Lymphatic system of head and neck

so hi everyone myself dr saiti team mgskonker so the next topic from your anatomy for your basics paper is a lymphatic system of hydra neck so as every every essay question has to start with content so you have to put on this contents as given here so you can start the introduction like it's a closed system of lymphatic channels or vessels through which the lymph flows so it's actually one way system where the limb flows from the tissue spaces to to the blood okay so this is how you can start the introduction and then you can go with next is the development so in the fifth week the lymphatic vessels and the main clusters of the lymph nodes are being formed and they arise from the budding of the limb sacs from the developing veins so it's just a mild uh introduction of the development okay so again the lymphoid organs then develop into a mison mesodermal mesenchymal cells and the thymus being the first lymphoid organ to appear okay and except spleen and tonsils other lymph node uh organs are actually poorly developed before the birth so they're actually developed after the bath except the spleen and tonsils so this is a little introduction of the development that you can give next coming to its anatomy and physiology which is very important so the lymphatic system actually consists of all these that is the limb the lymph vessels the lymphoid cells the lymphoid tissues lymph nodes and the lymphoid organs so we'll discuss with everything in detail so the lymph is nothing but the extracellular fluid connective tissue which is dominated by the lymphocytes so as the blood circulates throughout the body the nutrients the waste and the gases are being exchanged between the blood and the interstitial fluid so four primary hydro start hydrostatic and the colloidal osmotic forces actually determine the fluid movement through the capillary membrane those are called as a stalling forces so those include the capillary pressure the interstitial fluid pressure the capillary plasma colloidal osmotic pressure and the interstitial fluid cause osmotic pressure so this is how these are the stalling forces because of which the fluid actually gets exchanged so you think if you can just put this it's enough so just have a look and put this diagram that's more than enough okay so next coming to the lymphatic vessel so the lymphatic vessels are the one way system from uh in which the lymph flows towards the heart so this transport actually begins in microscopic blind and lymphatic capillaries so you can see the capillaries which are seen here okay so you can just put these uh the lymphatic capillaries the green capillaries which you can see in this diagram so you can draw this diagram and you can enhance your answer okay next the flow of the lymph is like wire lymphatic capillaries towards the vessels towards the trunk and finally to the ducts okay this is how the lymph flows so the lymph transport is actually the smooth vessel which is in the walls of the lymphatic trunks and the thoracic duct actually contracts rhythmically to help in pumping the lymph so this is how the lymph is being transported so the lymphoid cells are the lymphocytes which arise in the red bone marrow and they mature to form the t cells and b cells we know that so activated t cells manage the immune system so they directly attack the and destroy the infected cells and b cells are mainly responsible for producing the plasma cells which again are very important to secrete the antibodies okay so these are the lymphoid cells so next coming to the lymphoid tissue so again you can write it's largely it is a reticular connective tissue so the lymphocytes actually reside temporarily in the lymphoid tissue and then they leave to patrol the body again so just a little every ceased i as i suggest the headings of every question is very important so now the anat part we have been discussing the lymph the lymphoid cells the lymphoid tissue all that so first put headings and write description for everything so not entire detailed description is not required single line description or two three lines description is enough because essay question you can't write more than six to seven pages right so if you can put forward few flow charts and diagrams and descriptive part it will definitely increase your bulk of your answer okay so again the lymph nodes we know the important lymph nodes which are there so then they are actually main two major functions of the lymph nodes that is the lymph filters and it also activate the immune system okay so next coming to the structure of the lymph node so string lymph nodes are again very important so they're actually being shaped structures and histologically it has two characteristic distinct regions which includes the cortex and the medulla so it is actually it is a structure which is encapsulated and it has a connecting strands which are called as trabeculae okay so this is simple lymph node structure do draw this diagram if a lymphatic system is asked for the essay question this diagram will add or will fetch you more marks so draw this diagram it's simple to draw so do draw it next coming to the lymphoid organs the primary and the secondary the primary lymphoid organs are the thymus and the bone marrow so again you can describe the thymus so it is behind the sternum and especially well developed a newborn and the growing child so the surface of the thymus is divided into many lobes so this is the draw diagram of the thymus if you can draw it's okay or else you can ignore it's okay so next coming to the spleen spleen is again a lymphoid organ so it is one of the largest inflate organ okay so here with we have given a basic idea of the an anatomy part or the important aspect related to the lymphatic system so you have to write in in a same order okay just make first after this discussion again note the important headings and the individual descriptive part which is important that's enough okay so you can write the lymphatic cells the lymphoid tissues the lymph nodes the lymphoid organs again individually you can have the individual descriptions you can add it later okay so next coming to the tonsils these are again the lymphoid organs so coming to the oral facial region so coming important in the oro facial regions are the tonsils okay so we know the valdez ring so this valdez ring diagram has to fall in so you can diagrams which are important as i said it's a cross structure cross section of the lymph node you have to draw later you have to draw this valdez ring if it is oro facial region so valid ring all these are the important lymphoid organs related to the oral facial ring so you have to draw this diagram okay so which include the tubal tonsils and esophageal tonsils or the eddy noise the palatine the lingual tonsils and the lateral pharyngeal bands so these have to you have to put in this word and you have to draw this diagon that will be very fetching so then you have to classify okay the hedonic lymph nodes you have to classify like which come under the superficial and the deep okay the outer circle the inner circle these are the outer circle and these are the inner circle and the deep terminal lymph nodes that