Lymphatic System & Cervical Lymph Nodes by Dr. Ashish jaiswal


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Lymphatic System & Cervical Lymph Nodes by Dr. Ashish jaiswal

  1. 1. 1<br />Dr. Ashish Jaiswal<br />
  2. 2. - Dr. Ashish K. Jaiswal<br />1st Year MDS<br />Public health Dentistry<br />Sibar Institute of Dental Sciences<br />Date – Monday 20th June 2011<br />Dr. Ashish Jaiswal<br />Lymphatic System &<br />The Cervical Lymph Nodes<br />
  3. 3. Contents<br />Introduction<br />Development<br />Lymphatic System<br />Immunology<br />Functions<br />Lymphatic Drainage<br />Examination<br />Lymphatic Diseases<br />Investigations<br />Management<br />Conclusion<br />3<br />Dr. Ashish Jaiswal<br />
  4. 4. LYMPHATIC SYSTEM<br />Definition :<br />Lymphatic system can be defined as closed system of channels through which the fluid is drained from interstitial spaces into the blood venous system via thoracic & right lymphatic duct.<br />4<br />Dr. Ashish Jaiswal<br />
  5. 5. Development<br />Derived from mesoderm<br />Begins developing at the end of 6th week of intrauterine life.<br />Originates from six lymph sacs:<br />Two Jugular<br />Two Ilial<br />One Retroperitonial<br />One Chyle Cistern<br />5<br />Dr. Ashish Jaiswal<br />
  6. 6. Lymphatic System<br />Lymphoid Organs<br />Lymphoid Tissue<br />Lymphatic Cells<br />Lymph<br />Lymph Nodes<br />Lymph Capillaries<br />Lymphatic Trunks<br />Lymphatic Ducts<br />6<br />Dr. Ashish Jaiswal<br />
  7. 7. Lymphatic System<br />Lymphoid Organs :<br />Spleen<br />Thymus<br />Tonsils <br />Lymph nodes<br />7<br />Dr. Ashish Jaiswal<br />
  8. 8. Spleen<br /><ul><li>It lies behind the stomach, high up on the left side of the abdomen, on a level with the 9th to 11th ribs.
  9. 9. Similar to a lymph node in shape and structure but is much larger.
  10. 10. It is the largest lymphatic organ in the body.</li></ul>Consists of two types of tissue called<br />White pulp & Red pulp<br />8<br />Dr. Ashish Jaiswal<br />
  11. 11. Function of Spleen<br />Filters blood<br />Stores blood <br />9<br />Dr. Ashish Jaiswal<br />
  12. 12. Thymus<br />Location : It is located in the anterior superior mediastinum, in front of the heart & behind the sternum.<br />Function : Function of the thymus is the processing and maturation of the undifferentiated lymphocytes into T-lymphocytes or T-cells, which are associated with antibody production.<br />10<br />Dr. Ashish Jaiswal<br />
  13. 13. 11<br />Dr. Ashish Jaiswal<br />
  14. 14. Tonsils<br />Cluster of lymphatic tissue just under the mucous membranes that line the nose, mouth, and pharynx (throat) called tonsils. <br />There are three groups of tonsils. 1. Pharyngeal tonsils 2. Palatine tonsils 3. Lingual tonsils<br />Provide protection against harmful substances and pathogens that may enter the body through the nose or mouth. <br />12<br />Dr. Ashish Jaiswal<br />
  15. 15. 13<br />Dr. Ashish Jaiswal<br />
  16. 16. Waldeyer’s Lymphatic Rings<br />Retropharyngeal Node<br />Jugulodigastric Node<br />Jugular Chain of Nodes<br />Submandibular Nodes<br />Submental Nodes<br /><ul><li>Pharyngeal Tonsil
  17. 17. Tubal Tonsil
  18. 18. Palatine Tonsil
  19. 19. Lingual Tonsil</li></ul>Inner Ring Outer Ring<br />14<br />Dr. Ashish Jaiswal<br />
  20. 20. Lymphatic Cells<br />15<br />Dr. Ashish Jaiswal<br />
  21. 21. Lymphatic Cells <br />T-cells (Thymus dependent)<br />Cytotoxic T-cells<br />Regulatory T-cells<br />Helper T-cells<br />Suppressor T-cells<br />Memory T-cells<br />B-cells (Bone marrow derived) <br />Plasma cells<br />Memory B-cells<br />NK cells (Natural Killer)<br />Dr. Ashish Jaiswal<br />
