Lymph Node Pathology and Related Conditions

Lymph Nodes and Lymphatic System

• Lymph nodes are categorized into two main groups:
  • Circular
  • Vertical
• Circular lymph nodes:
  • Inner crucial area
  • Examples: Submandibular, parotid, posterior auricular, auricular
• Vertical lymph nodes:
  • Superficial: Located in the superficial fascia.
  • Associated Structures: axillary lymph nodes, axillary vein, femoral vein, para-aortic lymph nodes
  • Anterior group
    • Superficial
    • Nonsignificant
  • Subclavian: Non-controlled.

Lymph Node Involvement and Related Anatomy

• Regions and their Lymphatic Drainage:
  • Floor of the mouth and gums can be affected (e.g., cheeks).
  • Mesopharynx and tonsils.
  • Lower jugular area: Thyroid.
  • Supraclavicular lymph node enlargement: May indicate cancer originating from the stomach or gastrointestinal tract (GIT), potentially due to retrograde lymphatic spread.
  • Specific Drainage Areas:
    • Ear, submental area, lower lip, lower fork, and tip of the tongue drain to the submental lymph nodes.
    • Anterior two-thirds of the tongue, floor of the mouth, and gums drain to the submandibular lymph nodes.
    • Oropharynx drains to the upper deep cervical lymph nodes.
    • Cavity of the oropharynx and pharynx drains to the middle deep cervical lymph nodes.
    • Thyroid and upper esophagus drains to the lower deep cervical lymph nodes.
    • Supraclavicular area: Fibrotic lymph nodes may be present.

Systemic vs. Local Symptoms of Lymph Node Issues

• Systemic Symptoms:
  • Examples: Fever, anorexia, headache, malaise.
• Local Symptoms:
  • Signs: Redness, heat, tenderness, firm to soft texture; possible suppuration and abscess formation with drainage.

Inflammatory and Infectious Conditions

• Inflammatory Conditions:
  • Systemic Symptoms: Fever, anorexia, headache, malaise.
• Tuberculosis (TB):
  • Characteristic Symptoms: Low-grade fever, night sweats, loss of weight.
  • Significance: Important to differentiate from other conditions through diagnostic tests.

Diagnostic Approach

• Initial Assessment:
  • Lymph node persistence for three weeks warrants further investigation.
• Diagnostic Tests:
  • Arithmetic Sedimentation Rate (ESR): A rate above 100 may suggest malignancy, rheumatic fever, TB, or autoimmune disorders.
    • ESR > 100: Indicates potential malignancy, rheumatic fever, tuberculosis, or an autoimmune disorder.
  • Imaging: CT scan for any swelling in the neck.
  • Anamorphosis antibody technology
  • Biopsy: Can be operative.
    • Hep B Impha
    • Fine Needle Cytology: Aspiration.
    • EBRA if swelling is present
    • True-cut biopsy: An operative procedure.

Abscess Management

• Primary vs. Secondary Abscesses: Distinguished by duration (three weeks).
• Abscess Characteristics: Narrowing, pitting edema, fluctuation.
• Surgical Drainage: Necessary for abscesses.
  • Tuberculosis (TB): Drainage is not the primary approach; drug of choice is preferred.
• Neck Dissection: Block Neck Dissection - Comprehensive removal of lymph nodes and surrounding tissue.
  • Block Neck Dissection: Involves removing deep cervical fascia and the internal jugular vein.
  • Used in tumor removal and comprehensive lymph node dissection.

Salivary Glands and Related Issues

• Minor Salivary Glands: Found throughout the oral cavity except in the gingiva, anterior hard palate, and colonic glands.
• Ecthyma Mabufia
• Multiple Infections: Can lead to full papilla, stricture formation, and systemic manifestations.
  • Systemic Symptoms: Fever, anorexia, headache, malaise.
  • Local Symptoms: Redness, heat, tenderness, pus, pitting edema, or fluctuation.
• Drainage of Abscesses: Requires care to avoid damaging important nerve structures, utilizing special methods.
  • Health and Methods
  • Pre-disposing Factors: Infections should be restricted.

Oral and Lingual Considerations

• Related Structures: Floor of the mouth, tongue.
• Tongue: Important for assessing pre-cancerous conditions and cancers.
• Tooth Irritation: Multiple irritations may lead to pre-cancerous conditions.
• Pain: Severe, throbbing pain with abscess; fever is hectic.

Anatomical Relationships

• Sublingual Nerve: Important landmark during procedures.