Lymph nodes in the head and neck can be examined and classified into different levels. There are about 300 lymph nodes in the head and neck region organized into two circles - the outer and inner circles. The outer circle includes submental, submandibular, preauricular and occipital nodes. The inner circle includes prelaryngeal, pretracheal, paratracheal and retropharyngeal nodes. Lymph nodes are further classified into 6 levels from I to VI based on their location for cancer staging and treatment planning. Lymph nodes examine antigen filtration and immune response initiation making examination important for clinical assessment.
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Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
New Drug Discovery and Development .....NEHA GUPTA
The "New Drug Discovery and Development" process involves the identification, design, testing, and manufacturing of novel pharmaceutical compounds with the aim of introducing new and improved treatments for various medical conditions. This comprehensive endeavor encompasses various stages, including target identification, preclinical studies, clinical trials, regulatory approval, and post-market surveillance. It involves multidisciplinary collaboration among scientists, researchers, clinicians, regulatory experts, and pharmaceutical companies to bring innovative therapies to market and address unmet medical needs.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
2. EXAMINATION OF LYMPH NODES OF HEAD AND
NECK AND ITS APPLIED ASPECT
GUIDED BY:
Dr. Neeraj Chauhan
Dr. Abhishek Gupta
Presented by:
Dr. Arshdeep Kaur
MDS-1st year
Dept. of Public Health Dentistry
Bhabha College Of Dental
Sciences and Research Centre 2
3. Contents
Introduction
Anatomy of lymph nodes
Function of lymph nodes
Classification of lymph nodes
Draining areas
Examination of lymph nodes
Applied aspect
3
4. INTRODUCTION
• Lymphatic system is the part of the immune system
comprising a network of lymphatic vessels that carry
a clear fluid called lymph (from Latin lympha
“water”) in a unidirectional pathway
• Lymphatic system is absent in CNS, cornea,
superficial layer of skin, bones, alveoli of lung.
• Lymphatic system is essential drainage system which
is essential to venous system.
4
5. • Most tissue fluid formed at the arterial end of
capillaries is absorbed back into the blood by venous
end capillaries and rest of tissue fluid (10-20%) is
absorbed by lymphatics.
• Larger particles like proteins and particulate matter
can be removed from the tissue fluid only by the
lymphatics.
• Therefore lymphatic system may be regarded as
drainage system of “coarse type” & venous system as
“fine type”
5
7. COMPONENTS OF LYMPHATIC SYSTEM
• Lymph vessels
Bone marrow
• Central lymphoid organs
Thymus
lymph nodes
• Peripheral lymphoid organs Spleen
Tonsils
• Circulating lymphocytes
7
8. LYMPH NODES
Lymph nodes are peripheral lymphoid organs
connected to the circulation by a afferent & efferent
lymphatics.
These are ovoid or bean shaped nodular formation
composed of dense accumulation of lymphoid tissue,
vary in size from 2 to 20mm & average of 15mm in
longitudinal diameter.
There are about 800 lymph nodes in the body and
around 300 are located in head and neck.
8
9. Lymph nodes usually occur in groups.
Superficial lymph nodes are located in subcutaneous
connective tissue.
Deeper nodes lie beneath the fascia and muscles.
Superficial lymphnodes are gateways for assessing
health of entire lymphatic system.
9
11. Path of lymph flow through a lymph node
Afferent lymphatics carry [afferent to bring to] lymph to the
lymph node from peripheral tissues. The afferent lymphatics
penetrate the capsule of the lymph node on the side opposite
to hilum.
The afferent vessels deliver lymph to the subcapsular space, a
meshwork of reticular fibers, macrophages, and dendritic cells.
Dendritic cells are involved in the initiation of immune
response.
Lymph next flow into the outer cortex , which contains B cells
with germinal centers that resemble those of lymphoid nodule.
11
12. Lymph then flows through lymph sinuses in the deep cortex,
which is dominated by T cells.
Efferent lymphatics [efferent to bring out] leave the lymph node
at the hilum. These vessels collect lymph from the medullary
sinus and carry it towards the venous circulation.
Lymph continues into the medullary sinus at the core of the
lymph node. This region contain B cells and plasma cells.
12
13. FUNCTIONS OF LYMPH NODES:
• Lymph nodes play an important role in the defense
mechanism of the body. They filter out micro-
organisms (such as bacteria) and foreign substances
such as toxins, etc.
