015. Lymphatic Drainage of Head & Neck
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Transcript of 015. Lymphatic Drainage of Head & Neck
LYMPHATIC DRAINAGE OF HEAD AND NECK
Dr. ZAKIRULLA. M
CONTENTS1. HISTORICAL PROSPECTIVES
2. DEVELOPMENT OF LYMPHATIC SYSTEM
3. LYMPHATIC SYSTEM
A) LYMPH
B) LYMPHATIC CHANNELS
C) LYMPHOID ORGANS
D) LYMPH NODES
4. TOPOGRAPHY OF LYMPH NODES
5. CLASSIFICATION OF LYMPH NODES
6. LYMPHATIC DRAINAGE OF INDIVIDUAL PART
7. CLINICAL CONSIDERATIONS
A) DISEASES OF LYMPHATICS AND LYMPH NODES
B) HODGKINS LYMPHOMA
C) CYSTIC HYGROMA
D) INFECTIOUS MONONUCLEOSIS
E) BLOCK DISSECTION OF NECK
Historical perspective
• Lymphatic system was known to ancient greeks like Hippocrates spoke of white blood, Aristotle described them as colorless fluid within tubules
• ERASISTRATUS in Alexandria was first to describe around 2000 years ago
• GASPARO ASELLI an Italian anatomist rediscovered lymphatic vessels in 1622
• VAN HOOK of leyden in 1652 demonstrated the presence of cisterna chyli and thoracic duct in humans
• STARLINGS work on hydrostatics and hydrodynamic forces
across the capillary membrane controlling the movement of
fluid described the dynamics of lymph formation
• OLOF RUDBECK of Swedish university described that
lymphatic system constitute a circulatory system separate
from blood circulation and was accepted by Royal Society of
London in 1751
• WILLIAM HUNTER in the late 18th century was the first
to describe
the functions of lymphatic system.
Historical perspective…..
Starts at 5th week of IUL First signs of lymphatic system are seen in the form of a number of
endothelium lined LYMPH SACS
Six primary lymph sacs are formedSix primary lymph sacs are formed1) 2 jugular sac (Right and Left) At the junction of subclavian and anterior cardinal veins
2) 2 Iliac sac (Right and Left) At the junction of the iliac and posterior cardinal vein
3) 1 Retroperitoneal (Unpaired) Near the root of the mesentry
4) 1 Cisterna chyli (Unpaired) Dorsal to retroperitoneal sac
DEVELOPMENT OF LYMPHATIC SYSTEM
JUGULAR LYMPH SAC
CISTERNA CHYLI
ILIAC SAC
RETROPERITONEAL LYMPH SAC
RELATIVE POSITIONS OF PRIMARY LYMPH SACS
LYMPHATIC VESSELS 1) From extension from the sac2) May form De novo and extend into various tissues
LYMPHNODESAll the sacs excepts the cisterna chyli are invaded by connective tissue and lymphocytes and are converted into groups of lymph nodes
LYMPH SINUSESRepresents portion of original cavity of the sac
THORACIC DUCTDerived from right and left channels that connect the cisterna chyli to the corresponding jugular sac.
DEVELOPMENT OF LYMPHATIC SYSTEM……
Accessory route by which the fluid can flow from the interstitial spaces into blood.
The removal of proteins from interstitial spaces is an essential function, without which we would die within about 24 hours.
Lymphatic system consist ofLymphatic system consist of
A) Lymph
B) Lymphatic channels
i) Lymphatic capillaries
ii) Lymphatic vessels
C) Lymphoid organs
D) Lymph nodes
LYMPHATIC SYSTEM LYMPHATIC SYSTEM
LYMPHLYMPH
Definition: Transparent, slightly yellowish liquid of alkaline reaction found in lymphatic vessels and derived from tissue fluid.
LYMPH is clear watery-appearing fluid found in lymphatic vessels.
Colloidal osmotic pressure < Plasma, but > Tissue fluid.
Formed by the passage of substances from blood capillaries into tissue spaces. This process is TRANSUDATION.
