Lymph Drainage of Head and Neck
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Questions and Answers

The upper cervical nodes primarily receive lymphatic drainage from the anterior part of the tongue and lower pharynx.

False (B)

The jugular lymph trunk is responsible for collecting lymph from the superior end of the deep cervical chain.

False (B)

All outlying lymph nodes in the head and neck ultimately drain into the superficial cervical group.

False (B)

Hyaline cartilage is a characteristic component covering the bone surfaces within the temporomandibular joint.

<p>False (B)</p> Signup and view all the answers

The articular disc of the temporomandibular joint is attached to the capsule exclusively at its anterior margin.

<p>False (B)</p> Signup and view all the answers

Submental nodes are positioned inferior to the chin, proximate to the midline.

<p>True (A)</p> Signup and view all the answers

The lateral temporomandibular ligament becomes most taut when the mandible is in the rest position.

<p>False (B)</p> Signup and view all the answers

Submandibular nodes are situated superiorly above the mandible, and some are embedded within the submandibular gland.

<p>False (B)</p> Signup and view all the answers

Anterior cervical nodes are positioned along the external jugular vein.

<p>False (B)</p> Signup and view all the answers

The sphenomandibular ligament is considered an accessory ligament of the temporomandibular joint because its lower attachment point is at the mandibular condyle.

<p>False (B)</p> Signup and view all the answers

Superficial cervical nodes are located adjacent to the external jugular vein.

<p>True (A)</p> Signup and view all the answers

According to Hilton's law, the temporomandibular joint receives nerve supply from the auriculotemporal nerve and fibers from the nerve to temporalis.

<p>False (B)</p> Signup and view all the answers

In the occluded position, the temporomandibular joint bears the primary burden of stabilization against upward blows to the mandible.

<p>False (B)</p> Signup and view all the answers

In the midline of the neck, lymph nodes can be found in the infrahyoid, prelaryngeal, and retrotracheal positions.

<p>False (B)</p> Signup and view all the answers

Occipital nodes are positioned over the upper attachment of the sternocleidomastoid muscle.

<p>False (B)</p> Signup and view all the answers

Spasm of the anterior deep fibers of the masseter muscle is primarily responsible for preventing reduction in cases of anterior dislocation of the temporomandibular joint.

<p>False (B)</p> Signup and view all the answers

Preauricular or parotid nodes are exclusively located outside the capsule of the parotid gland.

<p>False (B)</p> Signup and view all the answers

A typical separation of $5-6$ mm between the upper and lower teeth is observed when the mandible is in its rest position.

<p>False (B)</p> Signup and view all the answers

Deep cervical nodes are distributed along the carotid sheath, both anterior and posterior to it.

<p>True (A)</p> Signup and view all the answers

Jugulo-omohyoid nodes are classified within the upper group of deep cervical nodes.

<p>False (B)</p> Signup and view all the answers

The inverted epiglottis divides the bolus into three channels.

<p>False (B)</p> Signup and view all the answers

The sequence of swallowing begins in the larynx.

<p>False (B)</p> Signup and view all the answers

Passavant's ridge prevents food from entering the trachea.

<p>False (B)</p> Signup and view all the answers

The digastric and lateral pterygoid muscles cause the mandible to rotate, while the infrahyoid muscles serve to tether the pulley for the digastric tendon.

<p>True (A)</p> Signup and view all the answers

The elevation of the pharynx aids in propelling the bolus downwards.

<p>True (A)</p> Signup and view all the answers

The bolus travels down the esophagus at a speed of approximately 3-5 meters per second.

<p>False (B)</p> Signup and view all the answers

When the mouth is opened wide, the lateral pterygoid muscle pulls the head of the mandible out of the mandibular fossa.

<p>True (A)</p> Signup and view all the answers

In an unconscious patient, the mouth may fall open due to passive hinge movement in the upper compartment of the temporomandibular joint.

<p>False (B)</p> Signup and view all the answers

The peristaltic wave changes noticeably as it transitions from skeletal to visceral muscle in the esophagus.

<p>False (B)</p> Signup and view all the answers

The axis of mandibular movement during jaw opening and closing passes through the mental foramina.

<p>False (B)</p> Signup and view all the answers

The hyoid bone plays a passive role in the swallowing mechanism.