• Major functions are:
I. Lymphopoiesis
II. Filtration of lymph
III. Processing of antigens
13
14. • Multiplication of B cells and T cells from preexisting
lymphocytes in response to antigens.
• Antibodies produced are carried to circulation
indirectly helping to mount an immune response.
14
15. Lymph nodes are classified into
Peripheral nodes Deep cervical nodes
1. Jugulo-digastric node
2. Jugulo-omohyoid node
1. Pretracheal
2. Paratracheal
3. Retropharyngeal
4. Waldeyer’s ring
1. Submental
2. Submandibular
3. Preauricular
4. Postauricular
5. Occipital
6. Anterior cervical
7. Superficial
cervical nodes
Deep
Inner circle
of cervical
nodes
Superficial
Outer
circle of
cervical
nodes
15
17. • All the lymph from the region of head and neck
drains into deep cervical lymph nodes.
• Efferents from deep cervical lymph nodes form the
jugular trunk which on right side drains into right
lymphatic duct and on left side into thoracic duct,
which empty into the junction of the subclavian and
internal jugular veins on that respective sides
17
18. OUTER CIRCLE
• Formed by lymph node groups, which form the
pericervical or cervical collar at the juction of head
and neck.
• Extends from chin in front to the occiput behind.
• They include submental, submandibular, superficial
parotid (preauricular), mastoid (postauricular) in
relation with sternocleidomastoid muscle, occipital
nodes present in relation with trapezius muscle.
18
20. INNER CIRCLE
• Lymph node groups which lie deep to the
investing layer of deep cervical fascia.
• Lymph nodes of the inner circle consists of
Prelaryngeal
Pretracheal
Paratracheal
Retropharyngeal
Lingual and Infrahyoid nodes
20
22. WALDEYER’S LYMPHATIC RING
• Deep to inner circle,
there is a
submucosal ring of
aggregated masses
of lymphoid tissue
called tonsils, which
surround the
commencement of
air and food
passages.
• These together
constitute the
Waldeyer’s
lymphatic ring. 22
24. TERMINAL LYMPH NODES
• These are deep cervical lymph nodes that lie
along and around the internal jugular vein,
some within the carotid sheath & some on the
surface of the sheath, under cover of
sternocleidomastoid.
• Divided into upper and lower group
24
25. • Superior group of deep cervical lymph nodes: lie
along the upper part of internal jugular vein, they
lie above the omohyoid.
• Jugulodigastric node-subgroup of nodes that lies in a
triangle bounded behind by the internal jugular vein,
above by posterior belly of digastric and below by
the facial vein.
25
26. • The inferior deep cervical lymph nodes lie along the
lower part of internal jugular vein.
• Jugulo-omohyoid node-just above the intermediate
tendon of the omohyoid muscle.
• Tongue drains into jugulo-omohyoid nodes.
• A few nodes of the deep cervical group also extend
in front of Scalenus anterior muscle.
• Enlargement of the left scalene node is a common
finding in carcinoma of stomach (Virchow's node).
• Efferents from the lower deep cervical group drain
into the jugular lymph trunk.
26
31. Original classifiaction system of cervical lymph nodes
was developed by Rouviere in 1938.
In 1981, Shah recommended that cervical lymph
nodes be classified in a simpler fashion based on
levels.
The latest classification has been created by the
American Joint Committee on Cancer and the
American Academy of Otolaryngology-Head and
Neck Surgery.
31
34. The lymph nodes in the neck have historically been
divided into at least six anatomic neck lymph node
levels for the purpose of head and neck cancer
staging and therapy planning.