During fasting Transparent, yellowish color, alkaline in reactionAfter fatty food Milky due to presence of droplets of emulsified fat
COMPOSITION OF LYMPHCOMPOSITION OF LYMPH
1) WATER 94%2) SOLIDS 6%
A) PROTEINS (2-6%)AlbuminGlobulinFibrinogenProthrombinClotting factorsEnzymesAntibodies
B) LIPIDS (5-15%) Chylomicrons, Lipoproteins
C) CARBOHYDRATESGlucose 132.2 mg/100ml
D) OTHERSUrea, CreatininChlorides, PhosphorusCalcium
Proteins, calcium , phosphorus < plasma Chlorine, glucose > plasma
ARTERIES (BLOOD PLASMA)
BLOOD CAPILLARIES (BLOOD PLASMA)
LYMPHATIC VESSELS (LYMPH)
INTERSTITIAL SPACES (INTERSTITIAL FLUID)
LYMPHATIC CAPILLARIES (LYMPH)
LYMPHATIC DUCTS (LYMPH)
SUBCLAVIAN VEINS (BLOOD PLASMA).
FORMATION AND SEQUENCE OF FORMATION AND SEQUENCE OF FLUID FLOWFLUID FLOW
LYMPHATIC LYMPHATIC CIRCULATIONCIRCULATION
RATE OF LYMPH FLOWRATE OF LYMPH FLOW
Lymph flow through thoracic duct 100 ml/hr
Lymph flow through right lymphatic duct 20 ml/hr
Total lymph flow 120 ml/hr
• Lymph carries protein and large particulate matter away from the tissue space.
• Important role in redistribution of fluid in the body.
• Bacteria, toxins and other foreign bodies are removed from the tissues.
• Maintenance of structural and functional integrity of tissue.
FUNCTIONS OF LYMPHFUNCTIONS OF LYMPH
LYMPHATIC CAPILLARIES
• They form mesh like network of tiny tubes distributed throughout the tissue spaces.
• Begins as closed-ended vessels.• They lack well developed basal lamina• Lymphatic capillary vs blood capillary
LYMPHATIC CHANNELSLYMPHATIC CHANNELS
• They are lined by a single layer of endothelial cells.
• These are attached by Anchoring filaments
• Partly composed of fine collagen fibrils
LYMPHATIC CAPILLARIES are not found in– CNS– Cartilage– Spleen– Epidermis– Internal ear– Eyeball ie, Cornea– Bone marrow– Alveoli of lungs
However,these tissues contain minor interstitial channels called Pre-lymphatics
LYMPHATIC LYMPHATIC VALVESVALVES
When pressure is greater in interstitial fluid than lymph, the cells separate slightly, fluid enters the lymphatic capillary and vice versa
• Lymphatic capillaries repeatedly join to form bigger lymphatic vessels.
• It consist of external CT with an endothelial lining
• It has all 3 layers as in veins
i) Tunica intima
ii) Tunica media
iii) Tunica adventitia
• Superficially- veins
Deep - arteries.
• It carries tissue fluid from tissues to veins.
LYMPHATIC LYMPHATIC VESSELSVESSELS
• Skin vessels lie in subcutaneous tissue and generally follow veins
• Viscera vessels generally follow arteries forming plexuses around them.