  22. 22. 17<br />Dr. Ashish Jaiswal<br />
  23. 23. Lymphatics<br />Lymph capillaries<br />Lymph vessels<br />Lymphatic trunks<br />Lymphatic ducts<br />18<br />Dr. Ashish Jaiswal<br />
  24. 24. Lymphatic channels<br />Lymph capillaries & vessels form the lymphatic channel.<br />Almost all body tissues have special lymphatic channels.<br />19<br />Dr. Ashish Jaiswal<br />
  25. 25. Lymphatic Channels<br />20<br />Dr. Ashish Jaiswal<br />
  26. 26. Lymph Capillaries :<br />Dead end<br />Thin walled with single layered endothelium<br />Numerous valves<br />21<br />Dr. Ashish Jaiswal<br />
  27. 27. LYMPH<br />Lymph is nothing but interstitial fluid that flows into the lymphatics channels.<br />It is a transparent, slightly yellow, often opalescent liquid.<br />22<br />Dr. Ashish Jaiswal<br />
  28. 28. LYMPH<br />Lymph composition :<br />96% water & 4% solids<br />When lymph 1st enters the terminal lymphatics, it has almost the same composition as the interstitial fluid <br />23<br />Dr. Ashish Jaiswal<br />
  29. 29. LYMPH<br />Soilds :<br />Protiens – The overall protein concentration comes to 3-5g/dl<br />24<br />Dr. Ashish Jaiswal<br />
  30. 30. LYMPH<br />Soilds(cont.) :<br />Lipids<br />Carbohydrate<br />Nitrogenous substances<br />Electrolyte<br />Foreign bodies<br />25<br />Dr. Ashish Jaiswal<br />
  31. 31. LYMPH<br />Cellular composition of lymph<br />Mostly contains lymphocytes<br />Normal lymphocyte count of lymph is 1000-2000/cumm<br />Monocyte, macrophages & plasma cells are occasionally present.<br />26<br />Dr. Ashish Jaiswal<br />
  32. 32. LYMPH<br />Total quantity of lymph is 2-3 liters<br />120ml of lymph flows into blood per hour<br />Lymphatic flow determined by<br />Interstitial fluid pressure<br />Activity of lymphatic trunk<br />27<br />Dr. Ashish Jaiswal<br />
  33. 33. Functions of Lymph<br />Return of proteins<br />Redistribution of body fluid<br />Removes foreign bodies<br />Maintenance of structural & functional integrity of tissue<br />28<br />Dr. Ashish Jaiswal<br />
  34. 34. Lymph Nodes<br />Lymph nodes are small glands that are interposed during the course of lymph vessels.<br />29<br />Dr. Ashish Jaiswal<br />
  35. 35. Structure of Lymph Node<br />30<br />Dr. Ashish Jaiswal<br />
  36. 36. Lymph Nodes<br />Functions of lymph nodes<br />Filtration<br />Removal of foreign bodies<br />31<br />Dr. Ashish Jaiswal<br />
  37. 37. Lymph Nodes of the Head & Neck<br />32<br />Dr. Ashish Jaiswal<br />
  38. 38. Lymph Nodes of the Head & Neck<br />The entire lymph from the head and neck drains ultimately into the deep cervical nodes either directly or through the peripheral nodes.<br />Deep Cervical Lymph Nodes :<br />The deep cervical nodes form a vertical chain situated along the entire length of the internal jugular vein.<br />For descriptive purpose they are grouped as<br />Antero superior<br />Anteroinferior<br />Posterosuperior and<br />Posteroinferior<br />33<br />Dr. Ashish Jaiswal<br />
  39. 39. Jugulodigastric Node<br />Location : The jugulodigastric node is a member of the antero-superior group. <br />Drainage :It is the main node draining the tonsil. <br />34<br />Dr. Ashish Jaiswal<br />
  40. 40. Jugulo-Omohyoid Node<br />Location : The jugulo-omohyoidnode is a member of the postero-inferior group.<br />Drainage : It is the main lymph node of the tongue<br />35<br />Dr. Ashish Jaiswal<br />
  41. 41. Path of Deep Cervical lymph Nodes<br />36<br />Dr. Ashish Jaiswal<br />
