The examination of the neck forms an integral part of the general ear, nose and throat examination.
Inspection
Examine the neck in a good light from both the front and the sides.
Look for discolouration f the skin, surgical and traumatic scars, skin lesions and swellings, both pulsatile and non-pulsatile.
Palpation
Before palpation, ask if there are any areas of tenderness.
Always examine the patient from behind with the neck exposed down to the clavicles. Palpate the neck in a systematic way, feeling both superficially and slightly more deeply.
Be systematic
There are many ways to examine the neck but following a systematic route each time avoids missing a region. This is just one way of doing it:-
Start at the submental and submandibular region feeling for both lymph nodes and salivary glands. Consider symmetry, as the submandibular glands are often palpable in a thin neck, but not necessarily pathological. Some individuals feel the submandibular glands following weight loss for the first time and are alarmed. Conversely, weight gain may produce a submental “mass” or dewlap.
Come up to the parotid region as high as the zygoma and then down and around the ears.
Follow a route to the posterior triangle and down to the clavicles and across to the supraclavicular fossae.
Come back up to the centre of the neck and the suprasternal notch. Palpate the thyroid gland both at rest and swallowing. The latter is more comfortable for the patient with a mouthful of water.
Palpate the lateral neck nodes along the anterior border of sternocleidomastoid, back up to the submandibular triangle where you started.
Be aware:
There are certain normal structures in the neck that may be mistaken for lumps.
For example:
The dewlap – a collection of fat in the submental region
The carotid bifurcation – often felt in the elderly think neck as a “firm mass”, where the artery is calcified and hard.
The lateral process of the axis (C2) – may present as a bony mass between the mandible and mastoid in a thin neck. Turn the head to the opposite side as you palpate to define the bone. A bony parotid mass is uncommon.
The styloid process – if elongated and ossified, this may be palpable as it runs anteriorly from the mastoid to the mandible.
Cervical rib – this supernumerary rib which arises from the seventh cervical vertebra (a congenital abnormality) is occasionally picked up as a “mass” in the lower lateral neck.
Lymph node levels in the neck
The lymph nodes in the neck can be assigned a level, indicating drainage from a part of the upper respiratory and food passages.
Level 1
Submental and submandibular – drain mouth
Level 2
Upper jugulodigastric – drain tonsil
Level 3
Middle jugular – drain nasopharynx, oropharynx, mouth and larynx
Level 4
Inferior jugular – drain hypopharynx, subglottis, thyroid and oesophagus
Level 5
Posterior triangle – drain nasopharynx
Level 6
Anterior compartment – contains paratracheal and pretracheal nodes
ENT Doctor London is one of UK’s leading Rhinoplasty London clinics, and can be contacted on 0207 580 6970.
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05 5th, 2009 |