.Lymphoid organs are of two types; ENGESET (1959)
1 Primary lymphoid organs
Thymus
Bone marrow.( secondary)
2 Secondary lymphoid organs
Lymph node
Spleen
Palatine and pharyngeal tonsil
Payer’s patches
LYMPHOIDLYMPHOID
ORGANSORGANS
central
central
peripheral
peripheral
EPITHELIOEPITHELIO LYMPHOIDLYMPHOID TISSUETISSUE
SALT Skin associate lymphoid tissueGALT Gut associated lymphoid tissueBALT Bronchial associated lymphoid tissue
MALTI) D-MALT Located in lamina propria and submucosaII) O-MALT Scattered around the base of epithelium a) peripharyngeal lymphoid ring of tonsils b) Oesophageal nodules c) Nodules in GIT (absent in stomach)
THYMUS THYMUS GLANDGLAND
Thymus is a triangular, bilobed lymphatic organ Located in mediastinum, posterior to sternum and between
the lungs It is small in newborn infant, reaches its maximum size at 10-
12 yrs of age, follows gradual decrease in its size Most T cell arise before puberty, some continue to mature
through out the life
HISTOLOGY OF THYMUS
It consists of right and left lobes joined together by fibrous tissue
Each lobule consists of connective tissue capsule 1) CORTEX (outer) - composed of tightly packed lymphocytes epithelial cells, macrophages and T-cells 2) MEDULLA (Center) - Composed of epithelial cells Scattered lymphocytes
Medulla contains Thymic (Hassall's)corpuscles, which are remnants of dying cells
1) PROCESSING THE ‘T’’ LYMPHOCYTES
2) ENDOCRINE FUNCTIONS OF THYMUS They secretes hormones namely
a) Thymosin
b) Thymin
c) Thymic humoral factor
d) Thymulin
3) Medullary epithelial cells of thymus are thought to secrete
a) Lymphopoietin
b) Competence-inducing factor
FUNCTIONS OF THYMUS
Hyperactivity of thymus results in a condition known asMyasthenia Gravis
1) INVOLUTION OF THYMUS Enhanced a) Hypertropy of adrenal cortex b) Injection of cortisone or Androgenic hormone. Delayed Castration and adrenalectomy
2) MYASTHENIA GRAVIS CAUSE – Thymic hyperplasia or tumour C/F – Excessive fatiguability of voluntary muscles.
3) THYMIC TUMOURS may press on the trachea, oesophagus and large veins of neck causing - Hoarseness - Cough - Dysphagia - cyanosis
APPLIED ANATOMY
SPLEEN
Largest lymphoid tissue of the
body. It is a bean shape organ for
filtering blood.
Weighing about 150gm in adult
Situated in the left hypo- chondriac
region between stomach and
diaphragm lateral to the liver
There is no afferent lymphatic
vessels
MICROSCOPIC STRUCTURE
Capsule-with outer covering peritoneum
• Trabeculae
• Hilus (hilum)
• White pulp
• Red pulp
• Reticular network
• Blood vessels
White pulp is lymphatic tissue, mostly lymphocytes (B cells), arranged around central arteries.
Red pulp consists of venous sinuses filled with blood.
FUNCTIONS OF SPLEENFUNCTIONS OF SPLEEN
1) Formation of blood cells
2) Destruction of blood cells
3) Reservoir of blood
4) Role in defense of body
RUPTURED SPLEEN
SPLENOMEGALY - Malaria, CML, Cirrhosis, Typhoid.
SPLENECTOMY Results in 1) Moderate degree of hypochromic anaemia2) Cannot withstand severe anoxia3) Diminished resistance against infections4) Leucocyte count increases, may go upto 20,000-40,000 per cu.mm
Other structures, particularly red bone marrow and the liver, can take over functions normally carried out by the spleen
CLINICAL CONSIDERATIONCLINICAL CONSIDERATION
WALDEYER’S LYMPHATIC RING
• In relation to oropharyngeal isthmus, there are several aggregations of lymphoid tissue that constitute Waldeyer’s lymphatic ring.
• The most important aggregations are
1) Right and left palatine tonsils.
2) Pharyngeal tonsil.
3) Tubal tonsil
4) Lingual tonsil
Clinical anatomy
Tonsils are large in children, regress after puberty.
Tonsils are frequent sites of infection, specially in
children.
Tonsillectomy removal of tonsils due to
infections.
QUINSY -> Suppuration in the peritonsillar area
Tonsillitis may cause referred pain in ear GFN
LYMPH NODESLYMPH NODES
LYMPH NODES
• Lymph nodes are secondary lymphoid tissues, situated peripherally.
