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Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy
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Lymphatic & venous system of head and neck /certified fixed orthodontic courses by Indian dental academy

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The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.

Indian dental academy provides dental crown & Bridge,rotary endodontics,fixed orthodontics,
Dental implants courses.for details pls visit www.indiandentalacademy.com ,or call
0091-9248678078

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  • 1. INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • 2. www.indiandentalacademy.com
  • 3. LYMPHATIC & VENOUS SYSTEM OF HEAD AND NECK Moderator Dr David Tauro Presenter Dr Mahantesh.S www.indiandentalacademy.com
  • 4. CONTENTS Development of lymphatic system  Lymph fluid  Lymph node  Lymphatic vessels  Functions of lymphatic system  Classification Diagnosis of Lymphadenopathy Conclusion  References www.indiandentalacademy.com
  • 5. WHY LYMPHATIC SYSTEM ? www.indiandentalacademy.com
  • 6. LYMPHATIC SYSTEM  This system was described after the other parts of vascular system are already known.  The reason for this delay is their delicate and transparent appearance. www.indiandentalacademy.com
  • 7. EMBRY0LOGY OF LYMPHATIC SYSTEM      Lymph sacs -appear between 2 nd to 6 th week of IUL. 7 th week - jugular channel spread to connect with subclavin lymph sacs. 9 th week - thoracic duct is continuous channel draining into IJ -subclavin vein junction. 12 th week- all process are complete. 5 th month - valves begins to start. www.indiandentalacademy.com
  • 8. DEVELOPMENT OF LYMPH NODE   Jugular, lymph saccules and Peritoneal lymph saccules Invasion of neighboring Mesenchymal cells so called lymph sinuses evolve intra nodally. www.indiandentalacademy.com
  • 9. LYMPHATIC SYSTEM contents Cells, Organs Vessel Lymph fluid . lymphoid organ Primary / central Thymus and bone marrow Secondary / peripheral Spleen, tonsil and lymph node www.indiandentalacademy.com
  • 10. LYMPH FLUID Definition Transparent,colorless,or slightly yellow watery fluid with specific gravity of 1.015. Same as blood plasma but more dilute CONTENTS •Proteins •Fats •Cells •Interstitial fluid www.indiandentalacademy.com
  • 11. Lymph Fluid Central Intermediate www.indiandentalacademy.com Peripheral
  • 12. FORMATION OF LYMPH FLUID    FORMATION - Diffusion - Osmosis Terminal capillaries in the Interstitium 0.003ml/100kg/min tissues 2-3liters/day produced www.indiandentalacademy.com
  • 13. FACTORS AFFECTING THE LYMPH FORMATION  Environmental temperature  Body movement www.indiandentalacademy.com
  • 14. VELOCITY OF LYMPH FLOW  Depends on – Intrinsic Factors – Extrinsic Factors  Velocity is generally 3.1cm /min www.indiandentalacademy.com
  • 15. EXTRINSIC INTRINSIC Intraluminal pressure Lymphatic pump Interstial pressure Movement www.indiandentalacademy.com Muscular Arterial respiration
  • 16. Conditions where lymph production increase (pathologically)     Inflammation Venous stasis Mechanical insufficiency of vessels and valves Drugs –Serotonin,Prostaglandins,TXA2, Nor-adrenaline www.indiandentalacademy.com
  • 17. LYMPH NODE  These are the raison d,etre of the lymphatic system  Local aggregation of lymphoid tissue.  Lympha  colorless – yellow fluid (lymphocytes)  Nodus knot www.indiandentalacademy.com
  • 18. LYMPH NODE     800 L nodes in body 300 are present in head and neck 1 st defense station of the body. Localized mainly in fatty tissues & interposed between lymphatic flow www.indiandentalacademy.com
  • 19. SHAPE OF LYMPH NODE  Inguinal lymph nodes – large and round  Outer iliac lymph nodes – longish mass  Inner iliac lymph node – small and round  Head and neck lymph node- oval or kidney or spindle shaped www.indiandentalacademy.com
