Head and Neck Lymph Node Examination

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.

Lymphatic Drainage of Head and 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)

Examination of Head and Neck Lymph Nodes

Types of Infections and features related to Lymph Nodes:

Acute infection:

  • Tender
  • Mobile
  • Enlarged

Chronic Infection:

  • Non Tender
  • Mobile
  • Enlarged


  • Matted
  • Non Tender

Squamous Cell Carcinoma:

  • Fixed
  • Enlarged


  • Rubbery
  • Enlarged


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