• Architecture of Lymph nodes
Capsule
Cortex lymphoid follicles
Germinal centers
Para cortex
Medulla
Sinuses
Blood vessels
LYMPH NODES STRUCTURE
CORTEX (OUTER REGION)
MEDULLA
MEDULLARY SINUSES
MEDULLARY CHORD
CELLS PRESENT
LYMPHOCYTES
PLASMA CELLS
MACROPHAGES
1.Capsule& Trabeculae (Type I collagen)
• Composed mainly of collagen fibers, a few fibroblasts and elastin fibers,
• From the capsule, trabeculae of dense connective tissue extend radially into the nodes interior,
trabeculae
capsule
Reticulum / Stroma (Type III collagen)
• Supports the cell masses within them.
• Filters lymph by slowing down the flow.
Artery
Vein
Lymphatic channels Afferent Efferent
LYMPHATIC CHANNELS
CELL ZONES IN LYMPH NODES
FUNCTIONS OF LYMPH NODES
1) They produce and supply lymphocytes to the blood T-cell CELL MEDIATED IMMUNITY B-cell HUMORAL IMMUNITY
2) Bacteria and other particulate matter are removed from lymph by phagocytosis3) They act as a mechanical filters4) They produces globulins5) They carry immunological responses and help in development of immunity6) They temporarily stop the spread of cancer cells
HOW ARE lymphocytes FORMED?HOW ARE lymphocytes FORMED?
TURNER ( 1969 )and HOGG et al ( 1982 ) They lie in between spleen and lymph node.
HAEMAL / HAEMO LYMPH HAEMAL / HAEMO LYMPH NODESNODES
These lymph nodes possess red colour, due to the presence of blood in them
FOUNDFOUND Retroperitoneal tissue Mediastinum
Spleen may be regarded as the modified haemal lymph node
TOPOGRAPHY OF LYMPH NODES
• SUPERFICIAL/ DEEP
• RELATED VASCULATURE Buccal nodes Cervical nodes Clavicular nodes Inguinal nodes External iliac Internal iliac
• RELATIONS TO VISCERA: SM, Parotid, Pulmonary,
• GENERAL LOCATIONS LEG, ARM, HEAD AND NECK
RELATED TO LYMPH NODE CHAINS Primary Intermediary Terminal
NUMBER AND REGIONAL DISTRIBUTION
Head and neck 60-70
Arms/superficial thorax 40
Legs/superficial buttocks 30
Thorax 100
Abdomen/pelvis 230
Total 450-500 LN
CLASSIFICATION OF CERVICAL LYMPH NODES
HORIZONTAL CHAIN - Outer circle
- Inner circle
- Waldeyers ring
VERTICAL CHAIN
level 1 consist of sub mental, submandibular nodes
level 2 consist of upper jugular nodes
level 3 consist of middle jugular group
level 4 lower jugular group
level 5 posterior triangle group
level 6 anterior compartment group
level 7 superior mediastinal group
level 8 supraclavicular nodes
level 9 retropharyngeal nodes
LYMPHATIC DRAINAGE OF THE BODY
• 38-45 cm (15-18 in.) in length
• Begins as a dilation called the cisterna
chyli, anterior to the second lumbar
vertebra.
• Main collecting duct of lymphatic system.
• Receives lymph from left side of the head,
neck & chest, left upper limb, & entire body
inferior to the ribs
THORACIC DUCT (LEFT LYMPHATIC)
RIGHT LYMPHATIC DUCT• 1.25 cm (1/2 in.) long • Drains lymph from the upper right side of
the body • Collects lymph from right jugular trunk,
which drains right side of the head and neck.
