ORAL SURGURY PROJECT

Name-Pranoy Dutta Roll No.-03 Registration No.-2312 for 20010-11

The lymphatic system represents an accessory root through which fluid can flow from the interstitial spaces into the blood.It is auxillary to the venous system. Lymphatic system helps in carry proteins and large molecules which cannot be removed by direct absorption of the blood capillaries.

The main function of the lymphatic system is 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 helps in returning plasma proteins to the bloodstream. Lymphocytes are produced in the lymph nodes which provide the body an affective immunity by releasing antibody against infectious diseases. They filter out micro-organisms (such as bacteria) and foreign substances such as toxins, etc. It transports large molecular compounds (protein enzyme hormones) from the interstitial space to the bloodstream.

Overflow Mechanism
Small amount protein leak into the interstitial space which return to the circulation by venous end capillaries.

But after a certain limit protein tend to accumulate in the interstitial fluid which in turn increase colloidal osmotic pressure. In increased osmotic pressure fluid tends to accumulate in the interstitial space from blood capillary ;cause increased pressure and volume of interstitial fluid. Thus excess interstitial fluid pressure greatly increase the rate of lymph flow which carries away excess interstitial fluid and proteins.

Lymph-Lymph is a fluid similar in composition to blood plasma. It is

derived from blood plasma as fluids pass through capillary walls at the arterial end. As the interstitial fluid begins to accumulate, it is picked up and removed by tiny lymphatic vessels and returned to the blood. As soon as the interstitial fluid enters the lymph capillaries, it is called lymph.

Lymphocytes-

B-lymphocytes (B-cells) mature in the bone marrow. Tlymphocytes (T-cells) mature in the thymus gland

Lymphatic vessel-

Lymphatic vessels, unlike blood vessels, only carry fluid away from the tissues. The smallest lymphatic vessels are the lymph capillaries, which begin in the tissue spaces as blind-ended sacs.

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Lymphoid organsLymph Nodes Tonsils Spleen Thymus

The lymphatic organs include:

Lymph is a fluid similar in composition to blood plasma. It is derived from the interstitial fluid that flows into the lymphatic's. As the interstitial fluid begins to accumulate, it is picked up and removed by tiny lymphatic vessels and returned to the blood. As soon as the interstitial fluid enters the lymph capillaries, it is called lymph. Returning the fluid to the blood prevents oedema and helps to maintain normal blood volume and pressure. Rate of lymph flow:2-3 liter per day

Lymphatic vessels only carry fluid away from the tissues. The smallest lymphatic vessels are the lymph capillaries, which begin in the tissue spaces as blind-ended sacs. Lymph capillaries are found in all regions of the body except the bone marrow, central nervous system, and tissues, such as the epidermis, that lack blood vessels. The wall of the lymph capillary is composed of endothelium in which the simple squamous cells overlap to form a simple one-way valve. This arrangement permits fluid to enter the capillary but prevents lymph from leaving the vessel.

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Lymphatic organs are characterized by clusters of lymphocytes and other cells, such as macrophages, enmeshed in a framework of short, branching connective tissue fibers. The lymphocytes originate in the red bone marrow with other types of blood cells and are carried in the blood from the bone marrow to the lymphatic organs. When the body is exposed to microorganisms and other foreign substances, the lymphocytes proliferate within the lymphatic organs and are sent in the blood to the site of the invasion. This is part of the immune response that attempts to destroy the invading agent. The lymphatic organs include: Lymph Nodes Tonsils Spleen Thymus

Circular chain of lymph nodes

Occipital Position
Between mastoid process and external occipital protuberance Part of the occipital region

Post auricular
On the mastoid process ,superficial to the attachm ent of sterno cleiomastoid Temporal regional scalp,back of the pinna,Ex ternal auditory meatus.

Pre auricular
Just in front of the tragus superficial to the parotidomass eteric fascia. Anterior surface of the pinna and side of the scalp.

Parotid
In the substace of the parotid gland

Facial
a)sup.supramandibul ar Buccinator Infraorbital

b)Deep-near max artery near lat pteryg muscle

Draining area

Eyelid,scalp, ex aud meatu s,deep nose, nasopharynx, tympanic cavity

Sup.-

Conjunctiva,eye lid,nose,cheek. Deep-Back of the nose,pharynx,t emporal fossa,infratemp oral fascia.

Anterior cervical Position

Sup.-Near ant
jugular vein

Submental
In the submental triangle.

Submaxillary Superior cervical

In the sub maxillary triangle near submaxillary salivary gland. Around the external jugular vein,on the external surface of the sternocleidomas toid. The parotid region and lower part of the ear.

Deep-

Infrahyoid, Prelaryngeal Pretracheal

Draining area

Sup-It drains the skin of the neck. Deep-It drains the larynx thyroid gland and trachea.

