Ch. 10 Lymphatic System, H&N, Fall 2025

Lymphatic system is part of the

immune system

Lymphatic System is a

NETWORK OF TINY CHANNELS AND NODES

Tonsillar tissue in oral cavity & pharynx are

part of the lymphatic system

afferent vessels

lymph flows IN

efferent vessels

lymph flows OUT

Lymph vessels are found in

pulp tissue in a tooth

Lymph vessels have one way

valves

tonsils are helpful in

immune process

in clinic we palpate the whole

chain of lymph nodes

shape of lymph nodes

Bean shaped and clustered

lymph nodes filter

toxins

_______ and _______ in lymph nodes can indicate an infection

swelling and tenderness

lymph nodes contain lymphocytes/ they are derived from

stem cells in bone marrow

T-cells mature in the

thymus gland
--Respond to foreign antigens in tissue fluids

2 types of nodes

• Superficial

• Deep

lymph nodes components

-afferent vessel
-efferent vessel
-hilus
-types of nodes

hilus

depression on one side where the lymph flows out/ material settles there before it goes out

types of nodes

-Primary (regional) "master nodes"—drain into secondary nodes (heavy hitters)
-Secondary (central)
-tertiary

tonsillar tissue

Masses of tissue in the oral cavity and pharynx that remove toxic products

tonsillar tissue located

near airway and food passages

lymphatic ducts size

large

where do lymph ducts drain

drain into the venous system of the blood of the chest area
-Drainage depends of the side of the body involved

5 groups of superficial lymph nodes in the head

occipital
-retroauricular/ posterioauricular
-anterior auricular
-superficial parotid
-facial nodes

occipital lymph nodes/ how many and where do they empty into

-1-3 bilaterally on the posterior base of the head /back of skull
• Empty into the deep cervical nodes of the neck

occipital nodes drain the

scalp

where are postauricular or retro auricular lymph nodes

posterior to each ear

the retro auricular nodes and the anterior auricular nodes drain the

scalp
external ear
lacrimal gland

where is the anterior auricular node or the preauricular node?

in front of the ear

superficial parotid nodes location

Superficial to Parotid gland/ in the cheeks

superficial parotid nodes drain the

scalp
external ear
lacrimal gland

facial nodes location

superficial to the facial vein
close to the nose, upper lip area, and toward the angle of the mandible

facial lymph nodes drain the

lateral eyelid
nose
cheek

Deep lymph nodes of the head cannot be

Cannot be palpated due to depth!!!

Deep Parotid Nodes- how many and what do they drain

10 drains the middle ear, auditory tube, and parotid salivary gland

Retropharyngeal Nodes

- Drains the pharynx, palate, paranasal sinuses, and nasal cavity/ behind the pharynx

cervical nodes

They drain either the right or left sides Categorized as: Upper/Middle/Lower Anterior or Lateral/Posterior Superficial or deep

the 3 deep lymph nodes of the head

deep parotid glands
Retropharyngeal Nodes
cervical nodes

superficial cervical lymph nodes

submental
submandibular
external jugular
anterior jugular
deep cervical lymph nodes

submental nodes are located

under the chin
2-3 nodes inferior to chin (between bellies of the digastric muscle)

submental nodes drains fluid from the

-mandibular incisors/ anterior teeth
-tip or apex of tongue
-chin
-lower lip
- floor of mouth
- with associated periodontium and gingiva

submental nodes Empty into

submandibular nodes and then deep cervical nodes.

submandibular (more on the angle of the mandible) nodes drain

-submental nodes
-cheeks, upper lip, body of tongue
• anterior hard palate
• most of teeth with associated periodontium and gingiva EXCEPT MAND. INCISORS AND MAX 3rd MOLARS.

External Jugular Nodes aka

Superficial cervical nodes
• These empty into the Deep Cervical Nodes

Anterior Jugular Nodes

AKA Anterior Cervical Nodes
• Drain infrahyoid region of neck
• Empty into Deep Cervical Nodes

Deep Cervical Nodes- number and what they drain

15-30 that drain submandibular nodes
• Drains 3rd molar region
• Structures of the oropharynx are drained by the Superior Deep Cervical Nodes
• Superior Deep Cervical Nodes are drained by Inferior Deep Cervical Nodes

paper- deep cervical nodes drain the

posterior hard palate
soft palate
maxillary third molars
tonsils
base of tongue
thyroid gland

Primary Node, Secondary Node, and Tertiary Node

1st node affected by a disease process is primary___________
• 2nd node affected by a disease process is secondary___________
• 3rd node affected by a disease process is tertiary_________

The superior deep cervial lymph nodes are located deep beneath the

SCM muscle, superior relative to the point where the omohyoid muscle crosses the internal jugular veins/ cervical nodes are in front of and behind the SCM

One node of the superior deep cervical nodes can be prominent and palpable, the

jugulodiagastirc lymph node or the tonsillar lymph node, when the palatine tonsils undergo node enlargement or lymphadenopathy.

