Cervical lymph nodes

Cervical lymph nodes, brief ppt.

1. CERVICAL LYMPH NODES SIGNIFICANCE By Dr. S G YADUNAND

2. INTRODUCTION Lymphatics and lymph vessels play an important role in draining waste fluid from the body. Hence they are vulnerable for various infections. Lymphatics are connected to a group of lymph nodes and then drain into the veins. Hence infections of the lymphatics give rise to enlargement of lymph nodes.

3. Lymphatics of Head and Neck Lymphatic network of head and neck area is located in two layers separated by deep cervical fascia Superficial Lymphatics : drain to sub-occipital, pre-auricular and post-auricular, facial and external jugular, submental and submandibular lymph nodes. These groups eventually drain into the deep cervical lymph nodes Deep cervical lymph nodes are along the Internal Jugular Vein and in the central neck (drains the lymph from oral cavity, pharynx, larynx, and true glands of neck.

4. Levels of Neck Nodes Lymph nodes of the neck are further classified by levels. High clinical importance  Level I – 1A Submental & 1B Submandibular  Level II – 2A Superior Jugular & 2B Jugulo -digastric  Level III – Middle Jugular  Level IV – Lower Jugular  Level V – Posterior Triangle  Level VI – Anterior/Central Compartment  Level VII – Superior Mediastinal

5. Cervical Lymphadenopathy Lymphadenopathy or adenopathy is disease of the lymph nodes, in which they are abnormal in size, number, or consistency . Lymphadenopathy of an inflammatory type (the most common type) is lymphadenitis, producing swollen or enlarged lymph nodes. Cervical nodes drain the tongue, external ear, parotid gland, and deeper structures of the neck, including the larynx, thyroid, and trachea. Inflammation or direct infection of these areas causes subsequent engorgement and hyperplasia of their respective node groups. Cervical lymphadenopathy is a common problem in children. Adenopathy is most common in cervical nodes in children and is usually related to infectious etiologie s.

6. CONT..  Lymphadenopathy is a common and nonspecific sign. Common causes include infections (from minor ones such as the common cold to dangerous ones such as HIV/AIDS), autoimmune diseases, and cancers . Lymphadenopathy posterior to the sternocleidomastoid is typically a more ominous finding, with a higher risk of serious underlying disease . The involvement of specific nodal groups is an indicator of pathologically-affected organs and tissues, especially in the context of malignancy. Lymphadenopathy is also frequently idiopathic and self-limiting.

7. PRESENTATION OF LYPHADENOPATHY BY ANATOMIC PERCENTAGES

8. Infectious Etiologies Cervical adenopathy is a common feature of many viral infections . The classic manifestation of group A streptococcal pharyngitis is sore throat, fever, and anterior cervical lymphadenopathy. Mycobacterium tuberculosis may manifest with a suppurative lymph node Catscratch disease caused by a bacteria, presents with subacute lymphadenopathy often in the cervical region. The disease develops after the infected pet (usually a kitten) inoculates the host, usually through a scratch.

9. Other types of LYMPHADENOPATHY Submaxillary and Submental lymphadenopathy: These nodes drain the teeth, tongue, gums, and buccal mucosa. Their enlargement is usually the result of localized infection, such as pharyngitis, herpetic gingivostomatitis , and dental abscess . Occipital lymphadenopathy: Occipital nodes drain the posterior scalp. These nodes are palpable in 5% of healthy children. Common etiologies of occipital lymphadenopathy include tinea capitis , seborrheic dermatitis, insect bites , orbital cellulitis, and pediculosis . Viral etiologies include rubella and roseola infantum . Rarely, occipital lymphadenopathy may be noted after enucleation of the eye for retinoblastoma. Pre-auricular lymphadenopathy: Pre-auricular nodes drain the conjunctivae, skin of the cheek, eyelids, and temporal region of the scalp and rarely are palpable in healthy children. The Oculo -glandular syndrome consists of severe conjunctivitis, corneal ulceration, eyelid oedema, and ipsilateral pre-auricular lymphadenopathy. Supraclavicular lymphadenopathy: Supraclavicular nodes drain the head, neck, arms, superficial thorax, lungs, mediastinum, and abdomen. Left supraclavicular nodes also reflect intra- abdominal drainage and enlarge in response to malignancies in that region. This is particularly true when adenopathy in this region occurs in the absence of other cervical adenopathy.

10. SIGNIFICANCE STATUS OF CERVICAL LYMPH NODES AT TIME OF PRESENTATION IS AN IMPORTANT FACTOR IN PROGNOSIS OF SQ. CELL CARCINOMA OF UPPER AERODIGESTIVE TRACT SURVIVAL IS REDUCED TO 50% IN C/O CERVICAL METASTASIS Dissemination of cancer to regional CLN sites in UADT occur in a predictable and stepwise manner. Spread from Primary metastasis – Selected group of lymph nodes will be effected (according to Classification based on L1 to L7) This is highly helpful in tackling the tumor surgically. Primary site of Metastasis along with the Cervical Lymph Node which are involved are surgically removed in such cases. In c/o Secondary Cervical metastasis Level of involved lymph node will guide us to the primary tumor.

11. PHYSICAL EXAMINATION Swelling of infectious origin usually – 2 weeks Swelling that persists more than 2 weeks should be sent for Investigations like USG,CT,MRI, Biopsy,Ca125 and malignancies should be ruled out ( irrespective of the size of the tumor ) Careful palpation of all the CLN should be done.

12. I f lymph nodes are detected, the following five characteristics should be noted and described: 1.Size 2.Pain/Tenderness 3.Consistency 4 .Mobility

13. 1.SIZE: Nodes are generally considered to be normal if they are up to 1 cm in diameter. Generally non-palpable lymph nodes larger than 2 cm in diameter (along with an abnormal chest radiograph and the absence of ENT symptoms ) were predictive of granulomatous diseases (i.e., tuberculosis, cat-scratch disease) or cancer (predominantly lymphomas).

14. 2.PAIN/TENDERNESS : Pain is usually the result of an inflammatory process or suppuration, but pain may also result from hemorrhage into the necrotic center of a malignant node. The presence or absence of tenderness does not reliably differentiate benign from malignant nodes 3.CONSISTENCY: Stony-hard nodes are typically a sign of cancer, usually metastatic. Very firm, rubbery nodes suggest lymphoma. Softer nodes are the result of infections or inflammatory conditions. Suppurant nodes may be fluctuant. 4.Mobility : Fixed nodes suggest metastatic carcinoma, whereas freely movable nodes may occur in infections

15. Conclusion I ntimate knowledge of the anatomic relationships of the lymphatic nodal levels and the structures they drain is critical in the delivery of appropriate therapy in many patients with cancers of the head and neck.

16.  TREATMENT & MANAGEMENT  Medical Care: Treatment is determined by the specific underlying etiology of lymphadenopathy. Mostly conservative treatment is done. Antibiotics should be given only if a bacterial infection is suspected. This treatment is often given before biopsy or aspiration is performed. Most enlarged lymph nodes are caused by an infectious process. If aspects of the clinical picture suggest malignancy, such as persistent fevers or weight loss, biopsy should be pursued sooner. Surgical care: Surgical care usually involves a biopsy. If lymphadenitis is present, aspirate may be needed for culture, and removal of the affected node may be indicated . Surgery indicated in case of malignancies.

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