Future is for those who believe in the beauty of their dreams .

DATE : 13/5/2010

In this lecture we will talk about the lymphatics in HEAD and NECK region. .
Lymphatic system is a draining system (like the venous system). ** It drains one way.
( when we speak about the circulatory system it has arteries that take blood to the tissues ,,, and the veins which return blood from tissues. SO, we have a circle.)

Lymphatic system is a one way system, that returns extra fluid from tissues to the blood ((responsible for the removal of extra fluid from
tissue spaces))

{Not all plasma fluid filtrated from blood capillaries return to the venous system,,, some fluid stay in the tissue,,,,, } So, we need extra

vessel to return this extra fluid which is the lymphatic system. ..

Lymph vessels are similar in structure to the veins that return extra fluid from tissue spaces to the venous part of the blood. lymph vessels mainly drain into the beginning of brachiocephalic vein ((when internal jugular vein meets the subclavian vein to form brachiocephalic vein))

Future is for those who believe in the beauty of their dreams .

Lymphatic system consist of: 1-Lymphatic vessels ( similar in structure to veins) Function : transport fluid which is called lymph ((Lymph in Latin means clear water)),,,,, so, it is clear colorless fluid ..

2- lymphatic tissues reticular connective tissue distribute all over the body rich in lymphocytes (( W.B.C )) Function : defend the body against disease causing agents.

Plasma fluid in the blood is called plasma The one that doesnt go back threw venous circulation and remains in the tissue interstitial fluid.. When interstitial fluid come back to lymphatic vessels and become rich with lymphocytes lymph ..... ..
SO, it is the same structure but different name according to its location,,, In blood In tissues plasma interstitial fluid

In lymph vessel lymph

2

Future is for those who believe in the beauty of their dreams .

Lymphatic tissues are :

))

((

note, that they all have lymphocytes

1-

Thymus : (area of maturation of T. lymphocytes ) located behind sternum. It goes involution (9omor) after puberty,, and what we see after puberty is a remnant of connective tissue.

2-

Spleen : resting at long access of rib 10, Protected by 9,10,11 ribs .. Tonsils : pharyngeal lingual palatine tubal . Lymph nodes.. Lymph nodules : smaller than lymph nodes . Found in the digestive system,,, mainly ((ileum and appendix ))

3-

4-

5-

. Lymphatic system links two body systems ((cardiovascular and immune system))..

Lymph :
It is a name given to tissue fluid once it enters lymph vessel and become rich with lymphocytes
3

Future is for those who believe in the beauty of their dreams .

Lymph = interstitial fluid + lymphocytes

Functions of lymphatic system:

1-

Draining excess interstitial fluid.

2- Carrying immune response threw lymphocytes (T,B cells). T. lymphocyte : release cytotoxin killing substances. C.D (clusters of differentiation) which are glycoproteins (protein + carbohydrate chain ) which are stronger than normal toxic protein.

B. lymphocytes : differentiate to plasma cells which produce immunoglobulin (antibodies)

3-transporting lipids into blood (from tissue to blood): Mainly lipids soluble vitamins . Vitamin A (vision) ,,, vitamin D ( absorption of calcium ) , vitamin K (coagulation) vitamin E ( antioxidant and help in neuron development)
deficiency of vitamin E ataxia (loose of coordination) ..

ex: vitamin D is made under skin when exposing to sun light we need this
vitamin to go to the blood threw lymphatic system from interstitial fluid
4

Future is for those who believe in the beauty of their dreams .

Lymphatics in head and neck region:

: regional groups of lymph nodes. : WALDYERs tonsiler ring. : terminal group of lymph nodes ( inside carotid sheet along with internal jugular vein) D.C.L.N

**All lymph vessels drains into D.C.L.N which drains the lymph to the venous circulation.

: regional group of lymph nodes :

Two L.N behind the head : (occipital and mastoid Two L.N in anterior aspect of the head.. :
Buccal in the cheek ,,,, parotid in the parotid.
{retro auricular})

Two beneath the mandible: Submental ,,, submandibular Two along superfacial jugular veins:. Anterior cervical along with anterior jugular vein . Superfacial cervical along with external jugular vein. Three L.N inside: Behind pharynx retropharyngeal . On the larynx laryngeal .

Future is for those who believe in the beauty of their dreams .

On the trachea tracheal .

Three questions to answer about regional lymph nodes : 1- Where each one is located? 2- Where they receive lymph from? (afferent) 3- Where they drain lymph into? (afferent)

Most lymph is drained into D.C.L.N

OCCIPITAL: 1- Location : occipital bone (at the apex of posterior triangle) 2- It receive lymph (afferent) (draining)posterior half of scalp 3- Drains lymph into D.C.L.N

MASTOID: 1- Location : over lateral surface of mastoid process 2- Drains scalp above auricle posterior medial aspect of auricleposterior wall of auditory canal (external auditory meatus )

3- Drains into D.L.C.N

6

Future is for those who believe in the beauty of their dreams .