Central part of the lip,floor of the mouth,tip of the tongue.

Inner angle of the eye,side of the nose,hole upper lip, cheeck,gum, Side of the tongue.

 Efferent from the circular chain drains into the deep cervical lymph nodes except facial and submental which drains into the submaxillary lymph nodes. Jugulo Digastric Position
Below the posterior bally of digastric between the angle of the mandible and ant border of sternocleidomas toid. Antero-superior group

Jugulo Omohyoid
Lies above the inferior bally of omohyoid, behind the jugular vein undercover the sternocleidomas toid. Postero-inferior group

Group

Waldeyer's tonsillar ring is an anatomical term collectively describing the annular arrangement of lymphoid tissue in the pharynx. Waldeyer's ring circumscribes the nasoand oropharynx, with some of its tonsillar tissue located above and some below the soft palate (and to the back of the oral cavity).

The status of the regional lymphatic's is one of the most important prognostic indicators in patients with head and neck cancer. HNSCCs that are localized to the primary site without regional lymph node metastasis have excellent cure rates with either surgery or radiation therapy. The presence of regional metastases results in cure rates that are approximately half of those obtainable if metastasis to the regional lymphatic's is not present. Thus the treatment of the neck has become one of the most actively debated topics in the field of head and neck oncology.

Cervical lymphadenopathy refers to lymphadenopathy of the cervical lymph nodes (the glands in the neck). Causes are: 1. Rubella 2. Cat scratch fever 3. Infectious mononucleosis 4. Streptococcal pharyngitis 5. Viral respiratory infection 6. Toxoplasmosis 7. Tuberculosis 8. Brucellosis 9. Primary herpes simplex infection 10. syphilis(secondary) 11. Cytomegalovirus 12. HIV 13. Histoplasmosis 14. chicken pox 15. Malignancy

Mycobacterial cervical lymphadenitis, also known as scrofula, refers to a lymphadenitis of the cervical lymph nodes associated with tuberculosis as well as non tuberculous (atypical) mycobacteria.

Tonsillitis is inflammation of the tonsils most commonly caused by viral or bacterial infection. Common sign & symptoms are: sore throat red, swollen tonsils pain when swallowing high temperature (fever) coughing headache tiredness chills a general sense of feeling unwell (malaise) white pus-filled spots on the tonsils swollen lymph nodes (glands) in the neck pain in the ears or neck

Peritonsillar abscess (PTA), also known as a quinsy is a recognized complication of tonsillitis and consists of a collection of pus beside the tonsil in what is referred to as Peritonsilar space. Sign & symptomps are:

Severe unilateral pain in the throat; Pyrexia above 103 degree F (39C); Unilateral Earache; Odynophagia and difficulty swallowing saliva; Change in voice muffled voice, hot potato voice; Intense salivation and dribbling, Thickened speech, Foetor oris, Halitosis; Pain in the neck; Malaise, Headache, Rigor

Lymphadenectomy or lymp h node dissection is the surgical removal of one or more groups of lymph nodes. It is almost always performed as part of the surgical management of cancer. In a regional lymph node dissection, some of the lymph nodes in the tumor area are removed; in a radical lymph node dissection, most or all of the lymph nodes in the tumor area are removed

The neck dissection is a surgical procedure for control of neck lymph node metastasis. This can be done for clinically or radiologically evident lymph nodes or as part of curative surgery where risk of occult nodal metastasis is deemed sufficiently high. The aim of the procedure is to remove lymph nodes from the neck into which cancer cells may have migrated. Metastasis of tumours into the lymph nodes of the neck is one of the strongest prognostic indicators for head and neck cancer. The metastases may originate from tumours of the upper aerodigestive tract, including the oral cavity, tongue, nasopharynx, oropharynx, hypopharynx, and larynx, as well as the thyroid, parotid and posterior scalp. Neck nodal metastasis can sometimes also originate from lung cancer or intra-abdominal malignancy. However, neck dissection is rarely performed for such purposes.

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A lymph node biopsy is the removal of lymph node tissue to be looked at under a microscope for signs of infection or a disease, such as cancer. There are several ways to do a lymph node biopsy. Such as: Fine-needle aspiration biopsy. Core needle biopsy. Open (surgical) biopsy.

We know that our oral cavity is the gateway of our entire system and as well as the gateway of various infections. So the lymphatics of head & neck region is far more important then any other part of the body. A brief knowledge of lymphatics of the head and neck help us to detect a huge spectrum of clinical manifestation as well as control and prevention of any disease. Lymphatic's of head and neck has a very major roll in metastasis of oral cancers. Thats why the anatomy and physiology of the lymph nodes of head & neck should be cleared.

Acknowledgment 1. Head & Neck Anatomy: A K D 2. Greys Anatomy 3. Wikipedia 4. www.bartleby.com 5. Oral Surgery: N A Malik