  42. 42. Peripheral Cervical lymph Nodes<br />The peripheral nodes are arranged in two circles,<br />1. Superficial and <br />2. Deep<br />The superficial circle of cervical lymph nodes is made up of the following groups:<br />(1) Submental<br />(2) Submandibular<br />(3) Buccaland mandibular(facial0<br />(4) Preauricular(parotid)<br />(5) Postaurtcular (masloicl)<br />(6) Occipital<br />(7) Anterior cervical<br />(8) Superficial cervical<br />37<br />Dr. Ashish Jaiswal<br />
  43. 43. Peripheral Cervical lymph Nodes<br />The deep (inner) circle of cervical lymph nodes includes the followtng –<br />(1) Prelaryngeal and pretracheal<br />(2) Paratracheal and<br />(3) Retropharyngeal nodes. <br />38<br />Dr. Ashish Jaiswal<br />
  44. 44. Lymph Nodes<br />Each lymph node is described under the following heads –<br />Location/Position<br />Drainage<br />Efferents<br />39<br />Dr. Ashish Jaiswal<br />
  45. 45. Submental Lymph Node<br />Location :<br />Submental Lymph Node<br />40<br />Dr. Ashish Jaiswal<br />
  46. 46. Submental Lymph Node<br />Drainage :<br />Superficial tissues below the chin<br />Central part of the lower lip<br />Lower incisors & gingiva<br />Anterior part of the floor of the mouth<br />Tip of the tongue<br />Mucous membrane of the lip & cheek<br />Efferent : Their efferent pass to the submandibular nodes<br />41<br />Dr. Ashish Jaiswal<br />
  47. 47. Submandibular Lymph Node<br />Location : <br />Submandibular Lymph node<br />42<br />Dr. Ashish Jaiswal<br />
  48. 48. Submandibular Lymph Node<br />Drainage :<br /> Upper & lower teeth & gingiva (except mandibular incisor)<br />Anterior nasal cavity<br />Palate<br />Body of the tongue<br />Upper lip<br />Lateral angle of the eye<br />Submental nodes<br />Efferents : Their efferent drains into the deep cervical nodes<br />43<br />Dr. Ashish Jaiswal<br />
  49. 49. Buccal & Mandibular Lymph Nodes<br />Location :<br />Buccal lies on the buccinator<br />Mandibular lies on the lower border of the mandible<br />Drainage :<br />Part of the cheek, lip & lower eyelid<br />Mucous membrane over the mandible<br />Efferents :<br />Their efferents pass to antero-superior group of deep cervical lymph node<br />44<br />Dr. Ashish Jaiswal<br />
  50. 50. Pre-auricular Lymph Node<br />Location : <br />Pre-auricular<br />Lymph Nodes<br />45<br />Dr. Ashish Jaiswal<br />
  51. 51. Pre-auricular Lymph Node<br />Drainage :<br />The temple<br />Side of the scalp<br />Lateral surface of the auricle<br />Middle ear<br />Parotid gland<br />Upper part of cheek<br />Parts of the eyelid & orbit<br />Efferents :<br />They pass to upper group of deep cervical nodes<br />46<br />Dr. Ashish Jaiswal<br />
  52. 52. Posterior-auricular ( Mastoid ) Node<br />Location : <br />Posterior-auricular Lymph Nodes<br />47<br />Dr. Ashish Jaiswal<br />
  53. 53. Posterior-auricular ( Mastoid ) nodes<br />Drainage : <br />They drain a strip of scalp just above and behind the auricle,<br />the upper half of the medial surface and margin of the auricle and <br />posterior wall of the external acoustic meatus<br />Efferents : Efferents pass to the postero superior group of deep cervical nodes. <br />48<br />Dr. Ashish Jaiswal<br />
  54. 54. Occipital Nodes<br />Location : <br />Occipital Lymph Node<br />49<br />Dr. Ashish Jaiswal<br />
  55. 55. Occipital nodes<br />Drainage : They drain the occipital region of the scalp.<br />Efferents : Efferentspass to the supra-clavicular members of the postero-inferior group of deep cervical nodes. <br />50<br />Dr. Ashish Jaiswal<br />