The jugulodiagastric node or the tonsilar node is located

inferior to the posterior belly of the digastric muscle and posterior to the angle of the mandible

superior deep cervical lymph nodes drainage- The superior deep cervical nodes are primary nodes draining the

posterior nasal cavity, posterior hard palate, soft palate, base of the tongue, maxillary third molars with associated periodontium and gingiva, tmj, esophagus, trachea, and the thyroid gland

Superior deep cervical lymph nodes, may be secondary nodes for all other nodes of the head and neck, except for

inferior deep cervical nodes
-the superior deep cervical nodes empty into the inferior deep cervical nodes or directly into the jugular trunk

The inferior deep cervical lymph nodes are a continuation of the

superior deep cervical group

The inferior deep cervical nodes are also located deep to the

scm muscle
-ask permission to palpate this area

inferior deep cervical lymph nodes cancers

thus because of this node communication, the inferior deep cervical nodes are at the greatest risk for the spread of breast cancer or adenocarcinoma

In addition to the deep cervical lymph nodes are the accessory and

supraclavicular node groups in the most inferior part of the neck

Accessory lymph nodes location/ drainage

The accessory lymph nodes are 2 to 6 in number and are located along the eleventh cranial or accessory nerve
-these nodes drain the scalp and neck regions and then drain into the supraclavicular nodes

the supraclavicular lymph nodes are located

Superiorly along the clavicle close to where the sternum joins
-bilateral

Supraclavicular lymph nodes: drainage

these nodes drain the lateral cervical triangles
(the supraclavicular nodes may empty into one of the jugular trunks or directly into the right lymphatic duct or thoracic duct) know that part

supraclavicular nodes pathology

-these nodes are located in the final endpoint of lymphatic drainage from the entire body
-because of the location, these nodes are at greatest risk for involving the spread of cancers arising from the lungs, esophagus, and stomach
-therefor inspection of these nodes is important in any patient assesment

The palatine tonsills, what patients call their tonsills are two rounded masses of variable size located in the

the oral cavity between the anterior and posterior faucial pillars on each side of the fauces

Palatine tonsills

these 2 vertical folds are formed by muscles of the soft palate: the palatoglossus muscle forms the anterior faucial pillar and the palatopharyngeus muscles forms the posterior faucial pillar
-alot of the tissue is linked up as one

Lingual tonsill

the lingual tonsil is an indistinct layer of lymphoid nodules located intraorally on the dorsal surface of the base of the tongue

Pharyngeal Tonsils are located

on the posterior wall of the nasopharynx

Also called Adenoids

pharyngeal tonsil
-Enlarged in children

What happens when tonsils are removed

When children have tonsils and adenoids removed, usually remove ALL the tonsils except the lingual tonsils in tongue

tonsillar crypts

portion of tonsils that trap and destroy bacteria and particulate matter.

when a patient has a disease process such as cancer or infection active in a region, the regions lymph nodes respond

The resultant increase in size and change consistency of the lymphoid tissue is considered lymphadenopathy

The change in lymph nodes consistancy can range from

firmer to boney hard

Nodes can remain mobile or free from the surrounding tissue during a disease. however these nodes can also become

attached or fixed to the surrounding tissue, such as skin, bone, or muscle, as the disease process progresses to involve the regional tissue

When the nodes are involved with lymphadenopathy

the nodes can also feel tender to the patient when palpated. This tenderness is because of pressure on the area nerves resulting from the node's enlargement.

lymph node inflammation

lymphadenitis
-commonly occurs with microbial infections, such as with S. aureus, and s. pyogenes infections locally with tonsillar or oral abscesses as well as systemically with mononucleosis or HIV infections

Which THREE TONSILS MAKE UP THE WALDEYER RING?

-palatine
-lingual
-pharyngeal (adenoids)
-tubul

What are tonsil stones?

Tonsilloliths, are hard white formations that are located on or within the tonsils.

TONSILLITIS & ABSCESS:

Spread of cancer from the primary site of a tumor to a secondary site is called

metastasis

If cancer is not stopped at the primary nodes, it will

spread to secondary nodes, metastasis progresses

If metastasis passes all lymph nodes, the cancer cells enter the

vascular system by way of the lymphatic ducts

Spread of cancer is quicker once it reaches the

blood vessels by way of nodes

Lymph nodes involved with cancer can be

hard, non-mobile and/or fixed

Cancerous nodes are not

tender

Infected nodes are

Mobile and Tender