Anatomy

Cervical Lymph Nodes → More details

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Levels of the Neck

• I: submental
• II: submandibular and upper third
• III: middle third
• IV: lower third
• V: posterior neck
• VI: central neck
• VII: antieror mediastinal </aside>

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Group of lymph node

1. Occipital
2. Post-auricle
3. Pre-auricle
4. Tonsilor (jugulodigastric)
5. Sub-mandibular
6. Sub-mental
7. Posterior triangle
8. Jugular (deep to SCM, superficial to scalene, palpate the ventral and dorsal surface of SCM)
9. Supra-clavicular
10. Infra-clavicular </aside>

Process

Inspection

• Ask the patient to relax

• Neck inspection (front to back)

  • SEADS: swelling, erythema, atrophy, deformity, scars
    • Scars (thyroid surgery: typically located above the suprasternal notch)
    • Base of the neck
  • Masses, lesions (midline)
  • Asymmetry
  • Goitre - front and side*
  • Ask the patient to take 🥤a sip of water, inspect for upward movement of thyroid gland
    • Abnormality in size, contour, and symmetry
    • Won't see normal thyroid tissue

Palpation

• Cradle the patient’s head with both hands.

• Patient neck slightly flexed

• Rolling the pads of your fingers in a circular motion, gently palpate all of the lymph node chains

  • Distinguish lymph node from vessel
  • Be systematic and compare sides

• Approach (I prefer the first approach honestly)

  

  1. Occipital → Post-auricle → Posterior triangle
  2. Pre-auricle → Tonsilor (jugulodigastric)
  3. Sub-mandibular → Sub-mental
  4. Jugular (deep to SCM, superficial to scalene, palpate the ventral and dorsal surface of SCM)
  5. Supra-clavicular → Associated malignancy
     • Virchow's nodes
     • Hunch shoulders forward = increase accessibility

Reporting

Lymph Node Descriptor