<p>False (B)</p> Signup and view all the answers

The medial and lateral pterygoid muscles work synergistically on one side to produce side-to-side jaw movements.

<p>True (A)</p> Signup and view all the answers

The larynx opens to resume respiration before the bolus enters the esophagus.

<p>False (B)</p> Signup and view all the answers

The epiglottis physically pushes the bolus into the lateral food channels.

<p>False (B)</p> Signup and view all the answers

During protraction of the mandible, the lateral pterygoids retract the heads of the mandible and the articular discs.

<p>False (B)</p> Signup and view all the answers

The elevation of the soft palate opens the auditory tube.

<p>True (A)</p> Signup and view all the answers

The stylohyoid and geniohyoid muscles primarily determine the vertical position of the hyoid bone.

<p>False (B)</p> Signup and view all the answers

The infrahyoid muscles elevate the hyoid bone and oppose the mylohyoid, geniohyoid, and stylohyoid muscles.

<p>False (B)</p> Signup and view all the answers

The first stage of swallowing involves the involuntary passage of the bolus through the oropharyngeal isthmus.

<p>False (B)</p> Signup and view all the answers

During swallowing, the epiglottis is actively pulled down by muscles to cover the larynx.

<p>False (B)</p> Signup and view all the answers

Flashcards

Lymph Drainage

The process by which lymph is transported from tissues to lymph nodes.

Deep Cervical Nodes

Nodes that are located along the carotid sheath in the neck.

Submental Nodes

Lymph nodes located below the chin near midline.

Submandibular Nodes

Lymph nodes located below the mandible, some within the submandibular gland.

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Anterior Cervical Nodes

Lymph nodes situated along the anterior jugular vein.

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Jugulodigastric Nodes

Palpable lymph nodes in the upper deep cervical group near the digastric muscle.

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Jugulo-Omohyoid Nodes

Lymph nodes found in the lower deep cervical group near the omohyoid muscle.

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Supraclavicular Group

The lowest group of lymph nodes near the clavicle.

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Occipital Nodes

Lymph nodes located over the upper attachment of the trapezius muscle.

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Retropharyngeal Nodes

Deep lymph nodes located behind the pharynx.

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Upper lymph nodes

Receive lymph from the back of the tongue, tonsils, and upper pharynx.

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Lower lymph nodes

Receive lymph from the face, anterior tongue, and lower pharynx.

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Jugular lymph trunk

Collects lymph from the lower deep cervical chain.

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Thoracic duct

Main duct that drains lymph into the venous system from the left trunk.

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Temporomandibular joint (TMJ)

A synovial joint connecting the mandible to the temporal bone.

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Articular disc of TMJ

Fibrocartilaginous disc that separates TMJ into upper and lower cavities.

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Lateral pterygoid muscle

Muscle that assists in moving the mandible during jaw movements.

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Stability of TMJ

Joint stability is greater when teeth are in occlusion rather than open.

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Anterior dislocation of TMJ

Common form of displacement in which the mandibular head moves forward.

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Movement of TMJ

In rest position, there’s a small gap (3-4 mm) between teeth.

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Mandibular Movements

Three types of movements: protraction/retraction, depression/elevation, side-to-side.

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Muscles of Mastication

Muscles involved in jaw movement: temporalis, masseter, medial/lateral pterygoids.

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Protraction

Movement of the jaw forward, commonly seen in defiance.

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Depression of Mandible

Opening the jaw involving hinge and gliding movements.

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Elevation of Mandible

Closing the jaw, primarily using masseters and pterygoids.

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Side-to-Side Movements

Lateral movements of the jaw for grinding food.

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Mylohyoid Muscles

Muscles forming the floor of the mouth and aiding in elevation.

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Swallowing Phases

Two stages: voluntary (bolus into oropharynx) and involuntary (pharygx/larynx elevation).

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Elevation of Hyoid Bone

Essential during swallowing, supports larynx movement.

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Aryepiglottic Muscles

Muscles that close the laryngeal inlet during swallowing.

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Bolus

A small, rounded mass of chewed food ready to swallow.

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Inverted Epiglottis

A flap that closes over the larynx during swallowing, guiding food.

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Stages of Swallowing

The sequence includes the mouth, pharynx stages.

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Hyoid Bone Movement

Elevates during swallowing to assist the bolus down.

