Lymph Nodes of Head & Neck

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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


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