05/02/23 Clinical Skills Resource Centre, University of Liverpool, UK 1

LYMPH NODES OF THE HEAD AND NECK

05/02/23 Clinical Skills Resource Centre, University of Liverpool, UK 2

Sites of possible palpable lymphadenopathy

Lymph nodes are part of the immune system and are involved in tissue fluid circulation

They may enlarge for a number of reasons, including infection, malignancy and systemic disease

As part of a general examination all groups should be assessed

Certain groups are assessed as part of limited local examinations, e.g. axillary in breast examination and cervical in ENT examination

Cervical

Supraclavicular

Axillary

Para-aortic(intra-abdominal)

Inguinal

Epitrochlear(behind the elbow)

05/02/23 Clinical Skills Resource Centre, University of Liverpool, UK 3

Some landmarks to become familiar with

Upper border clavicle

Sternomastoidmuscle

Trapeziusmuscle

Thyroid cartilageCricoid cartilage

Cricothyroid ligament

Suprasternal notch

05/02/23 Clinical Skills Resource Centre, University of Liverpool, UK 4

Lateral view of Lymph nodes of the neck

Preauricular Postauricular

Occipital

Posterior cervical

Supraclavicular

Submental

Submandibular

Deep cervical

Superficial cervical

Tonsillar

05/02/23 Clinical Skills Resource Centre, University of Liverpool, UK 5

Anterior view of Lymph nodes of head and neck

Superficalcervical

Deep cervicalPosterior

cervical

Supraclavicular Infraclavicular

05/02/23 Clinical Skills Resource Centre, University of Liverpool, UK 6

Examination of head and neck lymph nodes

The nodes of the neck may be examined from in front or behind with the patient seated and the neck exposed

Palpate one side at a time

Warn the patient that you will be standing behind them if you choose this approach

Method for either approach•Use the fingertips•Apply moderate pressure and rotate fingertips in the each of the areas where nodes might be found•Nodes are not normally palpable•Cervical lymph nodes are frequently enlarged in response to upper respiratory tract infections

05/02/23 Clinical Skills Resource Centre, University of Liverpool, UK 7

Lymph nodes can be examined from:

In front

or

Behind

↑ one hand at a time

05/02/23 Clinical Skills Resource Centre, University of Liverpool, UK 8

Positions in order usually examined 1Submental in the midline behind the tip of

the mandibleSubmandibular midway and along the inner

surface of the inferior margin of the mandibleTonsillar at the angle of the jawPre-auricular in front of the ear opposite the

tragusPost-auricular over the mastoid process

(behind the ear)

05/02/23 Clinical Skills Resource Centre, University of Liverpool, UK 9

Positions in order usually examined 2 Occipital back of the head at the base of the skull Posterior cervical run along the anterior border of the

trapezius muscle Superficial cervical along the body of the sternomastoid Deep cervical deep to the lateral border of the

sternomastoid. They are difficult to feel, press more firmly along the body of the sternomastoid.

Supra clavicular lie on top of the clavicle at the lateral border of the sternomastoid medially.

Infraclavicular lie along the inferior border of the clavicle