Transcript 24. para.lymph1242010-10

Pterygopalatine Ganglion
Preganglionic parasympathetic
secretomotor fibers arise in the
lacrimal nucleus of the facial nerve
which lies in the lower pons. They run
in the nervous intermedius of the
facial nerve, then in its greater
petrosal branch, then in the nerve of
pterygoid
canal.
Postganglionic parasympathetic
fibers reach the maxillary nerve by
one of its ganglionic branches. They
then run in the zygomatic nerve then
to its zygomatico-temporal branch
which joins the lacrimal nerve to
lacrimal gland.
Other postganglionic
parasympathetic fibers run in the
palatine nerves and nasal nerves to
the palatine and nasal glands.
Sympathetic postganglionic fibers
from the superior cervical ganglion
reach the ganglion via the internal
carotid plexus, then in the deep
petrosal nerve, then in the nerve of
pterygoid canal.
Branches:
1-The pharyngeal branch:
It supplies the mucous
membrane of the roof of the
nasal part of the pharynx.
2-The greater; lesser palatine ns.
They supply the mucous
membrane of the palate, tonsil
and nasal cavity.
3- The nasal & nasopalatine ns:
They enter the nose through
the sphenopalatine foramen
and supply the mucous
membrane and glands of the
nasal cavity.
Spheno-palatine foramen:
It connects the posterior part of the superior
meatus with the pterygo- palatine fossa.
4- Orbital branches:
They enter the orbit through the
inferior orbital fissure to
supply the smooth orbitalis
muscle which bridges the fissure
by sympathetic postganglionic fs
Lymph drainage
Regional Groups
1-Occipital lymph nodes
They lie at the apex of the postetrior
triangle. They receive lymph from the
back of the scalp. The efferent vessels
drain into the deep cervical lymph nodes.
2- Retroauricular
They are situated at the lateral
surface of the mastoid process. They
receive lymph from a strip of the scalp
above the auricle and from the posterior
wall of the external auditory meatus.
3- parotid
They are situated on or within the
parotid gland. They receive lymph from
a strip of the scalp above the parotid
salivary gland; lateral surface of the
auricle; anterior wall of the external
auditory meatus and lateral parts of the
eyelids. Also, the nodes that are deeply
placed in the gland, receive lymph from
the middle ear.
4- Buccal
They are situated over the
buccinator muscle, close to facial
vein. They lie along the course of
lymph vessels that drain into the
submandibular nodes.
5- Submandibular
They are situated on the
superficial surface of the
submandibular salivary gland
beneath the investing layer of
the deep cervical fascia.
They can palpated just below the
lower border of the mandible.
They receive lymph from the
frond of the scalp; nose and
adjacent cheek; upper & lower
lips( except the central part);
upper & lower teeth ( except
lower incisors); anterior two
third of the tongue ( except the
tip );floor of the mouth;
vestibule; gums and the frontal;
maxillary and ethmoidal air
6- Anterior cervical
They lay along the course of the
anterior jugular veins and receive
lymph from skin and superficial of the
front of the neck tissue.
7- Submental
They lay in the submental triangles
between the anterior bellies of the
digastric muscles. They receive
lymph from the tip of the tongue; floor
of the mouth beneath the tip of the
tongue; incisor teeth and associated
gums; central part of the lower lip and
the skin over the chin.
8- superficial cervical
They lay along the course of the
external jugular vein. They receive
lymph from the skin over the angle of
the mandible; the skin over the apex of
the parotid gland and the lobules of
the ear.
9- Retropharyngeal
They are situated in the
retropharyngeal space, in the
interval between the pharyngeal wall
and prevertebral fascia. They receive
lymph from the nasal part of the
pharynx, auditory tube and the upper
part of the cervical vertebral column.
10- laryngeal
They lay on the cricothyroid
membrane in front of the larynx. One
or 2 nodes are found in front of the
thyrohyoid membrane. They receive
lymph from adjacent structures.
11- tracheal
They lay lateral ( paratracheal ) or in
front of the trachea ( pretracheal )
nodes. They receive lymph from
thyroid and the other neighboring
structure.
N.B. All the previous nodes, their
efferent lymph vessels are drained into
the deep cervical nodes. Also, the submental drain into submandibular nodes
Deep Cervical Lymph Nodes
They form a chain along the course of the
internal jugular vein, from the skull to the
root of the neck. The sternocleidomastoid
muscle lies anterolaterally to it.
They divided into upper & lower nodes.
The upper deep are subdivided into:
Anterosuperior group ( jugulodigastric nods ):
They lay below and behind the angle of the
mandible and just below the posterior
belly of the digastric muscle . Their
afferent lymph vessels from the posterior
third of the tongue; tonsil; parotid;
submandibular and retro- pharyngeal
lymph nodes.
Posterosuperior group:
They are present in the posterior triangle
of the neck. Their afferent lymph vessels
from, deep muscles of the neck; mastoid
and occipital lymph nodes.
The lower deep are subdivided into:
Anteroinferior group ( juguloomohyoid nodes ):
They are present on the intermediate
tendon of the omohyoid muscle.
Their afferent lymph vessels are
mainly from the tongue; thyroid
gland; prelaryngeal; tracheal and
upper deep cervical lymph nodes.
Posteroinferior group
( supraclavicular nodes ):
They are present in the lower part of
the posterior triangle of the neck.
Their afferent lymph vessels are
from deep muscles of the neck and
upper deep cervical lymph nodes.
The efferent lymph vessels from
the lower deep cervical nodes
unite with efferent lymph vessels
from the upper deep group and
form the jugular lymph trunk.
This trunk may end:
1- Right lymphatic duct on the
right side.
2- Thoracic duct on the left side.
3- Subclavian lymph trunk or the
brachiocephalic veins on both
sides.
N.B. There is no lymph nodes or
lymph vessels in the orbital
cavity; cranial cavity and
central nerveous system
( drained by C.S.F. )