

• The lymphatic system first described by Olaus Rudbeck and Thomas Bartholin

• Lymphoid tissue is found in many organs, particularly the lymph nodes, and in the lymphoid follicles.

• Circulation and production- spleen, thymus, bone marrow.

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• Lymph is formed when interstitial fluid enters the initial lymphatic vessels of the lymphatic system. The lymph -moves along the lymphatic vessel network by- intrinsic contractions of the lymphatic vessels , by extrinsic compression of the lymphatic vessels via external tissue forces Eg. The contractions of skeletal muscles.

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Functions• It is responsible for the removal of interstitial fluid

from tissues.• It absorbs and transports fatty acids and fats to the

circulatory system.• It transports immune cells to and from the lymph

nodes in to the bone.• The lymph transports antigen-presenting cells

(APCs), such as dendritic cells, to the lymph nodes where an immune response is stimulated.

• Lymphatic tissue is a specialized connective tissue - reticular connective, that contains large quantities of lymphocytes.

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Clinical significance

• The study of lymphatic drainage of various organs is important in diagnosis, prognosis, and treatment of cancer.

• The lymphatic system, because of its physical proximity to many tissues of the body - for carrying cancerous cells b/w various parts of the body in a process called metastasis.

• Intervening lymph nodes can trap the cancer cells. If they are not successful in destroying the cancer cells the nodes may become sites of secondary tumours.

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Dental conditions• Tooth abcess• Cellulitis• Periodontitis• Irreversible pulpitis• Acute necrosis ulcerative gingivitis• Mouth sores

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Palpation of Lymph Nodes

• video

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Development of lymphatic tissueso develop • Lymphatic tissues –develops by end of 5th wk of embryonic

development. Lymphatic vessels develop - lymph sacs arise from developing veins, which are derived from mesoderm.

• The first lymph sacs - paired jugular lymph sacs at junction of the internal jugular and subclavian veins. From the jugular lymph sacs, lymphatic capillary plexuses spread to the thorax, upper limbs, neck and head.

• The next lymph sac - unpaired retroperitoneal lymph sac at the root of mesentery of the intestine, develops from primitive vena cava & mesonephric veins.

• The last of the lymph sacs - paired posterior lymph sacs, develop from the iliac veins.

• All lymph sacs become invaded by mesenchymal cells and are converted into groups of lymph nodes.

• The spleen develops from mesenchymal cell.• The thymus arises as an outgrowth of the third pharyngeal pouch.

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Organization Divided into the conducting system and the lymphoid tissue.• The conducting system - lymph and tubular vessels that include -

lymph capillaries, lymph vessels, right & left thoracic ducts.• The lymphoid tissue is involved in immune responses & consists of

lymphocytes & other white blood cells enmeshed in connective tissue through which the lymph passes.

Lymphoid tissue that are densely packed with lymphocytes- lymphoid follicles.

• Lymphoid tissue - structurally well organized- lymph nodes-• Lymphoid tissue -consist of loosely organized lymphoid follicles

known as the mucosa associated lymphoid tissue (MALT)

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Lymphoid tissue• Lymphoid tissue - concerned with immune

functions in defending the body against the infections and spread of tumours.

• It consists of connective tissue - types of white blood cells enmeshed in it, most numerous being the lymphocytes.

• The lymphoid tissue-o primary o secondaryo tertiary – few lymphocytes /immune role only in

inflammation

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Primary lymphoid organs• The central or primary lymphoid organs generate

lymphocytes from immature progenitor cells.• The thymus, bone marrow - primary lymphoid tissue. Secondary lymphoid organs• Secondary or peripheral lymphoid organs maintain mature

naive lymphocytes and initiate an adaptive immune response, sites of lymphocyte activation by antigen.

• Secondary lymphoid tissue - environment for the foreign (antigens) to interact with the lymphocytes. It is exemplified by the lymph nodes, and the lymphoid follicles in tonsils, spleen, adenoids, skin, etc. that are associated with (MALT).

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Lymph nodes• A lymph node - organized

collection of lymphoid tissue, through which the lymph passes on its way to returning to the blood. .

• The substance of a lymph node consists of

• outer portion -cortex, which contains the lymphoid follicles,

• an inner portion -medulla, • The hilum - depression on the

surface of the lymph node, which makes lymph node bean-shaped.

• Lymph follicles - dense collection of lymphocytes.

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Lymphatic drainage of the human body

Lymphatic drainage is organized into two separate and very unequal drainage.Structures within each area carry lymph to its destination, which is to returnto the circulatory system.The right drainage area removes lymph from the:- Right side of the head and neck- Right arm - Upper right quadrant of the body.Lymph from this area flows into the right lymphatic duct. This duct returns the lymph to the circulatory system by draining into the right subclavian vein.The left drainage area removes lymph from the rest of the body:- Left side of the head and neck- Left arm and the left upper quadrant- Lower extremities- Both legs

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Lymphatic drainage of the tissues of head and neck NN

1. The superficial tissues2. The deeper structures and viscera

Superficial tissue regional lymph node

deep cervical nodes

Deep Cervical Lymph Nodes16

1. The superior deep cervical lymph nodes- Jugulodigastric lymph nodesAfferent – Tongue, tonsilEfferent - Lower deep cervical lymph nodes- Jugular trunk

Deep Cervical Lymph Nodes

2. Inferior deep cervical lymph nodes• Jugular Omohyoid lymph nodes• Afferent - Tongue• Efferent - Jugular trunk

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Regional Lymph nodes of Head and Neck Drainage of superficial tissues• Occipital• Retroauricular• Parotid• Buccal (facial)• Submandibular• Submental• Anterior cervical