  • 20. LYMPH NODE  Size – 1- 30 um in diameter this depends mainly on primary function  Absorption -0.07ml/l node www.indiandentalacademy.com
  • 21. CELL ZONES Zone 1 Extreme periphery Loosely packed cells lymphocytes, macrophages Zone 2 More densely packed small lymphocytes and macrophages Zone 3. www.indiandentalacademy.com Germinal center
  • 22. STRUCTURAL CHANGES: – Expansion of B and T lymphocytes – Cortical region enlargement – Increase in no of macrophages in sinus , medullary sinus FUNCTIONAL CHANGES  Reduced filtering capacity  Immune cells No. increase www.indiandentalacademy.com
  • 23. FUNCTION OF LYMPH NODE  Biologic filtering  Production of lymphocytes in context of immune reactions. www.indiandentalacademy.com
  • 24. 1. Biologic filtering Afferent vessels Capsule Marginal sinus Marginal Zones Medullary cords Medullary sinus Efferent vessels www.indiandentalacademy.com Hilus
  • 25. 2.Immune reaction Antigen  Margninal sinus Bound to Macrophages & Reticular cells Adjacent T-helper cells  Present Ag to Immunocompetent lymphocytes -- Mantle zone ( B-Lymphocytes) Activated B cells www.indiandentalacademy.com Immunoblast
  • 26. IMMUNOBLAST Move towards germinal centre Differentiate Immunocytes & Plasma cells www.indiandentalacademy.com
  • 27. 5-7 days, Plasma cells  Medullary cords  Ab into the medulla Para cortical zone (T-lymphocytes) Suppressor T cells Helper T cells www.indiandentalacademy.com
  • 28. LYMPHATIC VESSELS  Anatomically similar to veins  Are thin-walled , serve as drainage channels  Initially lymph vessels are Finger-shaped and blind.  they drain intercellular spaces and serous sacs.  www.indiandentalacademy.com
  • 29. LYMPHATIC VESSELS  Abundant interlacing anastomoses  Interruption of the continuity by lymph nodes.   Drainage channels from many parts not drained by the venous system www.indiandentalacademy.com
  • 30. LYMPHATIC VESSELS  Wide vascular lumen. 30-50um .  Lymph capillaries dose not contains valves. valves are there in valvular precollectors .  Diameter larger than 10um only can spread or metastasis can take place. www.indiandentalacademy.com
  • 31. STRUCTURE OF LYMPHATIC VESSEL Initial lymph vessel Endothelial cells that are Surrounded by an incomplete and interrupted basal membrane These cells overlap like roof tiles Lymphatic collectors Intima consists of endothelial cells Collagen fibers and single muscle cells. Media contains bundles of smooth muscles surrounded By collagen fibers. Adventitia –longitudinal bundles of connective tissue,elastic fibers& Single smooth muscle cells www.indiandentalacademy.com
  • 32. FUNCTIONS OF ENDOTHELIAL CELLS   Intense protein synthesis Increase cellular transportation www.indiandentalacademy.com
  • 33. VALVES  Except initial lymphatic sinus or capillaries every lymph vessels has valves.  Valves may be – Bicuspid – Tricuspid – Quadricuspid www.indiandentalacademy.com
  • 34. www.indiandentalacademy.com
  • 35. FUNCTIONS OF LYMPH VESSELS  Transitional function of fluid between intercellular spaces and veins.  Immunity  Fats and proteins www.indiandentalacademy.com
  • 36. LYMPHATIC SYSTEM OF HEAD AND NECK REGION  LS of aero digestive mucosa consists of  Narrow –meshed ,superficial vascular system  Wide – meshed ,deeply situated vascular system www.indiandentalacademy.com
  • 37. LYMPHATIC DRAINAGE OF HEAD AND NECK SUPERFICIAL CERVICAL DEEP CERVICAL Outer circle (Pericervical collar) Inner circle (upper part of respiratory and alimentary passages) Surrounds IJV Spinal Accessory Base of skull- Neck www.indiandentalacademy.com
  • 38. www.indiandentalacademy.com
