1. The lymphatic system of the head and neck regions
Mark Kozsurek, M.D., Ph.D.
ED II., 17/03/2015

2. Protection from loss of blood by the action of clotting.
Transportation of gases, nutrients, waste, and cells that defend the body.
Regulation of the body's fluid and electrolyte balance, acid-base balance and body temperature.
Protection from loss of blood by the action of clotting.
Cleansing the cellular environment
Returning proteins and tissue fluids to the blood (drainage)
Providing a pathway for the absorption of fats and fat-soluble vitamins into the bloodstream.
Defending the body against disease
via the immune response

3. What is immune system and immun response?
humoral
cellular

4. What is lymph?
Only approx. 99% of the filtrated fluid is resorbed from the interstitial space! The remaining 1% is the lymph collected by the lympatic vessels and filtrated through the lymp nodes.

5. The final common pathway of the lymph

6. The structure and function of the lymph nodes

9. Lymph node regions of the head and neck
(or mastoid)

10. Lympatic drainage of the superficial layers of the head
(or retroauricular nodes)
Lympatic drainage of the superficial layers of the head
To superficial cervical nodes

11. Lympatic drainage of the deep layers of the head
posterior orbit, posterior nasal cavity, nasopharynx, pharyngeal tonsil, tympanic cavity, soft palate → retropharyngeal lymph nodes
anterior nasal cavity, hard palate, upper teeth, anterior 2/3 tongue, lower lateral teeth → submandibular lymph nodes
isthmus of the fauces, palatine tonsil, root of the tongue, lower posterior teeth → deep cervical nodes

12. Lympatic drainage of the neck
Superficial cervical nodes
- superficial to the Sternocleido-mastoid, along the ext. jugular vein
from the occipital and mastoid nodes, from the superficial layers of the neck
toward the deep cervical nodes
Deep cervical nodes
along the int. jugular vein
superior, inferior and anterior, posterior quadrants
- jugulo-digastric, jugulo-omohyoid, infrahyoid, prelaryngeal, paratracheal, supraclavicular, etc. nodes

13. Tonsils
Tonsil or MALT (mucosa associated lymphatic tissue) or lymphoepithelial organ.
Right under the epithelium lymphoid cells are embedded into a reticular network formed by reticulum cells and reticular fibres. Lymphocytes destroy the basement membrane and infiltrate the epithelium resulting in a unique mixture of the epithelial and lympatic tissues.
The surface is increased by folds and invaginations.
The secondary follicles represent the B-dependent zones, among the follicles the T-dependent regions are present.

14. T-dependent zone
B-dependent zone

15. Lymphatic ring of Waldeyer

16. Palatine tonsil

18. Tonsillectomy: removal of the palatine tonsil
uvula
palatine tonsil

19. Pharyngeal tonsil

21. Adenoid hypertrophy, otitis media
Adenotomy (reduction of the pharyngeal tonsil)

22. La Force adenotome
Beckmann’s adenotome

23. Lingual tonsil

24. Blood supply of the tonsils
(= a. palatina descendens)

25. Swollen lymph nodes
Normally only the superficial inguinal lymph nodes are palpable!
Superficially located, enlarged lymph nodes are directly palpable, the size of the deeper ones can be measured with ultrasonography or computer tomography. Lymph nodes bigger than 0.5 cm should be considered abnormal.
Note: swollen lymp nodes without pain are always more dangerous!
Reasons: inflammation (with pain) or hematological deseases, metastasis of malignant tumors (without pain).

26. Peritonsillar and retropharyngeal abscess

28. Thank you for your attention!