1. Lymphatic System
Lymphatic system: system of lymphatic vessels and organs
for the transport of lymph
lymph: filtrate produced in tissues and NOT reabsorbed by the capillaries of the CV system
produced through large-scale filtration of plasma into tissues
carried through a system of lymphatic vessels and filtered through lymph nodes

2. Lymphatic organs:
1) lymph nodes: found at certain points along the lymphatic system
-capsule surrounding an outer cortex and inner medulla
-cortex contains immune cells = lymphocytes
-medulla contains immune cells = macrophages
-cleans lymph and fights specific pathogens
2) tonsils: lymphatic tissue located in the pharynx (adenoids) or oral cavity
(palatine tonsils)
-collection of lymphocytes and
macrophages
-”cleans” food and drink and air
-first defense against pathogens
3) Spleen - collection of lymphocytes and
-cleans the blood
4) bone marrow – stem cells +
lymphocytes/macrophages
5) Thymus – production of T cells

3. Lymph nodes:
-1 to 2 cm bean shaped
-surrounded by a fibrous capsule which extend into the node to form trabeculae
-fed by afferent lymphatic vessels
-drained by efferent lymphatic vessels
-made up of tissue organized as an outer cortex and an inner medulla
-cortex contains numerous follicles – site of T and B cells
-outer cortex follicles = B cells
-deep cortex = site of T cells
-number and composition of the follicles can change according to the antigen being recognized
-medulla made up of medullary cords of lymphatic tissue = contain B cells, plasma B cells and macrophages
-between the cords are spaces called medullary sinuses = site of macrophages
lymph -> afferent vessel -> subcapsular sinus -> trabecular sinuses -> medullary sinuses -> efferent vessel
-cervical nodes
-clavicular nodes
-axillary nodes
-mediastinal nodes
-mesenteric nodes
-inguinal nodes

5. Lymph nodes Nodes of the head and neck drain into two large groups
Superior deep cervical nodes (SDCs)
Drain the external/middle ear, sinuses, nasal cavity, lacrimal gland, scalp and face
Also drains several oral structures: floor of mouth, base of tongue, maxillary and mandibular teeth, tonsils, salivary glands, palate
Inferior deep cervical nodes (IDCs)
Drains the cervical nodes (external & anterior jugular nodes)
Also drains some of the axillary nodes and the deep posterior triangle of the neck
Refer to handouts

6. Superficial nodes of Head & Neck
Nodes of the Head: drain to superior deep cervical nodes
Figures 10-3, 10-4, 10-5
Occipital – drain to inferior deep cervical nodes
Retroauricular
Anterior auricular
Superficial parotid
Facial nodes
Malar
Nasolabial
Buccal
mandibular
Nodes of the Cervical region: drain into superior or inferior deep cervical nodes
Retropharyngeal – drains into SDCs
Submental – drains into submandibular nodes
Submandibular – drains into SDCs
External jugular or Superficial lateral cervical nodes – drains into IDCs
Anterior jugular or Superficial anterior cervical nodes – drains into IDCs

7. Cervical Nodes

8. lymphatic system is ONE WAY (from tissues to heart)
-lymphatic vessels join to form two major ducts:
1) thoracic duct (joins to the left subclavian vein as the left lymphatic duct)
2) right lymphatic duct – connects to right subclavian vein
-right arm & thorax, right side of head and neck -> right jugular trunk -> right lymphatic duct -> right subclavian vein (at junction of internal jugular)
-left arm & thorax, lower body, left side of head and neck -> left jugular trunk -> thoracic duct -> left subclavian vein (at junction of internal jugular)
lymphatic system is ONE WAY
(from tissues to heart)

9. Lymphatic vessels -lymphatic vessels - for the transport of lymph
-larger lymphatic vessels are similar to blood vessels - presence of valves
-enters lymphatic capillaries from the tissues
-low pressure system - moves by
muscular contraction and breathing
-capillaries join to form lymphatic vessels

10. Tonsils not located along lymphatic vessels
drain into the superior deep cervical lymph nodes
reach their largest size during puberty
four types – known as Waldeyer’s ring
Palatine – located in oropharynx
Behind the palatoglossal arch
Lingual – base on tongue
Pharyngeal or Adenoids
located in nasopharynx
Tubal

11. other tonsillar complications
Tonsillitis is an inflammation the tonsils in the mouth and will often, but not necessarily, cause a sore throat and fever. It may be caused by Group A streptococcal bacteria and similar appearances may also be seen in glandular fever. Most tonsilitis however is viral in origin.
other tonsillar complications
peritonsillar abcesses or quinsy can eventually lead to septicaemia
hypertrophy of tonsils can disturb sleep, lead to snoring and mouth breath and even sleep apnea
consumption of mucus by bacteria on tonsils – produce whitish-yellow deposits called tonsilloliths or tonsil stones – produce a sulforous odour.

