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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 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 macrophages -cleans the blood 4) bone marrow – stem cells + lymphocytes/macrophages -cleans the blood 5) Thymus – production of T cells 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 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 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 Cervical Nodes -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) 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 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 • located in nasopharynx • 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 whitishyellow deposits called tonsilloliths or tonsil stones – produce a sulforous odour. Fascia • Two types 1. Superficial 2. Deep • Superficial fascia – Connects skin to underlying structures – Can contain copious amounts of fat • Deep fascia – two divisions – A. face & jaws – B. deep cervical 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) 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 • http://flashcarddb.com/cardset/124977-fascial-spaceslect-5-mod-4-flashcards • • • • • • • • • • • • • 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 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 -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 Temporal space Infratemporal space Submasseteric space The Masticator Spaces 1. Temporal space 2. Infratemporal space 3. Submasseteric space 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 Space of the body of the mandible -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 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. Parotid space 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