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Occipital Lymph Nodes19

• Afferent – Back of scalp • Efferent – Deep cervical lymph nodes

Retroauricular (mastoid) Lymph Nodes

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• Afferent - Strip of scalp above auricle - Posterior external auditory meatus

• Efferent - Deep cervical nodes

Buccal Lymph nodes

• Afferent - buccinator muscle facial vein

• Efferent - Submandibular lymph node

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Parotid Lymph Nodes- Superficial parotid nodes- Deep parotid nodesAfferent of superficial parotid nodes- Strip of scalp above the parotid salivary

gland- Lateral surface of auricle- Anterior wall of external auditory

meatus- Lateral part of the eyelidAfferent of deep parotid nodes- Middle earEfferent - Deep cervical nodes

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Submandibular Lymph nodeAfferent - Front of scalp- Nose and adjacent cheek- Upper lip- Lower lip ( centre part )- Frontal, maxillary, ethmoidal air sinus- Upper and lower teeth ( lower incisor )- Anterior 2/3 of tongue ( tip)- Floor of mouth, vestibule, gumEfferent - Deep cervical lymph nodes

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Submental Lymph nodeAfferent - Tip of tongue- Floor of mouth beneath the tip of tongue- Incisor teeth and associated

gum- Centre part of lower lip- Skin over chinEfferent – Submandibular nodes- Deep cervical lymph nodes(Jugulo-omohyoid nodes)

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Anterior Cervical Lymph nodes

• Afferent - Skin, superficial

tissue of the front of the neck

• Efferent - Deep cervical

lymph nodes

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Superficial Lymph nodes

• Afferent - Skin over the angle of

jaw- Skin over apex of

parotid- Salivary gland and

lobe of ear• Efferent - Deep cervical lymph

nodes

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Lymphatic Drainage of face27

Regional Lymph node

• Retropharyngeal• - Paratracheal• - Infrahyoid• - Prelaryngeal• - Pretracheal• - Lingual

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Retropharyngeal Lymph node

• Afferent - Nasal part of pharynx- Auditory tube- Upper part of cervical

vertebral column• Efferent- Deep cervical lymph

nodes

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Paratracheal Lymph nodes

• Afferent - Neighbouring

structures- Thyroid gland• Efferent - Deep cervical

lymph nodes

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Lymphatic drainage of mouth, teeth and tongue. Gums

- submandibularHard palate - Upper deep cervical- RetropharyngealSoft palate - Retropharyngeal- Upper deep cervicalAnterior part of floor of mouth- submental- Upper deep cervicalPosterior part of floor of mouth- submandibular - Upper deep cervicalUpper & lower teeth- submandibullar - deep cervicalLower incisors- submental

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Drainage of tongue

• Vallate papillae– Marginal, Central

vessels– Dorsal vessels

• Tip and frenulum of tongue

Marginal vessels Submental Jugulo – omohyoid Submandibular Jugulodigastric

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Tongue• Lateral margin of tongue– Marginal vessels– Submandibular– Jugulodigastric– Jugulo-omohyoid

• Posterior part of margin of tongue– Marginal vessels– Jugulodigastric

• Dorsal surface of tongue - Central vessels

- Deep cervical nodes - Submandibular nodes

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Lymphatic drainage of Pharynx and cervical parts of Esophagus

Pharynx and cervical part of esophagus

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Retropharyngeal or paratracheal

Deep cervical

Epiglotis Infrahyoid node

Lymphatic Diseases

• Acute lymphangitis• Lymphadenitis• Tonsillitis• LymphedemaAcute lymphangitis- is an inflammatory process of one or

more regions of lymphatic vessels. Bacteria frequently reach the lymphatic vessels from a scratch or wound. Often, a superficial streptococcal infection from the skin and/or the tissues just beneath the skin may easily spreads to the lymphatic vessels.

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Acute Lymphangitis

Facial Cellulitis37

• Lymphadenitis is an inflammatatory process of one or more lymph nodes or lymph node stations. Lymphadenitis is caused by an infection, which may be due to bacteria, viruses, protozoa or fungi, the infection spreads to a lymph node from a variety of sources: skin, ear, nose, tooth/gingiva or eye infection, cytomegalovirus infection, streptococcal infection, tuberculosis, or syphyllis. The infection may spread and involve many lymph nodes or remain limited to only those in one area of the body.

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Lymphadenitis

• Tonsillitis is the inflammatory process of the tonsils. It is mostly due to an infection by bacteria or viruses. Tonsillitis is the most common form of lymphadenitis.

• Lymphedema is the accumulation of lymph liquid causing a swelling. Lymphedema results when any condition or abnormality prevents lymph from being reabsorbed into the venous capillaries and/or from being adequately drained by the lymphatic capillaries and vessels as it normally is. As a result, the excess lymphatic fluid cannot be adequately drained from the tissues and Lymphedema results.

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Tonsillitis

Lymphedema

The conventional approach to lymphatic pathology

• Diuretics• Lymphatic Drainage Therapy (LDT)• NSAIDs• Antibiotics

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Conclusion44

• The lymphatic system is the part of the immune system in the human body.

• The study of lymphatic drainage of various organs is important in diagnosis, prognosis, and treatment of cancer and infectious diseases.

REFERENCES

• GRAY’S ANATOMY.• B D CHOURASIA ANATOMY.• COLOR ATLAS

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