  56. 56. Superficial Cervical Nodes<br />Location : <br />Superficial Cervical Lymph Node<br />51<br />Dr. Ashish Jaiswal<br />
  57. 57. Superficial Cervical Nodes<br />Drainage : They drain <br />the lobule of the auricle,<br />the floor of the external acoustic meatus,<br />and the skin over the lower parotid region and the angle of the jaw.<br />Efferents : Efferentspass to the upper and lower deep cervical nodes<br />52<br />Dr. Ashish Jaiswal<br />
  58. 58. Deep Cervical Lymph Nodes<br />Prelaryngeal and pretracheal<br />Paratracheal and<br />Retropharyngeal nodes. <br />53<br />Dr. Ashish Jaiswal<br />
  59. 59. Prelaryngeal and Pretracheal Nodes<br />Location :<br />Prelaryngeal and Pretracheal Nodes<br />54<br />Dr. Ashish Jaiswal<br />
  60. 60. Prelaryngeal and PretrachealNodes<br />Drainage : <br />The larynx,<br />The trachea <br />Isthmus of the thyroid.<br />Efferents : Their efferent to the nearby deep cervical nodes. <br />55<br />Dr. Ashish Jaiswal<br />
  61. 61. Paratracheal Nodes<br />Location :<br />Paratracheal Lymph Node<br />56<br />Dr. Ashish Jaiswal<br />
  62. 62. Paratracheal Nodes<br />Drainage : They receive lymph from the oesophagus, trachea & larynx<br />Efferents : Efferents pass to the deep cervical nodes<br />57<br />Dr. Ashish Jaiswal<br />
  63. 63. Retropharyngeal Nodes<br />Location :<br />Retropharyngeal nodes<br />58<br />Dr. Ashish Jaiswal<br />
  64. 64. Retropharyngeal Nodes<br />Drainage : <br />The pharynx,<br />The auditory tube,<br />Soft palate, <br />The posterior part of the hard palate,<br />The nose. <br />Efferents : Their efferents pass to the upper deep cervical nodes.<br />59<br />Dr. Ashish Jaiswal<br />
  65. 65. Main Lymphatic Trunks of the Neck<br />60<br />Dr. Ashish Jaiswal<br />
  66. 66. Thoracic Duct<br />Thoracic duct is the largest lymph trunk of the body.<br />It begins in the abdomen from the upper end of the cisternachyli, traverses the thorax, and ends on the left side of the root of the neck by opening into angle of junction between the left internal jugular the left subclavianvein.<br />Before its termination, it forms an arch at the level of the transverse process of vertebra C7 rising 3 to 4 cm above the clavicle.<br />61<br />Dr. Ashish Jaiswal<br />
  67. 67. Receives lymph from :<br />(1) Its tributaries in abdomen & thorax<br />(2) The left jugular trunk<br />(3) the left subclaviantrunk and<br />(4) the left bronchomediastinal trunk.<br /><ul><li>Drainage : It drains most of the parts of the body except for the right upper limb, the right halves of the head & neck and the thorax and the superior surface of the liver. </li></ul>62<br />Dr. Ashish Jaiswal<br />
  68. 68. Other Trunks<br />Right Jugular Trunk : It drains half of the head and neck. <br />Right SubclavianTrunk : It drains the upper limb. <br />Bronchomediastinal Trunk : It drains the lung, half of the mediastinum and parts of the anterior walls of the thorax and abdomen. <br />63<br />Dr. Ashish Jaiswal<br />
  69. 69. 64<br />Dr. Ashish Jaiswal<br />
  70. 70. 65<br />Dr. Ashish Jaiswal<br />
  71. 71. Main Lymphatic Trunks <br />left jugular trunk<br />right jugular trunk<br />left subclavian trunk<br />right subclavian trunk<br />left bronchomediastinal trunk<br />right bronchomediastinal trunk<br />right lumbar trunk<br />left lumbar trunk<br />intestinal trunk<br />66<br />Dr. Ashish Jaiswal<br />
  72. 72. Main Lymphatic Trunks <br />67<br />Dr. Ashish Jaiswal<br />
