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Anatomy

Head and Neck

Question 173 of 180

A 65 year old female smoker, presents to ED with a 3 month history of an ulcerated lesion on the middle of her lower lip. Biopsy demonstrates a squamous cell carcinoma. Which lymph nodes will most likely first be affected by spread of the malignancy:

Answer:

Submental nodes, inferior and posterior to the chin, drain lymphatics from the medial part of the lower lip and chin bilaterally.

Lymphatic Drainage of Face

Anatomy / Head and Neck / Face

Last Updated: 11th April 2019

Lymphatic drainage of the face primarily moves towards three groups of lymph nodes.

Submental Nodes

Submental nodes, inferior and posterior to the chin, drain lymphatics from the medial part of the lower lip and chin bilaterally (in addition to the tip of the tongue).

Submandibular Nodes

Submandibular nodes, superficial to the submandibular gland and inferior to the body of the mandible, drain lymphatics from the medial corner of the orbit, most of the external nose, the medial part of the cheek, the upper lip and the lateral part of the lower lip.

Preauricular and Parotid Nodes

The preauricular and parotid nodes, anterior to the ear, drain lymphatics from most of the eyelids, a part of the external nose and the lateral part of the cheek (in addition to the external acoustic meatus and the posterior orbit).

Henry Vandyke Carter [Public domain], via Wikimedia Commons

Lymphatic Drainage of the Face. (Image by Henry Vandyke Carter [Public domain], via Wikimedia Commons)

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  • Biochemistry
  • Blood Gases
  • Haematology
Biochemistry Normal Value
Sodium 135 – 145 mmol/l
Potassium 3.0 – 4.5 mmol/l
Urea 2.5 – 7.5 mmol/l
Glucose 3.5 – 5.0 mmol/l
Creatinine 35 – 135 μmol/l
Alanine Aminotransferase (ALT) 5 – 35 U/l
Gamma-glutamyl Transferase (GGT) < 65 U/l
Alkaline Phosphatase (ALP) 30 – 135 U/l
Aspartate Aminotransferase (AST) < 40 U/l
Total Protein 60 – 80 g/l
Albumin 35 – 50 g/l
Globulin 2.4 – 3.5 g/dl
Amylase < 70 U/l
Total Bilirubin 3 – 17 μmol/l
Calcium 2.1 – 2.5 mmol/l
Chloride 95 – 105 mmol/l
Phosphate 0.8 – 1.4 mmol/l
Haematology Normal Value
Haemoglobin 11.5 – 16.6 g/dl
White Blood Cells 4.0 – 11.0 x 109/l
Platelets 150 – 450 x 109/l
MCV 80 – 96 fl
MCHC 32 – 36 g/dl
Neutrophils 2.0 – 7.5 x 109/l
Lymphocytes 1.5 – 4.0 x 109/l
Monocytes 0.3 – 1.0 x 109/l
Eosinophils 0.1 – 0.5 x 109/l
Basophils < 0.2 x 109/l
Reticulocytes < 2%
Haematocrit 0.35 – 0.49
Red Cell Distribution Width 11 – 15%
Blood Gases Normal Value
pH 7.35 – 7.45
pO2 11 – 14 kPa
pCO2 4.5 – 6.0 kPa
Base Excess -2 – +2 mmol/l
Bicarbonate 24 – 30 mmol/l
Lactate < 2 mmol/l

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