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Soft Palate Elevation

The soft palate rises to close off the nasopharynx during swallowing.

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Auditory Tube Opening

The tube opens when the soft palate elevates, equalizing pressure.

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Pharyngeal Constrictors

Muscles that contract to push the bolus down into the esophagus.

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Peristaltic Wave

Wave-like muscle contractions that move the bolus through the esophagus.

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Esophagus Muscle Types

Consists of skeletal and visceral muscle for swallowing.

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Regurgitation Prevention

The bolus moves past the esophagus level, preventing it from going back up.

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Study Notes

Lymph Drainage of Head and Neck

  • Lymph from outlying nodes eventually drains into deep cervical nodes.
  • Outlying nodes are named based on location (e.g., submental, submandibular, cervical).
  • Some outlying nodes are subcutaneous and palpable, while others are deeper.
  • Deep cervical nodes are located along the carotid sheath, both anterior and posterior.
  • Deep cervical nodes are divided into upper and lower groups.
  • Upper group nodes receive lymph from the back of tongue, tonsils, ear, nose, sinuses, pharynx, and larynx.
  • Lower group nodes receive lymph from the face, anterior scalp, anterior tongue, lower pharynx, larynx, thyroid, and mediastinum (and possibly stomach).
  • Lymph from the lower deep cervical chain enters the jugular lymph trunk.
  • The left jugular trunk typically drains into the thoracic duct, or the internal jugular or subclavian veins.
  • The right jugular trunk drains into the right lymphatic duct or the right brachiocephalic vein.

Temporomandibular Joint

  • Synovial joint between the mandible's head and temporal bone's mandibular fossa.

  • Fibrocartilaginous disc separates upper and lower cavities.

  • Articulating surfaces lack hyaline cartilage.

  • Synovial membrane lines the newborn joint capsule, but normally reduces to a fringe.

  • Joint capsule is attached to the mandible's articular margin, anterior to the articular tubercle, posterior to the squamotympanic fissure, and medial and lateral between these lines.

  • Articular disc is attached to the capsule's inside, with an undulating shape to fit the bony surfaces.

  • Upper lateral pterygoid fibres insert into the anterior disc margin and capsule.

  • Lateral temporomandibular ligament connects zygomatic arch to mandible's neck and ramus, blends with deep capsule.

  • Ligament tightens with mandible retraction and protrusion.

  • Mandibular fossa is a deep spoon-shaped concavity.

  • Accessory ligament: sphenomandibular ligament runs between sphenoid and mandible, stays constant in length. Nerve supply comes from auriculotemporal and masseter nerves.

  • Stability: More stable with teeth in occlusion, due to tooth stabilization and muscle support preventing dislocation.

  • Less stable when jaw is open, as condyle slides and is susceptible to dislocation.

  • Anterior dislocation is common, usually resolves by repositioning the condyle.

  • Temporalis, masseter, medial, and lateral pterygoids are major masticatory muscles.

Movements

  • Jaw movements (protrusion, retraction, depression, elevation, side-to-side).

  • Lateral pterygoids pull mandible forward (protrusion); temporalis pulls mandible back (retraction).

  • Opening the mouth - combination of hinge and gliding movements.

  • Closing the mouth – masseters, medial pterygoids, and temporalis muscles contract.

  • Side-to-side movements result from alternating activity between pterygoid muscles.

  • During anterior dislocation, masseter spasm can prevent reduction; need to overcome muscle tension to release.

Floor of the Mouth

  • Floor of the mouth is composed of mylohyoid muscles.
  • Mylohyoid contraction elevates floor; geniohyoid and stylohyoid change position of hyoid bone and floor length.
  • Infrahyoid muscles oppose the elevators.

Swallowing

  • Swallowing involves voluntary (oral) and involuntary (pharyngeal/esophageal) stages.
  • Larynx and pharynx elevate to receive bolus, along with hyoid bone.
  • Laryngeal inlet closes, and epiglottis inverts to protect airway.
  • Peristaltic wave moves bolus through esophagus.
  • Soft palate elevates and seals off nasal cavity, opening auditory tube.

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Description

This quiz covers the lymphatic drainage of the head and neck, detailing how lymph from various outlying nodes is processed through deep cervical nodes. It explains the functions of upper and lower groups of nodes and their lymph sources. Test your understanding of this essential anatomical system.

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