Lymph Nodes of Head & Neck
What do I do first if I find unexplained enlarged lymph nodes?
1) carefully re-examine the regions they drain 2) assess lymph nodes everywhere to rule out generalized lymphadenopathy (seen in HIV/AIDS, mononucleosis, lymphoma, leukemia, and sarcoidosis)
tonsillar
at the angle of the mandible drains tonsillar & posterior pharyngeal regions, mouth, larynx, thyroid & trachea
occipital
at the base of skull posteriorly drains scalp, outer ear
supraclavicular
deep in the angle formed by the clavicle and sternomastoid muscle (lymphadenopathy here concerning for possible malignancy) R side drains esophagus, mediastinum, lungs, GI L side drains thorax, abdomen - possible lymphoma, thoracic or retroperitoneal cancer, bacterial/fungal infection
preauricular
in front of ear drains eye, middle ear & parotids
infraclavicular
inferior to the clavicle drains upper limb, may be enlarged in breast cancer or lymphoma
posterior cervical
inferior to the sternocleidomastoid along anterior edge of trapezius lymphadenopathy may be present with mono, respiratory infections or other viral illnesses
tender lymph nodes suggest
inflammation
hard or fixed lymph nodes suggest
malignancy
submental
midline (under the chin), a few centimeters behind tip of mandible drains anterior portion of the mouth, lower lip & teeth
submandibular
midway between angle & tip of mandible drains mouth mucosa, floor of mouth, face, nose & maxillary sinus
concerning lymphadenopathy
nodes are large, matted, fixed, tender to palpation
non-concerning lymphadenopathy "normal" lymph nodes
nodes are small, soft, mobile, nontender
"shotty" lymph nodes
scattered, small, mobile nodes (may feel soft or hard)
When palpating lymph nodes, note:
size, shape, consistency, mobility & number of nodes palpated
postauricular
superficial to the mastoid process drains inner & outer ear
anterior cervical
superficial to the sternocleidomastoid muscle drains internal structures of throat, posterior pharynx, tonsils, mouth, tongue & trachea