12. Fascia Two types Superficial fascia Deep fascia – two divisions
Connects skin to underlying structures
Can contain copious amounts of fat
Deep fascia – two divisions
A. face & jaws
B. deep cervical

13. Fascia Face & jaws: continuous with deep cervical fascia
Temporal – covers temporalis muscle and runs down to the zygomatic arch
Masseteric-parotid – below the zygomatic arch
Covers the masseter and parotid gland
Pterygoid – found on the medial side of the medial pterygoid muscle
Deep cervical: all continuous with each other and with the fascia of the face and jaw
Investing – most external layer
Surrounds the musculature of the neck
Completely encloses the submandibular and parotid glands (continuous with the masseteric-parotid fascia), the sternocleidomastoid and the trapezius
Carotid sheath – encloses the external carotid, the internal jugular and the vagus nerve
Visceral – encloses the thyroid gland, trachea, esophagus
Near the skull this fascia is known as the buccopharyngeal fascia
Vertebral – deepest layer
encloses the deep musculature of the vertebral column and the vertebral column itself (e.g. semispinalis, longissimus, spinalis)

16. Fascial spaces
Spaces created by the deep fascia of face, jaws and cervical regions
All interconnected with each other
With the exception of the parotid space
Parotid space
Contains the parotid gland and facial nerve branches, external jugular branches and retromandibular vein

17. Contain specific anatomical structures Retropharyngeal – danger space
Parapharyngeal – lymph nodes
Previsceral – nodes and cervical vessels
Space of the body of the mandible – mandible and inferior alveolar nerve
Vestibular space of mandible
Submental space – submental nodes and anterior jugular
Buccal - fat
Pterygomandibular space of infratemporal region
Canine
Sublingual – sublingual gland and ducts, submandibular ducts, lingual nerve and artery, cranial nerve XII
Submandibular – submandibular nodes and gland, facial artery
Masticator space – temporal space + submasseteric space + infratemporal space
Infratemporal space – maxillary artery, mandibular nerve, pteygoid plexus

18. Vestibular space
-these spaces communicate directly with the eponymous teeth
e.g. vestibular space of the maxilla – maxillary molars and
periodontium
e.g. vestibular space of the mandible – mandibular teeth and
peridontium

19. -buccal space: between the buccinator and masseter muscles
-contains fat
-covered by part of the parotid fascia
-communicates with the canine and pterygomandibular spaces & space of the body of the mandible
-canine space: anterior border is the orbicularis oris
-posterior border is the levator anguli superioris
-located above the upper lip and to the side of the maxillary canine
-sits below muscle that lift the upper lip: the levator labii superioris, orbicularis oris, zygomaticus muscles

20. The Masticator Spaces Temporal space Infratemporal space
Submasseteric space
The Masticator Spaces
Temporal space
Infratemporal space
Submasseteric space

21. Masticator spaces
General term for the area of the mandible & associated muscles of mastication
1. temporal space (fig. 11-7): between the fascia that covers the temporalis muscle and the actual muscle
2. infratemporal space (fig. 11-8): found in the infratemporal fossa
Medial border – lateral pterygoid m.
Lateral border – mandible and temporalis m.
Superior border/roof – greater wing of sphenoid
Anterior border – pharynx
Contains the pterygomandibular space (fig 11-8) – contains the inferior alveolar nerve
Contains part of maxillary artery, mandibular nerve & branches, medial and lateral pterygoid muscles
3. submasseteric space (fig. 11-9): between the masseter & ramus of mandible

23. Space of the body of the mandible Sublingual & Submandibular spaces
-contains the inferior alveolar nerve (V3) and inferior
alveolar artery (maxillary artery)
in addition to the mandibular dental plexus, mental
and incisive branches of the IAN
-sublingual and submandibular
spaces contain the SL and SM glands
and lymph nodes
-the SL space also contains the ducts
for the SL and SM glands
-the SM space contains
part of the facial artery
-the SL space contains part of the lingual
nerve and artery + XII
Sublingual &
Submandibular spaces

24. Submental & Submandibular spaces
-submental space: roof is the mylohyoid m.
-floor is the superficial fascia that covers the suprahyoid m.
-lateral border is the anterior belly of digastric m.
Submental &
Submandibular spaces

25. Parotid space

26. retropharyngeal spaces
Parapharyngeal space: lateral
To the pharynx
-media to the medial pterygoid m.
-adjacent to the carotid sheath
-Contains lymph nodes
-continues with retropharyngeal space
Retropharyngeal space: posterior to
pharynx
-located between the vertebral &
visceral fascia
-called the danger space: extends from base
of skull into the thorax
Parapharyngeal &
retropharyngeal spaces