Required instruments
Examination lamp, or good lighting in the examination room.
Procedure
- Sit down in front of the patient and ensure that there is adequate lighting for examination of the areas in question [Figure 52]. Check whether there are any swellings in the regions of the head and neck lymph node groups. Assess the colour of the skin over these swellings.
Figure 52
- Stand behind the patient.
- Place the first two distal phalanges of your right hand underneath the patient’s chin on the right-hand side [Figure 53]. Exert light pressure on the tissue and make small circular movements with both fingers. Move your fingers across the underside of the lower jaw and the part of the floor of the mouth that lies directly behind this. Whilst palpating, make your way to the mandibular angle to palpate the submental and submandibular lymph nodes [Figure 54].
Figure 53
Figure 54
- Next place your fingers in front of the patient’s ear [Figure 55] and palpate the preauricular lymph node groups in the same way.
Figure 55
- Repeat this procedure at the back of the ear [Figure 56] to examine the retroauricular lymph node groups.
Figure 56
- Now place your fingers in the occipital region, just beside the trapezius muscle [Figure 57]. With small circular movements palpate the suboccipital lymph nodes.
Figure 57
- Place the fingers high in the neck, just before the sternocleido-mastoid muscle [Figure 58] and follow this muscle whilst palpating with circular movements using the first two-thirds of your fingers, downwards to palpate the high, mid
[Figure 59], and low cervical [Figure 60] lymph node groups.
Figure 58
Figure 59
Figure 60
- Subsequently take hold of the sternocleidomastoid muscle with the thumb plus index and middle finger [figiure 61] to palpate the deep cervical lymph nodes. Ask the patient to tilt the head forward slightly during this procedure to allow the skin to relax.
Figure 61
- Now ask the patient to move the head slightly to the right so that the skin relaxes. Palpate deeply, just above the collar bone [Figure 62], to assess the supraclavicular lymph nodes.
Figure 62
- Place the finger tips just underneath the collar bone and palpate [Figure 63] deeply for the subclavicular lymph node groups.
Figure 63
- Examine the lymph node groups on the left-hand side in the same way.
When you feel the lymph nodes, describe their size, perimeters, consistency, surface, whether or not they have invaded surrounding tissue and assess the temperature of any swelling present and of the surrounding area.