Lymph

• Lymphatic System

  Part of the immune system that consists of vessels, nodes, ducts, and tonsils
• Lymphatic Vessels

  • Parallel the venous blood vessels, twice as many vessels, tissue fluid drains from surrounding region as lymph

  
• Lymph Flow

  Lymph flows into the lymph node by way of afferent vessels, flows out by way of a single efferent vessel, valves prevent backwards flow
• Lymph Nodes

  • Found throughout the body, connected in chains, help remove toxins
• Lymphatic Ducts

  • Right lymphatic duct, thoracic duct, all drain into venous system

  
• Lymphadenopathy

  Increase in size and change in consistency of lymphoid tissue in response to disease process such as cancer or infection
• Infectious Mononucleosis

  Caused by Epstein-Barr virus, frequently causes pharyngitis and inflamed palatine tonsils with exudate in teenagers and young adults
• Lymph Node Pathology in Cancer

  • Nodes can become bony hard, not painful, and possibly fixed to surrounding tissue, structures, and organs as cancer grows and spreads
• Lymph Node Pathology in Infection

  • Usually tender to palpation, enlarged, some pain
• Superficial Lymph Nodes of Head

  • Occipital, posterior auricular, anterior auricular, superficial parotid, facial lymph nodes

  
• Occipital Lymph Nodes

  1 to 3 in number, drain part of the scalp, empty into deep cervical nodes

  
• Drainage for Lymph Nodes of Head

  Right side drains to right lymphatic duct, left side and most of body drains into thoracic duct, all drains into venous system

  
• Examining Occipital Lymph Nodes

  Have patient lean head forward, palpate bilaterally at base of head

  
• Posterior Auricular Lymph Nodes

  1 to 3 in number, located posterior to each external acoustic meatus, drain external ear, lacrimal gland and adjacent areas, drain to deep cervical nodes

  
• Anterior Auricular Lymph Nodes

  1 to 3 in number, located immediately anterior to each tragus, drain external ear, lacrimal gland, and adjacent scalp and face, drain to deep cervical

  
• Superficial Parotid Lymph Nodes

  Up to 10 in number, just superficial to each parotid salivary gland, drain external ear, lacrimal, and scalp and face, drain to deep cervical nodes

  
• Examining Posterior Auricular, Anterior Auricular, and Superficial Parotid Lymph Nodes

  Bilaterally palpate these nodes, as well as the face and scalp anterior to and around each auricle

  
• Facial Lymph Nodes

  Up to 12 in number, superficially located along the facial vein, 4 subgroups: malar, nasolabial, buccal, mandibular

  
• Nasolabial Lymph Nodes

  Nodes located along the nasolabial sulcus

  
• Drainage for Facial Lymph Nodes

  Drain from one to the other in a superior to inferior fashion, then drain into deep cervical nodes by way of submandibular nodes
• Deep Lymph Nodes of Head

  Cannot usually be palpated during extraoral examination due to increased depth, include deep parotid and retropharyngeal lymph nodes, all drain into deep cervical nodes

  
• Deep Parotid Lymph Nodes

  Up to 10 in number, located deep within the parotid salivary gland, drain middle ear, auditory tube, parotid salivary gland
• Retropharyngeal Lymph Nodes

  Up to 3 in number at level of first cervical vertebra, posterior to palate, pharynx, paranasal sinuses, nasal cavity, drain to deep cervical nodes

  
• Superficial Cervical Lymph Nodes

  • Submental, submandibular, external jugular, anterior jugular lymph nodes

  
• Submental Lymph Nodes

  2 to 3 in number, located inferior to chin within submental fascial space and submental triangle, near midline inferior to mandibular symphysis in suprahyoid region, superficial to mylohyoid muscle

  
• Submandibular Lymph Nodes

  3 to 6 in number, located at inferior border of mandibular ramus, just superficial to submandibular salivary gland, within submandibular fascial space

  
• Submandibular Lymph Nodes: Drainage

  Drain cheeks, upper lip, body of tongue, anterior hard palate, all teeth except mandibular incisors and maxillary third molars
• Drainage for Superficial Cervical Lymph Nodes

  Drain to deep cervical nodes
• Lymph node

  Incipient drainage to the skin
• Teeth drainage

  Primary to submandibular lymph node, secondary to deep cervical lymph node
• Odontogenic infection spread

  Spread first into sublingual space, then possibly to other spaces
• Submandibular lymph nodes

  • Primary nodes for most teeth and associated tissue, except for maxillary third molars and mandibular incisors

  
• External jugular lymph nodes

  1 to 2 in number, located on each side of the neck along the external jugular vein, superficial to the SCM muscle

  
• Anterior jugular lymph nodes

  Located on each side of the neck along the length of the anterior jugular vein, anterior to the SCM muscle, as well as between the superficial layer of deep cervical fascia and the infrahyoid muscles

  
• Examining external and anterior jugular lymph nodes

  Have patient turn head to contralateral side, palpate nodes superficially on each side of SCM muscle to clavicle

  
• Deep cervical lymph nodes

  Omohyoid is landmark dividing superior and inferior deep cervical nodes

  
• Superior deep cervical lymph nodes

  Located deep beneath SCM muscle, superior to omohyoid

  
• Jugulodigastric lymph node/tonsillar node


  One node of superior deep cervical nodes that becomes palpable with tonsillar enlargement

  
• Examining deep cervical lymph nodes

  Palpate on underside of both anterior and posterior aspects of SCM muscle, start at angle of mandible and continue down to clavicle

  
• Superior deep cervical lymph nodes

  Primary nodes draining posterior nasal cavity, posterior hard palate, soft palate, base of tongue, maxillary third molars, TMJ, esophagus, trachea, thyroid gland