Level I: submental and submandibular
superiorly: mylohyoid muscle and mandible
inferiorly: inferior border of the hyoid bone
anteriorly: platysma muscle
posteriorly: posterior border of the submandibular
gland
There are two sublevels:
level Ia (submental nodes): anteromedial between
the anterior bellies of both digastric muscles
level Ib (submandibular nodes): posterolateral to the
anterior belly of the digastric muscles 34
35. • Level II: upper internal jugular (deep cervical) chain
• superiorly: base of the skull at the jugular fossa
• inferiorly: inferior border of the hyoid bone
• anteriorly: posterior border of the submandibular
gland
• posterolaterally: posterior border of
the sternocleidomastoid muscle
• medially: medial border of the internal carotid artery
• There are two sublevels:
• level IIa: inseparable from or anterior to the
posterior edge of the internal jugular vein;
includes jugulodigastric nodal group
• level IIb: posterior to and separable by a fat plane
from the internal jugular vein
35
36. • Level III: middle internal jugular (deep cervical)
chain
• superiorly: inferior border of the hyoid bone
• inferiorly: inferior border of the cricoid cartilage
• anteriorly: anterior border of the
sternocleidomastoid muscle
• posterolaterally: posterior border of the
sternocleidomastoid muscle
• medially: medial border of the common carotid
artery
36
37. • Level IV: lower internal jugular (deep cervical) chain
• superiorly: inferior border of the cricoid cartilage
• inferiorly: level of the clavicle
• anteriorly: anterior border of the
sternocleidomastoid muscle
• posterolaterally: oblique line drawn through the
posterolateral edge of the sternocleidomastoid
muscle and the lateral edge of the anterior scalene
muscle 2
• medially: medial border of the common carotid
artery
• includes medial supraclavicular
nodes including Virchow node
37
38. • Level V: posterior triangle
• superiorly: skull base at the apex of the convergence
of sternocleidomastoid and trapezius muscles
• inferiorly: level of the clavicle
• anteromedially: posterior border of the
sternocleidomastoid muscle
• posterolaterally: anterior border of the trapezius
muscle
• There are two sublevels:
• level Va: superior half, superior to inferior border of
the cricoid cartilage (posterior to levels II and III);
includes spinal accessory nodes
• level Vb: inferior half, inferior to inferior border of
the cricoid cartilage (posterior to level IV); includes
lateral supraclavicular nodes 1
38
39. • Level VI: central (anterior) compartment
• superiorly: inferior border of hyoid bone
• inferiorly: superior border
of manubrium (suprasternal notch)
• anteriorly: platysma muscle
• posteriorly: trachea (medially) and prevertebral
space (laterally)
• laterally: medial borders of both common carotid
arteries (medial to levels III and IV)
• includes anterior jugular, pretracheal, paratracheal,
prelaryngeal/precricoid (Delphian), and perithyroidal
nodes
39
40. • Termination
• All the levels above eventually drain to the jugular
trunk of their respective side and then to the right
lymphatic duct or the thoracic duct (left).
40
43. NODES
Sub mandibular
LOCATION
Lie within the
submandibular
region scattered
over the surface
of
submandibular
salivary gland.
An extension of
the
submandibular
group lie on the
cheek
superiorly
called the
buccal group.
DRAINING AREA
• Submental
nodes
• Cheek
• Nose
• Upper lip
• Maxillary
teeth
• Vestibule
• Gingiva
• Posterior
floor of the
mouth
• tongue
EFFERENT’S
Drain into
nodes of deep
cervical chain
43
44. NODES
Parotid nodes
Retro auricular
nodes
LOCATION
Lie superficial
to the capsule
of parotid
gland
Lie over the
mastoid
process
DRAINING
AREA
• The eyelid
• Temple
• Prominence
of cheeks
and
• The auricle
• The scalp
• The auricle
EFFERENT’S
• Deep
parotid
nodes
• Superficial
cervical
nodes
• Deep
cervical
nodes
44
45. NODES
Occipital
LOCATION
Lie just below
the superior
nuchal lines at
the trapezius
muscle and in
proximity with
occipital
artery.
DRAINING
AREA
From scalp
EFFERENT’S
Drain to deep
cervical nodes
45
46. NODES
SUPERFICIAL
CERVICAL
JUGULO-
DIGASTRIC
LOCATION
3-4 nodes lie
along the
external
jugular vein
and are
situated
superficial to
upper part of
sternocleido
mastoid.
Below the
posterior belly
of digastric
DRAINING
AREA
• Floor of
external
acoustic
meatus
• Lobule of
the ear
• Angle of the
jaw
• Palatal
tonsils
• Posterior
1/3rd of
tongue
EFFERENT’S
Lower deep
cervical nodes
Lower group
of deep
cervical nodes
46
47. NODES
JUGULO –
OMOHYOID
SUPRA
CLAVICULAR
NODES
LOCATION
On the internal
jugular vein, just
below the
intermediate
tendon of
omohyoid.
Supra clavicular
triangle
DRAINING AREA
• Directly from
the tongue and
indirectly from
submental,
submandibular,
upper deep
cervical nodes.
