Lymphatics of Head & Neck

8/13/2019 Lymphatics of Head & Neck

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OR L SURGURY PROJECT


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Name-Pranoy Dutta

Roll No.-03

Registration No.-2312 for 20010-11


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The lymphatic systemrepresents an accessory rootthrough which fluid can flowfrom the interstitial spacesinto the blood.It is auxillary to

the venous system. Lymphatic system helps in

carry proteins and largemolecules which cannot beremoved by direct absorption

of the blood capillaries.


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The main function of the lymphatic system is tocollect and transport tissue fluids from theintercellular spaces in all the tissues of the body,back to the veins in the blood system.

It helps in returning plasma proteins to thebloodstream.

Lymphocytes are produced in the lymph nodeswhich provide the body an affective immunity byreleasing antibody against infectious diseases.

They filter out micro-organisms (such as bacteria)and foreign substances such as toxins, etc.

It transports large molecular compounds (proteinenzyme hormones) from the interstitial space tothe bloodstream.


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Small amount protein leak into the interstitial space which

return to the circulation by venous end capillaries.

But after a certain limit protein tend to accumulate in the

interstitial fluid which in turn increase colloidal osmotic

pressure.

In increased osmotic pressure fluid tends to accumulate in

the interstitial space from blood capillary ;cause increased

pressure and volume of interstitial fluid.

Thus excess interstitial fluid pressure greatly increase the

rate of lymph flow which carries away excess interstitial

fluid and proteins.

Overflow Mechanism


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Lymph-Lymph is a fluid similar in composition to blood plasma. It isderived from blood plasma as fluids pass through capillary walls at thearterial end. As the interstitial fluid begins to accumulate, it is picked up andremoved by tiny lymphatic vessels and returned to the blood. As soon as theinterstitial fluid enters the lymph capillaries, it is called lymph.

Lymphocytes- B-lymphocytes (B-cells) mature in the bone marrow. T-lymphocytes (T-cells) mature in the thymus gland

Lymphatic vessel- Lymphatic vessels, unlike blood vessels, only carryfluid away from the tissues. The smallest lymphatic vessels are the lymph

capillaries, which begin in the tissue spaces as blind-ended sacs.

Lymphoid organs- The lymphatic organs include:

1. Lymph Nodes2. Tonsils

3. Spleen

4. Thymus


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Lymph is a fluid similar in composition toblood plasma. It is derived from theinterstitial fluid that flows into thelymphatic's. As the interstitial fluid beginsto accumulate, it is picked up and

removed by tiny lymphatic vessels andreturned to the blood. As soon as theinterstitial fluid enters the lymphcapillaries, it is called lymph. Returningthe fluid to the blood prevents oedema

and helps to maintain normal bloodvolume and pressure.

Rate of lymph flow:2-3 liter per day


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Lymphatic vessels only carry fluidaway from the tissues. The smallestlymphatic vessels are the lymphcapillaries, which begin in the tissuespaces as blind-ended sacs. Lymphcapillaries are found in all regions ofthe body except the bone marrow,

central nervous system, and tissues,such as the epidermis, that lack bloodvessels.

The wall of the lymph capillary iscomposed of endothelium in whichthe simple squamous cells overlap toform a simple one-way valve. Thisarrangement permits fluid to enter thecapillary but prevents lymph fromleaving the vessel.


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Lymphatic organs are characterized by clusters oflymphocytes and other cells, such as macrophages,enmeshed in a framework of short, branching connectivetissue fibers. The lymphocytes originate in the red bonemarrow with other types of blood cells and are carried inthe blood from the bone marrow to the lymphatic organs.

When the body is exposed to microorganisms and otherforeign substances, the lymphocytes proliferate within thelymphatic organs and are sent in the blood to the site ofthe invasion. This is part of the immune response thatattempts to destroy the invading agent.

The lymphatic organs include:

1. Lymph Nodes2. Tonsils3. Spleen4. Thymus


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Circular chain of lymph nodesOccipital Postauricular Preauricular Parotid Facial

Position Betweenmastoidprocess andexternaloccipitalprotuberance

On the

mastoidprocess,superficial tothe attachment of sternocleiomastoid

Just in front

of the tragussuperficial totheparotidomasseteric fascia.

In the

substace ofthe parotidgland

a)sup.-

supramandibularBuccinatorInfraorbitalb)Deep-nearmax artery nearlat pterygmuscle

Drainingarea

Part of theoccipitalregion

Temporalregionalscalp,back ofthe pinna,Externalauditorymeatus.

Anteriorsurface ofthe pinnaand side ofthe scalp.

Eyelid,scalp,ex aud meatus,deep nose,nasopharynx,tympaniccavity

Sup.-Conjunctiva,eyelid,nose,cheek.Deep-Back ofthenose,pharynx,temporalfossa,infratemporal fascia.


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nteriorcervical Submental Submaxillary SuperiorcervicalPosition Sup.-Near ant

jugular veinDeep-Infrahyoid,

PrelaryngealPretracheal

In the submentaltriangle.

In the submaxillarytriangle nearsubmaxillary

salivary gland.

Around theexternal jugularvein,on theexternal surface

of thesternocleidomastoid.

Drainingarea

Sup-It drains theskin of theneck.Deep-It drains

the larynxthyroid glandand trachea.

