1. 01/21/16 Clinical Skills Resource Centre, University of Liverpool, UK 1
LYMPH NODES OF THE HEAD
AND NECK

2. 01/21/16 Clinical Skills Resource Centre, University of Liverpool, UK 2
Sites of possible palpable lymphadenopathy
 Lymph nodes are part of the
immune system and are involved
in tissue fluid circulation
 They may enlarge for a number of
reasons, including infection,
malignancy and systemic disease
 As part of a general examination
all groups should be assessed
 Certain groups are assessed as
part of limited local examinations,
e.g. axillary in breast examination
and cervical in ENT examination
Cervical
Supraclavicular
Axillary
Para-aortic
(intra-abdominal)
Inguinal
Epitrochlear
(behind the elbow)

3. 01/21/16 Clinical Skills Resource Centre, University of Liverpool, UK 3
Some landmarks to become
familiar with
Upper border clavicle
Sternomastoid
muscle
Trapezius
muscle
Thyroid cartilage
Cricoid cartilage
Cricothyroid ligament
Suprasternal notch

4. 01/21/16 Clinical Skills Resource Centre, University of Liverpool, UK 4
Lateral view of
Lymph nodes of the neck
Preauricular Postauricular
Occipital
Posterior cervical
Supraclavicular
Submental
Submandibular
Deep cervical
Superficial cervical
Tonsillar

5. 01/21/16 Clinical Skills Resource Centre, University of Liverpool, UK 5
Anterior view of
Lymph nodes of head and neck
Superfical
cervical
Deep
cervicalPosterior
cervical
Supraclavicular Infraclavicular

6. 01/21/16 Clinical Skills Resource Centre, University of Liverpool, UK 6
Examination of head and neck lymph nodes
 The nodes of the neck
may be examined from
in front or behind with
the patient seated and
the neck exposed
 Palpate one side at a
time
 Warn the patient that
you will be standing
behind them if you
choose this approach
Method for either approach
•Use the fingertips
•Apply moderate pressure
and rotate fingertips in the
each of the areas where
nodes might be found
•Nodes are not normally
palpable
•Cervical lymph nodes are
frequently enlarged in
response to upper
respiratory tract infections

7. 01/21/16 Clinical Skills Resource Centre, University of Liverpool, UK 7
Lymph nodes can be examined from:
In front
or
Behind
↑ one hand
at a time

8. 01/21/16 Clinical Skills Resource Centre, University of Liverpool, UK 8
Positions in order usually examined 1
Submental in the midline behind the tip of
the mandible
Submandibular midway and along the inner
surface of the inferior margin of the mandible
Tonsillar at the angle of the jaw
Pre-auricular in front of the ear opposite the
tragus
Post-auricular over the mastoid process
(behind the ear)

9. 01/21/16 Clinical Skills Resource Centre, University of Liverpool, UK 9
Positions in order usually examined 2
 Occipital back of the head at the base of the skull
 Posterior cervical run along the anterior border of the
trapezius muscle
 Superficial cervical along the body of the
sternomastoid
 Deep cervical deep to the lateral border of the
sternomastoid. They are difficult to feel, press more
firmly along the body of the sternomastoid.
 Supra clavicular lie on top of the clavicle at the lateral
border of the sternomastoid medially.
 Infraclavicular lie along the inferior border of the
clavicle

10. 01/21/16 Clinical Skills Resource Centre, University of Liverpool, UK 9
Positions in order usually examined 2
 Occipital back of the head at the base of the skull
 Posterior cervical run along the anterior border of the
trapezius muscle
 Superficial cervical along the body of the
sternomastoid
 Deep cervical deep to the lateral border of the
sternomastoid. They are difficult to feel, press more
firmly along the body of the sternomastoid.
 Supra clavicular lie on top of the clavicle at the lateral
border of the sternomastoid medially.
 Infraclavicular lie along the inferior border of the
clavicle