  73. 73. Examination of Lymph Nodes<br />Inspection<br />Position<br />Number<br />Pressure effect<br />Palpation<br />Position<br />Number<br />Local temperature<br />Surface<br />Margin<br />Consistency<br />68<br />Dr. Ashish Jaiswal<br />
  74. 74. Examination<br />Principles of Palpation<br />Patient’s back erect<br />Stand behind the patient<br />Patient’s chin tipped slight <br /> toward chest<br />Palmer aspect of finger tips<br />Maintain slight pressure<br />69<br />Dr. Ashish Jaiswal<br />
  75. 75. 70<br />Dr. Ashish Jaiswal<br />
  76. 76. Examination<br />Sequence to palpate cervical lymph nodes <br />Begin with the most superior nodes & work down to clavicle<br />Anterior to tragus of the ear for pre-auricular node <br />Then mastoid & base of the skull for posterior auricular & occipital nodes<br />Under the chin for submental nodes<br />Then proceed further to palpate submandibular & sublingual lymph node<br />71<br />Dr. Ashish Jaiswal<br />
  77. 77. Examination<br />Examination of deep cervical lymph nodes –<br />To examine ask the patient to sit erect & them turn the head to one side to relax sternocliedomastoid muscle, use thumb & finger to palpate under the anterior 7 posterior border of relaxed muscle & repeat on other side.<br />72<br />Dr. Ashish Jaiswal<br />
  78. 78. Causes of Enlargement of Lymph Node<br />Inflammatory <br />Acute or chronic lymphaditis<br />Infection <br />Tuberculosis<br />Filariaris<br />Secondary syphilis<br />Infectious mononucleosis<br />Brucellosis<br />Neoplastic<br />Carcinoma<br />Sarcoma <br />Haematological<br />Hodgkins disease<br />Non-hodgkins lymphoma<br />Chronic lymphatic leukemia<br />Immunological<br />Aids<br />Drug reaction<br />Systemic lupus erythromatosus<br />Rheumatoid arthritis<br />73<br />Dr. Ashish Jaiswal<br />
  79. 79. Diseases of Lymphatic System<br />Lymphadenopathy<br />It is any disease of the lymph nodes<br />Lymphadenitis<br />It is the inflammation of one or more lymph nodes<br />Lymphadenocele<br />It the cyst of the lymph node<br />Lymphangiophlebitis<br />Inflammation of the lymphatic channels<br />Lyphatitis<br />Inflammation of some part of lymphatic system<br />Lymphadema<br />Chronic swelling of a part due to accumulation secondary to the obstruction of the lymphatic vessels or lymph node<br />Lymphogranuloma<br />Systemic infection leading to acute lymphadenopathy<br />74<br />Dr. Ashish Jaiswal<br />
  80. 80. Lymphatic Disease<br />Lymphoma<br />Any neoplastic disorder of lymphoid tissue <br />Lymphoblastoma<br />Poorly differentiated lymphocytic malignant lymphoma<br />Lymphoepithelioma<br />A pleomorphic poorly differentiated carcinoma arising from epithelium overlying lymphoid tissue<br />Lymphocytoma<br />Well differentiated lymphocytic malignant lymphoma<br />Lymphadenoma<br />It is a type of lymphoma<br />Lymphangioma<br />It is tumor of the newly formed lymph spaces & channels <br />75<br />Dr. Ashish Jaiswal<br />
  81. 81. Infections of Oral Cavity / Oral Sepsis<br />76<br />Dr. Ashish Jaiswal<br />
  82. 82. Lymph Node involvement<br />77<br />Dr. Ashish Jaiswal<br />
  83. 83. Infections of Oral Cavity / Oral Sepsis<br />Following are the various infectectious diseases of the oral cavity -<br />78<br />Dr. Ashish Jaiswal<br />
  84. 84. Oral Sepsis<br />PeriapicalOsteitis :<br />Bacteria from the necrotic pulp invade the marrow spaces of bone in the periapical region & causes inflammation leading to periapicalostitis.<br />Cellulitis :<br />It is defined as the as a non-suppurative inflammation of the subcutenious tissue extending along the connective tissue & the intercellular spaces<br />79<br />Dr. Ashish Jaiswal<br />
