Lymphatic System comprises of Lymph nodes in the Facial region which are related to the Oral cavity and are enlarged due to infection of the particular region. Palpation of Lymph nodes helps in Provisional Diagnosis of oral conditions. The Lymph nodes should be checked for tenderness, mobility, enlargement and consistency while performing a Examination. Facial Lymph nodes are divided into three groups – Infaorbital or Maxillary Lymph nodes, Mandibular lymph nodes and buccinator lymph nodes. From these groups the lymph nodes which are relevant to oral cavity are preauricular, submandibular, submental and cervical lymph nodes.
The Lymphatic drainage of the Oral cavity is further divided into Regional nodes and deep cervical nodes based on their position.
Regional Lymph Nodes and their drainage:
- Parotid node on top of the parotid gland which drains into these nodes
- Submandibular nodes located on the lateral wall of the submandibular gland, the cheek region drains into this along with the upper lip, lower lip, maxillary sinus along with upper and lower teeth, the floor of mouth, two thirds of the tongue, vestibule and the gums.
- Buccal Nodes are located on the buccinator muscle over the cheek and transport the lymph collected in the submandibular nodes.
- Submental Nodes are located below the chin in the submental triangle, the tip of the tongue, floor of anterior part of mouth, incisors, the central part of the lower lip and skin on chin drain into these nodes.
- Superficial cervical nodes are located on the external jugular vein and drain the skin over the angle of the mandible along with skin covering the parotid gland.
Palpation of Lymphnodes and its Provisional diagnosis:
- Submental Lymphnodes Enlargement: Infection to Anterior teeth
- Submandibular Lymphnodes Enlargement: Infection of Mandibular Molars
- Angle of mandible lymphnodes Enlargement: Tonsillar infection
- Palpable and Tender Lymphnodes with Fever and swelling: Acute infection
- Palpable Lymphnode with no pain: Chronic infection
- Hard fixed lymph node with stone like consistency: Malignancy
- Nontender and Matted Lymphnodes: Tuberculosis
Palpation of Lymphnodes is a very integral part of Diagnosis and to decide the treatment plan after other diagnostic tests to determine the source of infection.