Head and Neck Lymph Node Examination

Lymph nodes are also known as lymph glands and these are small lumps of tissue which are a part of body’s immune system. Lymph nodes consist of white blood cells which act as the body’s active immune system, by filtering harmful substances like bacteria and cancer cells from your body. Lymph nodes are located throughout the body in places such as neck, armpits, between lungs, around gut etc. 

Lymph nodes fight infections by filtering lymph fluids which is composed of fluid and waste products from your body tissues. These nodes help in activating your immune system in case of an infection. Lymph nodes play a very important part in diagnosis of many conditions such as cancers to simple infections. 

Examination of Lymph Nodes:

It is accomplished by inspection and palpation techniques for Lymph node examination. Head and Neck Lymph nodes are variable and the lymphnodes which are accessible for palpation in the Head and Neck region are Occipital, Parotid, sub Mandibular, Retroauricular, Sub mental Lymph Nodes. Waldeyers Ring is a Lymphatic ring in the neck region.

For detailed description of Waldeyrs Inner and Outer Lympahtic Ring: Waldeyers Ring

Principles of Examination of Lymph Nodes:

1. Inspection:

• Site
• Gross Enlargement (approximate size)
• Number

2. Palpation:

• Tenderness- Tender or Non-Tender
• Number
• Discrete/Matted

Palpation of Head and Neck Lymph Nodes:

1. Perauricular: They are palpated Anterior to or in front of the ear
2. Posterior auricular:  Palpated at the Mastoid Process or anterior to the mastoid
3. Occipital:  They are Palpated at the base of the skull Posteriorly
4. Tonsillar:  Tonsillar Lymph Nodes are Palpated at Angle of Mandible
5. Submandibular: These nodes are palpated at the lower border of the body of the mandible approximating the angle. The patient is asked to partially flex the neck towards the side that is being examined
6. Submental: Submental Lymph Nodes are palpated under the Chin. The clinician stands behind the seated patient.  The patient is asked to partially flex the neck towards the side that is being examined. Fingers of both the hands should be placed below the Chin under the lower border of the mandible and the submental lymph nodes should be cupped within the fingers of botht he hands
7. Anterior Superficial cervical: These Lymph nodes Lie superficial to the Sternocleidomastoid Muscle
8. Deep Cervical Lymph Nodes: Lies below the Sternomastoid Muscle and over the Cervical Fascia.
9. Posterior cervical: Palpated in the Posterior triangle of the neck close to the anterior border the trapezius
10. Supraclavicular: Examined just above the Clavicle, lateral to the attachment of the Sternomastoid muscle. The Supraclavicular nodes are palpated in the supra clavicular fossa bilaterally standing behind the patient. The patient can be instructed to elevate and hunch his/her shoulders forward (suggests thoracic or abdominal malignancy)

Types of Infections and features related to Lymph Nodes:

Acute infection:

• Tender
• Mobile
• Enlarged

Chronic Infection:

• Non Tender
• Mobile
• Enlarged

Tuberculosis:

• Matted
• Non Tender

Squamous Cell Carcinoma:

• Fixed
• Enlarged

Lymphomas:

• Rubbery
• Enlarged

Lymph nodes play an important role in diagnosis of many cancerous conditions in many parts of the body. As Lymph nodes filter harmful substances and waste products, with the presence of immune cells inside the lymph nodes it helps in destroying cancer cells and bacteria in the lymph fluid carried to your lymph nodes by lymphatic vessels. So in case cancer is suspected in the body, the related lymph nodes are palpated and examined and in some cases aspiration or biopsy is also performed to help in diagnosis. 

Lymphona is the cancer of Lymph nodes where the cancer starts in the lymph nodes and spreads to other parts of the body through lymph vessels.