  85. 85. Oral Sepsis<br />Absecss :<br />It is a localised collection of pus, surrounded by an area of inflamed tissue in which hypermia & infiltration of of leukocytes occurs.<br />Acute Periapical Abscess :<br />It is the collection of pus in the alveolar bone, at the root apex of the tooth, following death of the pulp.<br />80<br />Dr. Ashish Jaiswal<br />
  86. 86. Oral Sepsis<br />Peridontal abscess :<br />It is the collection of pus in the periodontium usually as a result of chronic peridontitis.<br />Acute Apical Perodontitis :<br />It is caused when inflammatory degradation products from the infected pulp penetrate periodontal ligament<br />81<br />Dr. Ashish Jaiswal<br />
  87. 87. Oral Sepsis<br />Pericoronal Abscess :<br />Also called as pericoronitis<br />Caused by infection of the surrounding soft tissues of a partially erupted or impacted tooth <br />Folliculitis :<br />It is caused when follicle of developing succedaneous teeth may become infected when their primary predecessord develop chronic perapical abscess<br />82<br />Dr. Ashish Jaiswal<br />
  88. 88. Oral Sepsis<br />Ludwigs Angina :<br />It is defined as rapidly spreading septic cellulitis involving the submandibular, submental & sublingual spaces.<br />Facial Spaces Infections :<br />They are the spaces situated between the planes of fascia in which infection may spread.<br />Osteomylitis :<br />It can be defines as inflammatory condition of the bone that begins as an infection of medullary cavity & the haversian system & extents to involve the periosteum of the affected area.<br />83<br />Dr. Ashish Jaiswal<br />
  89. 89. Investigations<br />Complete Blood Count<br />Chest Radiography<br />Serological investigation<br />Nodal Biopsy<br />Fine Needle Biopsy<br />Bone Marrow Aspiration<br />C. T. Scan<br />M.R.I <br />Lymphography<br />84<br />Dr. Ashish Jaiswal<br />
  90. 90. Management<br />Conventional<br />Diuretics<br />NSAID’s<br />Antibiotics<br />Lymphatic Drainage Therapy<br />Surgical : Neck Dissection<br />Radiotherapy<br />Chemotherapy<br />85<br />Dr. Ashish Jaiswal<br />
  91. 91. Conclusion<br />Knowledge of regional lymph nodes is important to prognosticate the probable involvement certain lymph nodes if the site of tumor or infection is known.<br />Conversely the knowledge of regional lymph nodes permits the diagnosis of an obscure site of a pathological process if a lymph node or group of lymph node is found diseased.<br />86<br />Dr. Ashish Jaiswal<br />
  92. 92. Role of Pubic Health Dentist<br />As public health dentists are the closest to the public – to the population, they should understand the lymphatic system & their diseases so as to identify them while general clinical examination in field studies & advice/perform necessary basic treatment & refer them for specific treatment.<br />87<br />Dr. Ashish Jaiswal<br />
  93. 93. References<br />B.D. Chaurasia : Human Anatomy, Regional And Applied Dissection And Clinical 4th Edition<br />Bhatnagar Et Al : Essential Of Human Embryology 3 rd edition<br />Das S : A Manual On Clinical Surgery, <br />Davidson : Principles And Practice Of Medicine.<br />Gray’s Anatomy.<br />InderbirSingh : Textbook Of Anatomy With Color Atlas.<br />Martini : Textbook of Anatomy<br />William G. Shafer Et Al : Textbook Of Oral Pathology.<br />Sembulingam : Text book medical physiology<br />Wikipedia – Lymphatic system & lymph nodes<br />Google Images<br />88<br />Dr. Ashish Jaiswal<br />
  94. 94. Thank You<br />89<br />Dr. Ashish Jaiswal<br />