PRESENTED BY

SAHAL ABU

IVth YEAR

BDS PART A

Lymphatic System

• The lymphatic system is the part of the immune system comprising a network of conduits called lymphatic vessels that carry a clear fluid called lymph in a unidirectional pathway and eventually conveying them into the heart.

Formation Of Lymph

As blood flows through the capillaries of the body, two opposing forces are exerted.

Blood pressure tends to force fluid through the walls of the capillaries into the tissue spaces, whereas the osmotic pressure of the blood tends to draw fluid into the vessels.

Fluid tends to pass out of vessels on the arterial side.

About 90% of this fluid returns to the blood vessels, the remaining 10% entering lymph vessels that eventually carry this lymph back to the venous circulation after passing through the lymph nodes.

FUNCTIONS• To collect and transport tissue fluids from the intercellular spaces in all

the tissues of the body, back to the veins in the blood system;

• It plays an important role in returning plasma proteins to thebloodstream;

• Digested fats are absorbed and then transported from the villi in the smallintestine to the bloodstream via the lacteals and lymph vessels.

• New lymphocytes are manufactured in the lymph nodes

• Antibodies and lymphocytes assist the body to build up an effective immunity to infectious diseases;

• Lymph nodes play an important role in the defence mechanism of the body. They filter out micro-organisms (such as bacteria) and foreign substances such as toxins, etc.

• It transports large molecular compounds (such as enzymes and hormones) from their manufactured sites to the bloodstream.

Importance In Dentistry

Clinical significance:

1. Diagnostic value

2. Aid in prediction of treatment outcome (modification of treatment plan/course)

3. Prediction of disease history and therefore prognosis.

4. Lymph vessels can also transmit other substances such as injected material.

LYMPH NODES

Superficial Nodes

Deep Nodes

Superficial cervical nodes

Node Location Areas Drained Drains Into

Superficial Lymph Nodes of the Head

Occipital (2-4) Located on the occipital bone

Occipital part of scalp Superficial cervical lymph nodesAccessary lymph nodes

Mastoid (1-3) Superficial to sternocleidomastoidinsertion

Posterior parietal scalpSkin of ear, posterior external acoustic meatus

Superior deep cervical nodes Accessary lymph nodes

Preauricular (2-3) Anterior to ear over parotid fascia

Anterior parietal scalpAnterior surface of ear

Superior deep cervical lymph nodes

Parotid (up to 10 or more)

About parotid gland and under parotid fasciaDeep to parotid gland

External acoustic meatusSkin of frontal and temporal regionsEyelids, tympanic cavityCheek, nose (posterior palate)

Superior deep cervical lymph nodes

FacialSuperficial(up to 12)MaxillaryBuccalMandibular

Distributed along course of facial artery and vein

Skin and mucous membranes of eyelids, nose, cheek

Submandibularnodes

Cervical Lymph Nodes

Superficial Lie along the course of anterior jugular vein between superficial cervical fascia and infrahyoidfascia

Skin, muscles, and viscera of infrahyoidregion of neck

Superior deep cervical lymph nodes

Deep Between viscera of neck and investing layer of deep cervical fascia

Adjoining parts of trachea, larynx, thyroid gland

Superior deep cervical lymph nodes

Anterior cervical/Superficial

Submental (2-3) Submental triangle ChinMedial part of lower lipLower incisor teeth and gingivaTip of tongueCheeks

Submandibularlymph node to jugulo-omohyoidlymph node and superior deep cervical lymph nodes

Submandibular(3-6)

Submandibulartriangle adjacent to submandibulargland

Facial nodesChinLateral upper and lower lipsSubmental nodesCheeks and nose, anterior nasal cavityMaxillary and mandibularteeth and gingivaOral palateLateral parts of anterior 2/3 of tongue

Superior deep cervical lymph nodes and jugulo-omohyoid lymph nodes

Superficial cervical (1-2)

Along external jugular vein superficial to sternocleidomastoid muscle

Lower part of ear and parotid region

Superior deep cervical lymph nodes

Deep Cervical Lymph Nodes

Superior deep cervical

Surrounding internal jugular vein deep to sternocleidomastoidand superior to omohyoid muscle

Occipital nodesMastoid nodesPreauricular nodesParotid nodesSubmandibular nodesSuperficial cervical nodesRetropharyngeal nodes

Inferior deep cervical nodes or separate channel to jugulo-subclavianjunction

Jugulodigastric Junction of internal jugular vein and posterior digastricmuscle

Palatine and lingual tonsilsPosterior palateLateral portions of the anterior 2/3 of tongue

Inferior deep cervical lymph nodes

Jugulo-omohyoid Above junction of internal jugular vein and omohyoidmuscle

Posterior 1/3 of tongueSubmandibularnodesSubmental nodes

Inferior deep cervical lymph nodes

Inferior deep cervical

Along internal jugular vein below omohyoid muscle deep to the sternocleidomastoidmuscle

Transverse cervical nodesAnterior cervical nodesSuperior deep cervical nodes

Jugular trunk

Retropharyngeal(1-3)

Retropharyngeal space

Posterior nasal cavityParanasal sinusesHard and soft palateNasopharynx, oropharynxAuditory tube

Superior deep cervical nodes

Lymphatic drainage of teeth

Lymphatics Of Tongue

Applied aspects

• When a lymph node is under challenge from a foreign antigen, itmay become swollen and painful to the touch— a condition calledlymphadenitis.

• Commonly palpated and accessible lymph nodes are - the cervical,axillary, and inguinal.

• Lymph nodes are common sites of metastatic cancer becausecancer cells from almost any organ can break loose, enter thelymphatic capillaries, and lodge in the nodes.

• Lymphadenopathy is a collective term for all lymph node diseases