• Axillary
• Thorax
• Abdomen
• Pelvis
EFFERENT’S
Thoracic duct
Thoracic duct
47
49. LYMPHADENOPATHY:
• Lymph nodes which are abnormal in size, number or
consistency and is often used as a synonym for
swollen or enlarged lymph nodes.
Classified as generalized or localised
Generalized: 2 or more non contiguous area
Localised – involve one area
49
50. Causes of enlargement of lymph
nodes
Inflammatory Neoplastic
Acute or chronic Carcinoma
Lymphadenitis Sarcoma
Infection
Tuberculosis
Filariasis
Secondary syphilis
Infectious mononucleosis
50
52. Clinical examination:
• History – Age
Duration
Group first affected
Pain
Fever
Primary focus
Loss of appetite & weight loss
Pressure effects
Past history
Family history
52
53. Local examination
• Inspection – number, position, size, overlying
skin swelling, pressure effects.
• Palpation – consistency, matted or not, fixity
to surrounded structures, drainage area.
General examination:
Lymph nodes in other parts of the body.
53
54. AGE: Tuberculosis, Syphilis and primary malignant
lymphomas affect young age.
DURATION: Short (acute lymphadenitis)
GROUP AFFECTED FIRST: In case of Hodgkin’s
lymphoma and tuberculosis cervical group is affected
first, whereas in filariasis inguinal LN’s are affected
earlier.
PAIN: Acute and chronic infections are painful but in
case of syphilis, primary malignant lymphomas and
secondary carcinomas, infection is painless.
FEVER: evening rise of temperature is characteristic
feature of TB, whereas in case of filaria fever is periodic
( once in month).
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55. • PRIMARY FOCUS: In acute and chronic septic
lymphadenitis. It is usual practice to look for primary
focus in drainage area.
• LOSS OF APPETITE & WEIGHT: Incase of malignant
lymphadenopathies.
• PRESSURE EFFECTS: e.g. Dysphagia may occur when
esophagus is pressurized.
• PAST HISTORY: enlargement of epitrochlear and
suboccipital group of lymphnodes may be enlarged
in secondary stage of syphilis.
• FAMILY HISTORY: sometimes history of TB in families.
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56. • INSPECTION:
• NUMBER: single or mutiple, there is generalized
involvement of LN’s in hodgkin’s lymphoma, TB,
Lymphosarcoma, sarcoidosis.
• POSITION: Cervical group is involved in case of TB,
epitrochlear and occipital in case of secondary syphilis.
• SKIN OVER THE SWELLING:
In acute lymphadenitis skin becomes inflammed with
redness, oedema, brawny induration.
Skin over tuberculous lymphadenitis and cold abscess
remains “cold” till they reach a point of bursting when
skin becomes red and glossy.
Over rapidly growig lymphosarcoma skin becomes tense,
shining with dilated subcutaneous veins.
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57. • PRESSURE EFFECTS:
• Careful inspection of whole body must be made to detect any
pressure effect due to enlargement of LN’s.
• Edema and swelling of upper limb – enlargement of axillary LN’s.
• Edema and swelling of lower limb - enlargement of inguinal LN’s
• Swelling & venous engorgement of face and neck may occur due
to pressure effect of lymph nodes at the root of the neck.
• Hypoglossal nerve may be involved from enlarged upper group
of cervical LN’s due to Hodgkin’s disease or secondary
carcinoma.
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58. PALPATION
NUMBER
LOCAL RISE IN TEMPERATURE
TENDERNESS
CONSISTENCY – Enlarged LN’S should be carefully
palpated with palmar aspects of 3 fingers. While
rolling the fingers against the swelling slight pressure
is maintained to know the actual consistency.
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59. Enlarged lymph nodes may be:
• Soft
• Elastic & rubbery (hodgkin’s disease)
• Firm, discrete and shotty (syphilis)
• Stony hard (Secondary Carcinoma)
• Matted or Not: A group of lymph nodes that feels
connected and move as a unit is known as
matted.
E.g. Acute lymphadenitis
Metastatic carcinoma
Tuberculosis
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60. FIXITY TO SURROUNDING STRUCTURE:
The enlarged lymph node should be carefully palpated to
know if they are fixed to:
• Skin
• The deep fascia
• The muscles
• The vessels
• The nerves
Eg: Any primary malignant growth of lymph nodes like
lymphosarcoma, reticulosarcoma, histosarcoma or secondary
carcinoma fixed to surrounding structures-first to deep fascia
& underlying muscle followed by adjoining structures and
ultimately overlying skin.