  • 39. SUPERFICIAL CERVICAL NODES (Inner circle) Pre-laryngeal Deep cervical Anterior Deep cervical fascia(beneath) cervical nodes nodes Pre-tracheal Trachea Para-tracheal Oesophagus and trachea Retropharyngeal Retropharyngeal space Larynx,trachea Deep cervical ,oesophagus nodes and thyroid gland Pharynx, palatine tonsil,sphenoid sinus www.indiandentalacademy.com Upper deep cervical nodes
  • 40. DEEP CERVICAL LYMPH NODES Jugulodigastric nodes Triangular region(digastr ic, facial vein and IJV) Palatine tonsil and tongue(post.1/ 3rd) Juguloomohyoid nodes On IJV above intermediate tendon of omohyoid Tongue,subJugular lymph mental,subtrunk mandibular and upper deep cervical www.indiandentalacademy.com Upper deep cervicaljug ular trunk
  • 41. www.indiandentalacademy.com
  • 42. SUB-MENTAL SUB-MANDIBULAR PAROTID NODES UPPER DEEP CERVICAL CHAIN OF NODES LOWER DEEP CERVICAL CHAIN OF NODES www.indiandentalacademy.com 3rd Molars Tongue (base) Tonsillar area Soft palate
  • 43. LOWER DEEP CERVICAL Left lower body Right upper body (bilaterally) RIGHT LYMPHATIC DUCT Right Brachiocephalic THORACIC DUCT vein Left Brachiocephalic Subclavian vein www.indiandentalacademy.com vein
  • 44. Levels of Lymph nodes (SLOAN –KETTERING CANCER CENTER, NY ) I II VI III v IV www.indiandentalacademy.com
  • 45. CLINICAL CONSIDERATIONS  Normal lymph nodes not palpable www.indiandentalacademy.com
  • 46. LYMPHADENOPATHY www.indiandentalacademy.com
  • 47. EXAMINATION  How long swelling has been present?  Is it painful ?  Does it vary with size? www.indiandentalacademy.com
  • 48. GENERAL PRINCIPLES Inspection Palpation Compare with contra lateral side. Site Size Consistency Tenderness Fixation www.indiandentalacademy.com
  • 49. Consistency/Texture  Stony hard  Metastatic cancer  Firm, Rubbery  Lymphoma  Soft  Infection Inflammatory  Shotty  Viral infection www.indiandentalacademy.com
  • 50. PALPABLE LYMPHNODES AND PROBABLE ASSOCIATED CONDITIONS  Tender, Mobile, enlarged  Acute infection  Non-tender, Mobile, Enlarged  Chronic infection  Matted, Non tender  Tuberculosis  Fixed, Enlarged  Carcinoma  Rubbery, Enlarged  Lymphomas www.indiandentalacademy.com
  • 51. Matted:Group of nodes – Connected – as a unit Benign / Malignant Benign Malignant TB Metastatic carcinoma Sarcoidosis Lymphomas Lymphogranuloma venereum www.indiandentalacademy.com
  • 52. Key Points in Diagnosing Lymphadenopathy    In the absence of obvious infection consider it as metastatic tumor until otherwise proven. FNAC - useful investigation. Open biopsy- recurrence, survival, further examination is difficult, fungation. nerve damage may occur. www.indiandentalacademy.com
  • 53. AGE  <16yrsinfection,congenital, neoplasia.  16-40yrs- inflammation, neoplasia  >40yrs- neoplastic. www.indiandentalacademy.com
  • 54. CERVICAL LYMPHADENOPATHY Classification Localised Generalised 2 or more non contiguous area www.indiandentalacademy.com Involve one area
  • 55.  - - - CAUSES FOR CERVICAL LYMPHADENOPATHY Local Infection-dental infections, tonsillitis, skin sepsis, TB node. Neoplasia-lymphoma or metastatic. General URTI, infectious mononucleosis, toxoplasmosis, cat-scratch fever, HIV Sarcodosis, Hodgkin's and non-Hodgkin's lymphoma. Congenital- cystic hygroma. www.indiandentalacademy.com
  • 56. CONCLUSION www.indiandentalacademy.com
  • 57. REFERENCES          Text book of surgical anatomy – Mag Craker Text book of general anatomy 39 th ed – Grants Clinical oriented anatomy –Moore Head &neck emergencys-Mike parry Text book of head &neck anatomy 2 nd ed – Holleinsheid Atlas of general histology – De Floire Text book of Human histology- Inderbir Singh Metastases of head and neck – R. Kim Davis Text book medicine-Davidson www.indiandentalacademy.com
  • 58. Thank you www.indiandentalacademy.com
  • 59. CLINICAL STAGING  Scan and attach www.indiandentalacademy.com
  • 60. Thank you For more details please visit www.indiandentalacademy.com www.indiandentalacademy.com

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