• Right broncho mediastinal trunk, which drains the right side of the thorax, right lung, right side of the heart.
parotid
Sub mental Submandibular
occipitalmastoid
Lower deep cervical
Jugulo-omohyoid
Buccal
Superficial cervical
Upper deep cervical
prelaryngeal
pre tracheal
LYMPH NODES OF HEAD AND NECK REGION
LYMPH NODES OF HEAD AND NECK REGION
• Occipital nodes Superficial group 2-3 nodes lies b/w SCM and trapezius Deep group 1-3 nodes lies deep to splenius muscle • Post auricular nodes 2-4 nodes• Parotid nodes 20 nodes intra glandular extra glandular• Submandibular nodes pre glandular post glandular pre vascular post vascular intra capsular NODE OF STOHR
• Sub mental nodes 2-8 nodes• Sub lingual nodes• Retro pharyngeal nodes 2-3 nodes
• Anterior cervical group
1. Anterior jugular chain
2. Juxta visceral chain
a) Pre laryngeal group: cricothyroid membrane
b) Pre tracheal: isthmus of thyroid gland
c) Para tracheal: recurrent laryngeal nerve
• Lateral cervical nodes 1) Superficial group: E J V 2) Deep group: a) Spinal accessory chain b) Transverse cervical chain c) Internal jugular chain
• Spinal accessory chain: 20 nodes Drain : occipital, post auricle, supra scapular, posterior sclap • Transverse cervical group:12 nodes drain : spinal accessory, skin from upper thorax, lower neck
• Internal jugular chain Upper groupUpper group: above hyoid bone Middle groupMiddle group: b/w hyoid and cricoid cartilage Lower groupLower group: below cricoid cartilage
Drain: nasal fossa, pharynx, tongue, salivary glands thyroid & para thyroids. efferent: into thoracic duct and subclavian vein
• Sentinal nodes: Highest JD nodes near angle of mand.
• Signal nodes: Lowest along the IJV (Virchow’s Nodes)
OCCIPITAL LYMPH NODEOCCIPITAL LYMPH NODELOCATION: At the apex of the posterior triangle superficial
to the attachment of the trapezius.
AFFERENT: Occipital part of the scalp
Upper part of the back of the neck
EFFERENT: Deep cervical node
LYMPH NODES IN LYMPH NODES IN HEADHEAD
LOCATION: These nodes lie on the mastoid process superficial
to the sternomastoid
AFFERENT: Posterior parietal region of scalp
Skin of the mastoid region
Posterior auricle
EFFERENT: Infra parotid nodes
Internal jugular nodes
Spinal accessory nodes
RETRO AURICULAR NODESRETRO AURICULAR NODES
LOCATION: The parotid lymph nodes lie partly in the superficial
fascia and partly deep to the deep fascia
AFFERENT: Temple Side of the scalp Lateral surface of the auricle External acoustic meatus
EFFERENT: Deep cervical nodes
PAROTID LYMPH NODEPAROTID LYMPH NODE
LOCATION: The buccal node lies on the buccinator.
AFFERENT: Cheek Lower eyelid
EFFERENT: anterosuperior group
of deep cervical nodes.
BUCCAL LYMPH NODEBUCCAL LYMPH NODE
LOCATION: in the submental triangle and on surface of
mylohoid muscle
AFFERENT: lower lip (middle part),
Chin, tip of tongue, Anterior gingiva Anterior floor of mouth
EFFERENT: Submandibular nodes, Jugulo-omohyoid nodes
SUBMENTAL LYMPH NODESUBMENTAL LYMPH NODE
LOCATION: Submandibular region, between the SM gland and medial surface of mandible
AFFERENT: Upper & lower lip (lateral part), Cheek medial canthus of eye soft palate, submental nodes SM salivary gland, Anterior 2/3rd of tongue Posterior floor of mouth, teeth
EFFERENT: Jugular group of nodes
SUBMANDIBULAR LYMPH NODESUBMANDIBULAR LYMPH NODE
Lymphatic drainage of scalp and ear• Anterior part of scalp pre-auricular lymph nodes
• Posterior part of scalp post-auricular (mastoid)
occipital lymph nodes
• External acoustic meatus,
middle ear and auditory tube deep parotid lymph nodes
TO SUMMARISETO SUMMARISE
• Upper part Preauricular Lymph nodes
• Middle part. Submandibular lymph nodes
• Lower part Submental lymph nodes
LYMPHATIC DRAINAGE OF FACE
LYMPHATIC DRAINAGE OF THE SUPERFICIAL TISSUES OF LYMPHATIC DRAINAGE OF THE SUPERFICIAL TISSUES OF THE HEAD AND NECKTHE HEAD AND NECK
Groups concerned are:
2) In the head: Occipital Retro-auricular (Mastoid), Parotid, Buccal (Facial)
2) In the neckSubmandibularSubmentalAnterior cervicalSuperficial cervical.
