JARINGAN LIMFE KEPALA DAN LEHER

dzulhiba

KEKURANGAN

Anatomi, topografi, fungsi dan hubungan dengan penyakitnya

1.

2.

Fungsi pembuluh limfe : mengangkut cairan dari jaringan menuju darah. mengangkut lemak dan bahan bahan asing dirombak ke nodus limfe. Pembuluh limfa bermuara di berbagai jaringan termasuk sirkulasi terbuka

SISTEM LIMFATIK

Pembuluh getah bening / limfe

Organ-organ Limfatik

PEMBULUH GETAH BENING

PEMBULUH GETAH BENING

Kapiler getah bening

Pembuluh getah bening yg lebih besar

Pembuluh Limfe besar

Kapiler getah bening

Pembuluh getah bening yg lebih besar

Pembuluh Limfe besar

A. KAPILER GETAH
BENING

Have one way minivalves allowing excess fluid to enter but not leave Picks up bacteria and viruses as well as proteins, electrolytes and fluid (lymph nodes destroy most pathogens) Absent from bone, bone marrow, teeth, CNS Enter lymphatic collecting vessels

B. PEMBULUH GETAH BENING YANG LEBIH BESAR

Similar to blood vessels (3 layers), but thin & delicate Superficial ones in skin travel with superficial veins Deep ones of trunk and digestive viscera travel with deep arteries Very low pressure Drain into lymph nodes

Dalam perjalanan

pembuluh getah bening yang besar

mencurahkan isinya ke kelenjar getah bening (Lymph Nodes)

LYMPH TRUNKS/BATANG LIMPH

Lymphatic collecting vessels converge Five major lymph trunks : Lumbar trunks Receives lymph from lower limbs Intestinal trunk Receives lymph from digestive organs Bronchomediastinal trunks Collects lymph from thoracic viscera Subclavian trunks Receive lymph from upper limbs and thoracic wall Jugular trunks Drain lymph from the head and neck

LYMPH DUCTS
Cisterna chyli Located at the union of lumbar and intestinal trunks Thoracic duct Ascends along vertebral bodies Empties into venous circulation Junction of left internal jugular and left subclavian veins Drains three quarters of the body mengalirkan dari seluruh tubuh selain bagian kanan Right lymphatic duct Empties into right internal jugular and subclavian veins mengalirkan dari kanan kepala dan leher, lengan kanan dan dada kanan

DRAINASE KGB LEHER DAN KEPALA

Dibagi 7 level

Level Ithe submental and submandibular nodes

Level Iathe submental nodes Level Ibthe submandibular nodes and gland Level IIupper jugular chain nodes Level IIajugulodigastric nodes Level IIbsubmuscular recess

Level IIImiddle jugular chain nodes Level IVlower jugular chain nodes

Level Vposterior triangle nodes

Level Va Level Vb

Level VIanterior compartment nodes Level VIIparatracheal nodes

LEVEL ITHE SUBMENTAL AND

SUBMANDIBULAR NODES
Level Ia - node submental ; medial to the anterior belly of the digastric muscle bilaterally, symphysis of mandible superiorly, and hyoid inferiorly Level Ibthe submandibular nodes and gland; posterior to the anterior belly of digastric anterior to the posterior belly of digastric inferior to the body of the mandibula

* Belly = perut

LEVEL IIUPPER JUGULAR CHAIN NODES

Level IIajugulodigastric nodes deep to sternocleidomastoid (SCM) muscle, anterior to the posterior border of the muscle, posterior to the posterior aspect of the posterior belly of digastric, superior to the level of the hyoid, inferior to spinal accessory nerve (CN XI)

LEVEL IIUPPER JUGULAR CHAIN NODES

Level IIbsubmuscular recess; superior to spinal accessory nerve to the level of the skull base

Recess : berhenti

LEVEL IIIMIDDLE JUGULAR CHAIN NODES

inferior to the hyoid, superior to the level of the cricoid, deep to SCM muscle from posterior border of the muscle to the strap muscles medially

Strap : mengikat/ melilit

LEVEL IVLOWER JUGULAR CHAIN NODES

inferior to the level of the cricoid superior to the clavicle deep to SCM muscle from posterior border of the muscle to the strap muscles medially

LEVEL VPOSTERIOR TRIANGLE NODES

Level Va lateral to the posterior aspect of the SCM muscle inferior and medial to splenius capitis and trapezius superior to the spinal accessory nerve

Level Vb lateral to the posterior aspect of SCM muscle medial to trapezius inferior to the spinal accessory nerve superior to the clavicle

LEVEL VIANTERIOR COMPARTMENT NODES

inferior to the hyoid superior to suprasternal notch medial to the lateral extent of the strap muscles bilaterally

Notch : derajat

LEVEL VIIPARATRACHEAL NODES

inferior to the suprasternal notch in the upper mediastinum

Notch : derajat

Patterns of spread from primary tumor sites in the head and neck to cervical lymphatics are well described The location and incidence of metastasis vary according to the primary site

Primary tumors within the oral cavity and lip metastasize to the nodes in levels I, II, and III Skip metastases may occur with oral tongue cancers such that involvement of nodes in level III or IV may occur without involvement of higher echelon nodes (levels I & II). Involvement : keterlibatan

Tumors arising in the oropharynx, hypopharynx, and larynx most commonly spread to the lymph nodes of the lateral neck in levels II, III, and IV.

Arising : timbul, spread : lebar/ menjalar

Isolated level V lymphadenopathy is uncommon with oral cavity, pharyngeal, and laryngeal primaries. Malignancies of the nasopharynx and thyroid commonly spread to level V nodes in addition to the jugular chain nodes.

Retropharyngeal lymph nodes are sites for metastasis from tumors of the nasopharynx, soft palate, and lateral and posterior walls of the oropharynx and hypopharynx.

Tumors of the hypopharynx, cervical esophagus, and thyroid frequently involve the paratracheal nodal compartment, and may extend to the lymphatics in the upper mediastinum (level VII) The Delphian node, a pretracheal lymph node, may become involved by advanced tumors of the glottis with subglottic spread.

Involve : keterlibatan

BOBORBAH.