is the upper jugular digastric and the inner comes the homo hyoid so the outer circle importantly the submandibular supplemental buccal parotid moistoid occipital and the superficial cervical and the anterior cervical whereas the inner circle includes the pre laryngeal pre tracheal para tracheal and the retropharyngeal so this is directly taken from your chaurasia so next this is according to the gray's anatomy so horizontal chain uh textbook this is given like that so you even you can mention so according to grace it is given like this even while writing the answer if you if you can mention that's again fetching so horizontal chain outer circle inner circle and the valdez ring okay so the outer circle in the head and in the neck again you can classify so in the head it's hospital retroacticular parotid and buccal and in the neck it's submandibular submental and the cervical lymph node so like this you can write so inner circle again all these that is pre-danger pre-tracheal paratract electrophagy lingual and the infra hyoid okay so the vertical chain includes all these so you have you have to write accordingly so this is if you're right it's really fetching okay so according to shower rasher it's uh that classification which was clearly described in the flow chart and according to the grace it is like it is given like this outer circle and the inner circle and again horizontal and the vertical chains are being given so you can write like that now in case if it is an essay answer you can just put a box like this you can draw a very big box and you can write the innervations efference and the difference of that particular lymph node so do have a look of individual lymph nodes it's quite simple the name itself has the has the reference and reference hospital is like the hospital region and difference is to the superior cervical glands okay it's like that so posterior clear is again from the temporal region or the auricular and a pinna that's the back side of the external auditory meatus and again it difference or it goes to the superior deep uh cervical gland so the pyrotech individual glands you can individual lymph nodes you can write so so do write do make a note of this it's very important so if you write because that is the main heart of your answer okay so again the facial nodes the submandibular nodes so how the the location the reference and the difference if you write like this it is really fetching so do write it like this all the other nodes like the submental the anterior cervical and the superficial cervical so i'm not going to read everything anyways this is there in these boxes so just make a note of this so the rest all is one thing and this is again another thing so this is the main scoring part the diagrams and this box will fetch you more marks so do draw this box if you can okay so next coming to the drainage of the scalp and the ear so it's just additive points it's not required but if you can write for the scalp and the ear its its useful so just write these if you can next of the face this is actually important so this diagram again you can draw so the upper part is to the preorder lymph nodes the middle part is submandibular and the lower part is to sub mental so you can draw this diagram so as it shows and you can label it there so do draw the diagram and do mention for the lymphatic drainage of the face so coming to the clinical approach so you need to take the detailed history of if you if you think the patient is having an any etiology of related and large lymph nodes then you have to take the detailed history later you have to evaluate you know every every dentist usually does this or inspection and palpation so we have to evaluate for the location number size consistency discrete the number of unmatted nodes tenderness and even fix it to the underlying structure so this examination is important so how do you examine you everyone knows that so but you have to write because the clinical aspects is very important so individual nodes you have to write for pre oracle post oracle so periodically it's like in front of the ear you do with your in uh fingers and then digital aspect of your fingers and again post oracle do submit the submandibular glands you have to bend the neck towards the side of examination for supplement you'll have to bend the neck forwards and then you have to examine okay again this diagram clearly shows the super superficial cervical the posterior cervical you have to bend opposite and you have to the look for the lymph nodes deep cervical and the supraclavicular okay this is how you have to examine then if the palpation node characteristics you have to write so it could be the acute infection its last soft pain full mobile discrete rapid onset chronic infection it is large form less tender lymphomas it is rubbery inconsistency metastatic cancer it is tony hard and it is fixed to the underlying structures so you have to write these this very fetching syphilis it is shorter lymph nodes tuberculosis tuberculosis you know what the matter dymph nodes are there but again it is as three stages the first stage nodes are enlarged without matting in the second stage matting is same third stage collapses occur and other applied aspects so it's again useful so lymph node examination and lymph nodes evaluation is very important in prediction of the disease history for diagnosis and also in prediction for the prognosis and the treatment outcome okay so for head and neck side so especially for the oral medicine and oral pathology students you have to write the nodal staging of the node nodal staging end stage and you have to write okay so this is very important so next again you have to write the disease of the lymphatics that is lymph lymphangitis neoplasms of the lymphatics you have to just mention these and then you have to write the disease of the specific lymph nodes either it could be inflammatory neuroplastic or leukemias or autoimmune disorders you can write this classification which is given here and then you have to clearly mention about the lymphadenitis so it could be any infectious or it could be added to any other underlying cause so you can write these and lymphadenopathy is nothing but the enlargement of one or more lymph nodes which is described as greater than one centimeter in its size so generalized lymphadenopathy these are the causes so it could be infectious like systemic viral infections or infectious mononucleosis or hiv or it could be any malignant etiology like the leukemias or lymphomas and storage disorders like the niemann pics disease and localized lymphadenopathy it could be the in local infection cervical infections either bacterial viral and all that or a non-infectious etiology could be acute leukemia lymphomas kawasaki disease and neuroblastoma okay so sub maxillary and submental again the oral and dental infections and occipital includes rubella and scalp infections and pre-oracular includes any skin infections or scat scratch disease or any ophthalmic infection so supraclavicular lymphadenopathy okay the workhorse nodes we call it so if it is on left uh left uh it's related to malignancy on right it is inter thoracic lesions simple so i have just give a