Lymphatic drainage of deep tissue of head and neck
• Head and neck tissues deep to deep fascia
Deep cervical lymph nodes
• Nasopharynx, pharyngotympanic membrane.
Retropharyngeal
• Trachea, oesophagus, thyroid
Paratracheal
Lymphatic drainage of mouth, teeth, tonsil, tongue
• Gingiva Submandibular lymph nodes
• Hard palate Superficial deep cervical • etropharyngeal
• Soft palate Retropharyngeal
• Floor of the mouth Submental (deep cervical) Submandibular LN
• Teeth Submandibular and deep cervical Submental lymph nodes• Tonsil Jugulodigastric nodes
• Tip Submental (deep cervical)
• Anterior 2/3rds Submandibular and
Deep cervical
• Posterior 1/3rd Jugulo-omohyoid lymph
nodes.
TONGUETONGUE
• Mucous membrane of nasal cavity
anterior part
• Posterior part Deep cervical
• Frontal and maxillary sinus Submandibular
• Sphenoid and ethmoid Retropharyngeal
Submandibular deep cervical LN
Lymphatic drainage of nasal cavity and paranasal sinus
DISEASES OF LYMPHATICS
LYMPHANGITISLYMPHANGITIS 1.Acute lymphangitis
2.Chronic lymphangitis
3.Neoplasms of lymphatics:
a. Benign neoplasms
1. Cystic Hygroma [Hydrocoele]
2. Lymphangioma
b.Malignant neoplasms:
i. Lymphangiosarcoma
ii. lymphoedema
1)primary lymphoedema
2)secondary lymphoedema
• LYMPHADENITIS: 1.Inflammatory -Acute lymphadenitis -Chronic lymphadenitis -Granulomatous lymphadenitis
a.Bacterial origin b.Viral origin c.Fungal origin2. Neoplastic:- Benign:- almost non existing -Malignant a. primary b.secondary3. Lymphatic leukaemias4. Autoimmune disorders
DISEASES OF LYMPH NODES
CAUSES OF LYMPHADENOPATHY
1 INFECTIVE:• Bacterial: Streptococcal, TB, brucellosis• Viral: Epstein-Barr, HIV• Protozoal: Toxoplasmosis• Fungal: Histoplasmosis
2 NEOPLASTIC:• Primary: Leukaemias, lymphomas• Secondary: eg. Lung, breast, thyroid, stomach
3 CONNECTIVE TISSUE DISORDERS:• Rheumatoid arthritis • SLE
4 SARCOIDOSIS
5 AMYLOIDOSIS
6 DRUGS:• Phenytoin
INVESTIGATIONS
1. CLINICAL EXAMINATION2. BLOOD3. ASPIRATION4. MONTOUX TEST5. GORDONS BIOLOGICAL TEST6. BIOPSY7. RADIOLOGICAL EXAMINATION8. LYMPHANGIOGRAPHY9. LAPROSCOPY10. IMAGING
• “If a node is palpable, it must be abnormal”
• Most lymph nodes should be examined by
extraoral, bimanual palpation from behind the
patient.
CLINICAL EXAMINATION OF THE LYMPH NODES
• Do not extend the neck since sternomastoid must be
relaxed.
• Use the pulp of the finger tips and try to roll the
gland against adjacent harder structures.
