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CERVICAL LYMPHADENOPATHY

CERVICAL LYMPHADENOPATHY. Dept of Oral Medicine & Radiology Yenepoya Dental College Mangalore. Lymphnodes are encapsulated centres of lymphocyte differetiation and proliferation. Small, oval or reniform bodies About 0.1 – 2.5 cm long Numerous in neck, mediastinum, post

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CERVICAL LYMPHADENOPATHY

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  1. CERVICALLYMPHADENOPATHY Dept of Oral Medicine & Radiology Yenepoya Dental College Mangalore

  2. Lymphnodes are encapsulated centres of lymphocyte differetiation and proliferation

  3. Small, oval or reniform bodies • About 0.1 – 2.5 cm long • Numerous in neck, mediastinum, post abdominal wall & pelvis • about - 400 - 450 LN • Head and neck - 60 – 70 LN

  4. FUNCTIONS • Generate mature and prime B and T cells • Add antibodies to circulation • Filter particles, microbes from lymph

  5. Submental • Submandibular • Parotid • Upper cervical • Middle cervical • Lower cervical • Supraclavicular fossa • Posterior triangle (accessory chain)

  6. Lymphadenitis - an inflammation or infection of lymph node and frequently occurs when an infection is present in the tissues drained by particular node pathway

  7. CAUSES I . INFECTION BACTERIAL / VIRAL / PARASITIC II. NEOPLASIA PRIMARY SECONDARY- Ca / Mal Malanoma III. MISCELANIOUS SARCOIDOSIS / DRUG REACTION/C T DISEASES

  8. Adenovirus CMV Enterovirus EBV Herpes simplex Staphlococcus infection Cat Scratch Diseas Hodgkin's disease Lymphomas Leukemia Metastatic disease Histiocytosis SLE Kawasaki Disease Infectious Causes Non-infectious causes

  9. LYMPH NODES a. SITE , b. SIZE , c. NUMBER , d. TENDERNESS e.CONSISTANCY, f.. FIXITY,

  10. INVESTIGATION • HISTORY • CLINICAL EXAMINATION • TEMP/ DRAINAGE/ DENTAL & MUCOSAL /ENT • SPECIAL INVESTIGATION • BLOOD PICTURE • CHEST X RAY • SEROLOGY • KVIEM TEST • MANTOUX TEST • FNAC / FNAB • BIOPSY

  11. F N A C

  12. Two distinct types of benign LN enlargement • Non tender • Tender / painful

  13. NON TENDER LYMPHOID HYPERPLASIA • Persistent chronic lymphadenitis or A permanenly enlarged LN after acute or chronic lymphadenitis • LN are solitary, discrete, asymtomatic and freely movable • Submandibular ,submental and subdigastric LN

  14. D/D Secondary carcinoma – hard & fixed Management Patient recalled after 2 week & evaluated If doubtful – removal of node & examination

  15. ACUTE LYMPHADENITIS: • Most common pathologic cervical enlargement • Primary infection in oral cavity, nasal cavity , tonsils or Pharynx • Cause painful , swollen nodes in submental, submandibular / subdigastric • Rapid regression of inflammation - nodes Normal & non- palpable

  16. SEVERAL NODES MAY BE INVOLVED • MOVABLE OR FIXED D/D • LUDWIG’S ANGINA • INFECTED CYST

  17. MANAGEMENT • When primary infection eliminated Lymphadenitis regress • Adequate doses of antibiotics

  18. METASTATIC CARCINOMA TO CERVICAL NODES • LN are frequent sites • Result of metastatic spread from primary tumors of head & neck • Squmous cell carcinoma is most common tumor spreading to cervical LN • Adenocarcinoma of salivary glands, Scc of skin & melonoma metastasize

  19. Lymphatic trunks drain upper extremities & rest of body below clavicles, so solitary metastatic nodes can be from primary tumors of breast, lungs & stomach FEATURES • Usually painless • Detected on clinical examination • Feel stony hard & freely movable till they penetrate node capsule & Invade surrounding tissues • Submandibular & subdigastric nodes most frequent sites

  20. D/D • Fibrosed nodes or nodes undergone non tender lymphoid hyperplasia • Lymphoma (rubbery) MANAGEMENT • Combination of resection, radiation & chemotherapy • Prognosis is guarded

  21. LYMPHOMA A neoplastic proliferation within the reticuloendothelial system that occurs as primry tumor of lymph node

  22. FEATURES • Solitary / multiple • Unilateral / bilateral • Usually rubbery • Advanced cases – patient is ill with fever, TC & DLC may be markedly changed • Other node groups axillae, groin & mediastinum involved

  23. D/D • Multiple & disseminated nodal involvement occur in certain viral diseases & in mononucleosis • Nodes are tender & painful MANAGEMENT • Radiation & chemotoxic drugs

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