Central part ofthe lip,floor ofthe mouth,tip ofthe tongue.

Inner angle ofthe eye,side ofthe nose,holeupper lip,

cheeck,gum,Side of thetongue.

The parotidregion and lowerpart of the ear.


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Efferent from the circular chain drains into the deepcervical lymph nodes except facial and submental whichdrains into the submaxillary lymph nodes.

JuguloDigastric JuguloOmohyoidPosition Below the

posterior ballyof digastricbetween theangle of themandible andant border of

sternocleidomastoid.

Lies above theinferior bally ofomohyoid,behind the

jugular veinundercover thesternocleidomas

toid.

Group Antero-superiorgroup

Postero-inferiorgroup


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Waldeyer's tonsillar ring isan anatomical termcollectively describingthe annular arrangementof lymphoid tissue in

the pharynx. Waldeyer'sring circumscribesthe naso-and oropharynx, withsome of its tonsillar tissue

located above and somebelow the soft palate (andto the back of the oralcavity).


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The status of the regional lymphatic's is one of themost important prognostic indicators inpatients with head and neck cancer. HNSCCs thatare localized to the primary site withoutregional lymph node metastasis have excellent

cure rates with either surgery or radiationtherapy. The presence of regional metastasesresults in cure rates that are approximately halfof those obtainable if metastasis to the regionallymphatic's is not present. Thus the

treatment of the neck has become one of the mostactively debated topics in the field of headand neck oncology.


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Cervical lymphadenopathy refers to lymphadenopathy of the cervical lymphnodes (the glands in the neck). Causes are:1. Rubella

2. Cat scratch fever3. Infectious mononucleosis4. Streptococcal pharyngitis

5. Viral respiratory infection6. Toxoplasmosis7. Tuberculosis8. Brucellosis9. Primary herpes simplex infection10. syphilis(secondary)11. Cytomegalovirus

12. HIV13. Histoplasmosis14. chicken pox15. Malignancy


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Mycobacterial cervicallymphadenitis, alsoknown as scrofula,refers to

a lymphadenitis of thecervical lymph nodesassociatedwith tuberculosis as

well as nontuberculous (atypical)mycobacteria.


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Tonsillitis is inflammation ofthe tonsils most commonly caused by viralor bacterial infection.

Common sign & symptoms are:

sore throat

red, swollen tonsils

pain when swallowing high temperature (fever)

coughing

headache

tiredness

chills

a general sense of feeling unwell (malaise) white pus-filled spots on the tonsils

swollen lymph nodes (glands) in the neck

pain in the ears or neck


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Peritonsillarabscess (PTA), also known asa quinsy is a recognized complicationof tonsillitis and consists of a collectionof pus beside the tonsil in what is referred toas Peritonsilar space.

Sign & symptomps are:

Severe unilateral pain in the throat;

Pyrexia above 103 degree F (39C); Unilateral Earache;

Odynophagia and difficulty swallowingsaliva;

Change in voice muffled voice, hotpotato voice;

Intense salivation and dribbling, Thickenedspeech, Foetor oris, Halitosis;

Pain in the neck;

Malaise, Headache, Rigor


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Lymphadenectomy or lymphnodedissection is thesurgical removal of one ormore groups of lymphnodes. It is almost alwaysperformed as part ofthe surgical management

of cancer. In a regionallymphnodedissection,some of the lymph nodesin the tumor area areremoved; in a radicallymphnodedissection, most or allof the lymph nodes in the

tumor area are removed


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The neckdissection is a surgical procedure forcontrol of neck lymph node metastasis. This canbe done for clinically or radiologically evidentlymph nodes or as part of curative surgery whererisk of occult nodal metastasis is deemedsufficiently high. The aim of the procedure is toremove lymph nodes from the neck into which

cancer cells may have migrated. Metastasis oftumours into the lymph nodes of the neck is one ofthe strongest prognostic indicators for head andneck cancer. The metastases may originate fromtumours of the upper aerodigestive tract, includingthe oral cavity, tongue, nasopharynx, oropharynx,

hypopharynx, and larynx, as well asthe thyroid, parotid and posterior scalp. Necknodal metastasis can sometimes also originatefrom lung cancer or intra-abdominal malignancy.However, neck dissection is rarely performed forsuch purposes.


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A lymph node biopsy is theremoval of lymph nodetissue to be looked at undera microscope for signs ofinfection or a disease, suchas cancer.

There are several ways to doa lymph node biopsy. Suchas:

1. Fine-needleaspiration biopsy.

2. Core needle biopsy.

3. Open (surgical) biopsy.


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We know that our oral cavity is thegateway of our entire system and aswell as the gateway of variousinfections. So the lymphatics of head& neck region is far more importantthen any other part of the body. Abrief knowledge of lymphatics of thehead and neck help us to detect ahuge spectrum of clinicalmanifestation as well as control andprevention of any disease.Lymphatic's of head and neck has avery major roll in metastasis of oral

cancers. Thats why the anatomy andphysiology of the lymph nodes ofhead & neck should be cleared.


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Acknowledgment1. Head & Neck Anatomy: A K D

2. Greys Anatomy

3.

Wikipedia4. www.bartleby.com

5. Oral Surgery: N A Malik

Lymphatics of Head & Neck

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