GENERAL PRINCIPLES
• Inspection
• Palpation
• Compare with contra lateral side
• Assess
1) Number
2) Site
3) Size
4) Consistency
5) Tenderness
6) Fixation
EXAMINATION OF LYMPHNODES
Pre-auricular lymph nodes
Examination of submandibular lymph nodes:
•Submandibular-, patients head tipped to the side being examined.
•Operator stands behind the patient.
Examination of submental lymph nodes
Submental- Tip the head forward and try to roll the node against the inner aspect of the mandible
Palpation of Posterior Cervical Nodes:
• Dorsal pads of the fingertips are used to palpate along the anterior surface of the trapezius muscle
• Then moved slowly in a circular motion toward the posterior surface of the SCM muscle
Palpation for Supraclavicular Lymph Nodes
• The examiners free hand is used to flex the patient’s head forward to relax the soft tissues of the anterior neck
• The fingers are hooked over the clavicle lateral to the SCM muscle
:
• Acute infection- large, soft, painful, mobile, discrete,
rapid onset.
• Chronic infection large, firm, less tender, mobile
• Lymphoma rubbery hard, matted, painless,
multiple
• Metastatic cancer Stony hard, fixed to the
underlying tissues, painless
• Syphilis (primary) Firm discrete shotty
• Tuberculosis-
• Stage I: Lymph nodes enlarged without matting
• Stage II: Lymph nodes enlarged with matting
• Stage III: Cold abscess
PALPABLE NODE CHARACTERISTICS
HODGKINS LYMPHOMA
C/F:- Painless and progressive enlargement of lymph node. cervical lymphadenopathy followed by axillary and inguinal lymph nodes - Spread of LN in contiguity ie., from 1 set of LN to next
Symptoms: Fever, chills, night sweat, wt. loss., Typical fever (pel-Ebstein fever) Pain in bones and abdominal pain Hepatosplenomegaly.
Diagnosis: Reed sternberg cells
Treatment : Radiotherapy, chemotherapy.
The 4 stages of Hodgkin’s lymphoma
1- Involvement of single lymph node or extra lymphatic organ
2- Involvement of 2 or more lymph nodes on same side of
diaphragm or extra lymphatic organ and one or more lymph tissue involvement on the same side.
3- Involvement of lymph nodes on both the sides of the diaphragm and/ or extra lymphatic organ
4- Diffuse involvement of one or more lymphatic organ or tissue
CYSTIC HYGROMA
It is a cystic swelling which contains multiple locules of clear lymph
DEVELOPMENT
Site Posterior triangle of neck Cheek, axilla, groin AGE It manifest in early infancy Occasionally present at birth
SYMPTOMSLump or swellingSwelling gives impulse on coughing Surface smooth/ lobulatedTranslucency Brilliant translucent swelling
TREATMENT Surgical excision
INFECTIOUS MONONUCLEOSIS
CAUSE EB virus, predominantly affect young adults Transmitted in saliva and aerosol
C/FFever, headache, sore throatGeneralised lymph node enlargement Splenomegaly
DIAGNOSIS• Lymphocytosis in the blood• Paul-bunnel test
BLOCK DISSECTION OF NECKBLOCK DISSECTION OF NECK
INDICATIONINDICATION
When the primary growth is operable, the primary growth
is adequately excised along with excision of the involved nodes
STRUCTURES REMOVED EN BLOCSTRUCTURES REMOVED EN BLOC
Submental, SM, upper and lower deep cervical group
Posterior cervical group and supraclavicular group.
Sternomastoid muscle
IJV
Spinal accessary nerve
Branches of ECA
1. Human physiology; Chatterjee, 10th Edition,.
2. Text of Medical Physiology; Arthur C.Guyton, 10th Edition, W.B. Saunders Company.
3. Text of Physiology and biochemistry; George H.Bell, 9th Edition,.
4. Gray’s Anatomy; Henry Gray, 38th Edition, Churchill Livingstone.
5. Cunningham’s Textbook of Anatomy, G.J. Romanes, 12th Edition, Oxford University Press.
6. www.google.com
REFERENCES