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61. DRAINING AREA
• Cervical LN’s receive
lymphatics from –
head, face, mouth,
pharynx and neck.
• Left supra-clavicular
LN’s (virchows)
receives lymphatics
from upper limb, left
side of chest and also
viscera of abdomen
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63. METHOD OF PALPATION
• a, b, c, d, e :
examination of
lymphatic
groups around
skull base
• Examined in
their circle
around the
base of the
skull
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64. • The deep
cervical lymph
chain, lies
around the IJV,
• The chain
passes deep to
the
sternomastoid
muscle & in the
lower neck,
extends
laterally into
the
supraclavicular
region.
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65. • Although the vast majority of cervical
lymphadenopathy is related to head & neck,
the scalene nodes are an exception. This gp.
Of supraclavicular nodes is situated behind
the lower end of the sternomastoid muscle.
They are a common site for metastases from
breast, lung, gastrointestinal & genitourinary
malignances, particularly on the left side.
• The scalene nodes can easily be missed if you
don’t palpate deep to the sternomastoid.
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66. • To assess whether a
mass is deep, fixed to,
or superficial to the
sternomastoid muscle,
ask the subject to turn
their chin away from
the side being
examined, pressing
against your hand.
This allows the
demonstration of
mobility of superficial
or deep masses in
relation to the tensed
muscle
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67. • Palpate the superficial
lymph chain along the
length of the EJV
completing the
examination by
palpation along the
borders of the trachea &
larynx for nodes along
the anterior jugular
vein.
• Occasionally nodes are
encountered on the
isthmus of the thyroid
gland & over the larynx;
these small “delphium”
nodes are related to
thyroid & other
superficial malignances.
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69. fine-needle aspiration, excisional biopsy remains
the initial diagnostic procedure of choice.
Modern cross-sectional imaging modalities such
as ultrasound (US), computed tomography (CT)
and magnetic resonance imaging (MRI) allow
reliable detection of cervical lymph nodes.
However, the differentiation between benign
and malignant lymph nodes remains
challenging.
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70. • Alternative imaging modalities such as single
photon emission computed tomography (SPECT)
and positron emission tomography (PET) can help
to differentiate between benign and malignant
LN’s.
• In a recent meta-analysis, ultrasound and US-
guided fine needle aspiration cytology (USgFNAC)
have been shown to be valuable tools in
characterizing cervical LN’s.
• Sentinel node biopsy has greater accuracy in
determining lymph node status for carcinoma
than commonly used imaging methods.
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71. Lymphography:
valuable tool for detection of lymphatic fistulas
and lymphatic leakage
Lymphangioscintigraphy
Tc-99m – intradermally, and after 1 minute and
again after 10-30 minutes
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72. APPLIED ASPECTS
• Lymphatics are primarily meant for coarse
drainage including cell debris & micro-organisms,
from the tissue spaces to the regional lymph
nodes, where the foreign & noxious material is
filtered off by the phagocytic activity of
macrophages for its final disposal by the
appropriate immune responses within the nodes.
• Thus the lymphatic system is the first line of
defence of our body.
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73. • The arrangement of lymphatics of head and
neck is in such a manner that there is every
possibility of checking or blocking of lymph
flow.
• While draining from an infected area, the
lymphatics & lymph nodes carrying infected
debris may become inflamed, resulting in
lymphangitis & lymphadenitis.
• Enlarged lymph nodes may interfere with
salivary secretions and can cause dry mouth.
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74. • Lymphatics provide most convenient route of
spread of cancerous cells.
• Helpful in diagnosis of primary site of cancer.
• Helps in predicting the prognosis & classifying
the stage of cancer.
• Helps the surgeon in doing block dissections
during operative procedures.
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75. CONCLUSION
• The location of the lymph node may help to
determine the site of malignancy.
• Diffuse, bilateral involvement suggests a
systemic malignancy (e.g. lymphoma) while
those limited to a specific anatomic region are
more likely associated with a local problem
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76. REFERANCES
• Human anatomy head and neck – BD Chourasia
4/e
• Loachim’s lymph node pathology – Harry L.
loachim, Jeffery .4/E
• A manual on clinical surgery – S.Das 6/E
• Applied anatomy of lymphatics – D.O Millard
• Text book of head and neck anatomy – Hiatt,
Gartner 4/E
• Principles and practice of radiation oncology –
Edward halperin, Carlos perez 5/E
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