PAROTID 1- Location : on the surface or inside parotid tissue.. 2- Parotid lymph nodes which are located on the surface drains :
the scalp above parotid lateral surface of the auricle anterior wall of external auditory meatus (E . O . M ) lateral aspect of the eyelids..
Parotid lymph nodes which located inside the tissue is specialized for

draining the tympanic cavity (middle ear)

3- Drains lymph to D.C.L.N

BUCCAL: [facial lymph nodes] 1- Location : over buccinator muscle and close to facial vein. 2- Drains (similar to what facial vein drains)
Anterior half of the scalp (forehead) nose frontal air sinus

3- Efferent : directly draining into submandibular then to D.C.L.N

((Directly draining into submandibular L.N and indirectly into D.C.L.N))
7

Future is for those who believe in the beauty of their dreams .

when we have infection in frontal air sinus or the nose, the first node to enlarge is Buccal then submandibular then D.C.L.N

SUBMANDIBULAR : (deep lymph node)

1-

Submandibular triangle , Superfacial to submandibular gland, deep to investing layer of deep cervical facia.

2-

Drains Buccal lymph nodes ( anything drains into Buccal lymph nodes
will go to submandibular lymph nodes)

upper lip lateral aspect of

lower lip ( central part of lower lip drains to submental L.N) maxillary and ethmoidal air sinuses upper and lower teeth (except lower
incisors) mouth)

all gingival (except lower labial , lingual gingiva and floor of the

3-

Efferent : D.C.L.N

SUBMENTAL:
12-

Location: inside Submental triangle. Drains tip of the tongue floor of the mouth associated with the tip of the tongue lower incisors and associated gums central part of lower lip

3-

Efferent : drains into submandibular then to D.C.L.N

Future is for those who believe in the beauty of their dreams .

Abscess of lower lateral incisor enlargement of Submental L.N then submandibular L.N will enlarge If the enlargement is only in the submandibular L.N we know that the infection isnt in lower incisors ,,,, coz if the infection is in lower incisors ,,then the enlargement will be on the submandibular and Submental L.N.

ANTERIOR CERVICAL L.N 1- Location : along the course of anterior jugular vein .. 2- Drains anterior part of the neck. 3- Drains to D.C.L.N

SUPERFACIAL L.N
1-

Location : along the course of external jugular vein (at the angle of the mandible)

2- Drains the angle of the mandible lobule of the auricle. 3- Drains to D.C.L.N

SO , we have 3 lymph groups contribute to the drainage of the auricle Medially mastoid L.N Laterally parotid L.N lobule superficial cervical L.N

Future is for those who believe in the beauty of their dreams .

WALDYERS TONSILER RING:

1- Pharyngeal tonsil roof of nasopharynx 2- Tubal tonsil lateral wall of nasopharynx 3- Palatine tonsil lateral wall of oropharynx 4- Lingual tonsil floor of the oropharynx

Terminal group D.C.L

Chain of lymph nodes located at the course of internal jugular vein (anteriolateral aspect of the vein )
They extend from base of skull to the root of the neck within carotid sheet

((carotid sheet contains : common carotid artery , internal jugular , vagus

nerve , D.C.L)

Afferent : receive lymph from all lymph structures in the head and neck. Efferent : efferent fibers of all lymph nodes communicate with each other and make large vessel (jugular lymph trunk) Jugular lymph trunk drain to Right side of the body : into right lymphatic duct . Left side: into thoracic duct.

10

Future is for those who believe in the beauty of their dreams .

Right lymphatic duct and thoracic duct drains into the venous system at the beginning of brachiocephalic veins ( at the corner when internal jugular meets subclavian vein)

` Two clinically important nodes jugulodigastric with digastric muscle

angle of mandible), (located behind and below

related to posterior belly of digastric.

juguloomohyoid with omohyoid muscle.

Jugulodigastric L.N :
Draining palatine tonsils and posterior third of the tongue (lingual tonsil) In tonsillitis (infection of palatine tonsils) , most lymph node enlarge is jugulodigasric. When the doctor palpate behind your angle of the mandible when you have tonsillitis , he palpates jugulodigastric L.N.

Around tendon of omohyoid muscle juguloomohyoid Draining medial anterior 2/3 of the tongue

Tongue drainage :
Tip Submental Medial anterior 2/3 juguloomgyioid. Post 1/3 jugulodigastric . Lateral anterior 2/3 submandibular
11

Future is for those who believe in the beauty of their dreams .

ENLARGMENT OF LYMPH NODES:

That means that there is inflammatory process (infection) or malignancy (metastasis of the tumors by lymph threw lymphatic vessels)

To distinguish between tumor and infection depends on the nature of examination. If lymph nodes are enlarged , soft and tender (painful) , indication of infection tonsillitis If the lymph nodes are enlarged and rubber, hard and there is no pain tumor lymphoma malignant.

The end
Done by : ETHAR . T . AL-DIBS

I hope that you enjoyed reading this lecture,,, I made this lecture without slides, SO,, I hope that there wont be any mistakes,,,,,

GOOOOOOOD LUCK

12