Lymph Nodes: The major lymph node groups are located along the anterior and posterior aspects of the neck and on the underside of the jaw. If the nodes are quite big, you may be able to see them bulging under the skin, particularly if the enlargement is asymmetric (i.e. it will be more obvious if one side is larger then the other). To palpate, use the pads of all four fingertips as these are the most sensitive parts of your hands. Examine both sides of the head simultaneously, walking your fingers down the area in question while applying steady, gentle pressure. The major groups of lymph nodes as well as the structures that they drain, are listed below. The description of drainage pathways are rough approximations as there is frequently a fair amount of variability and overlap. Nodes are generally examined in the following order:
1. Anterior Cervical (both superficial and deep): Nodes that lie both on top of
and beneath the sternocleidomastoid muscles (SCM) on either side of the neck,
from the angle of the jaw to the top of the clavicle. This muscle allows the
head to turn to the right and left. The right SCM turns the head to the left
and vice versa. They can be easily identified by asking the patient to turn
their head into your hand while you provide resistance. Drainage: The internal
structures of the throat as well as part of the posterior pharynx, tonsils,
and thyroid gland.
2. Posterior Cervical: Extend in a line posterior to the SCMs but in front of the
trapezius, from the level of the mastoid bone to the clavicle. Drainage: The
skin on the back of the head. Also frequently enlarged during upper
respiratory infections (e.g. mononucleosis).
3. Tonsillar: Located just below the angle of the mandible. Drainage: The
tonsilar and posterior pharyngeal regions.
4. Sub-Mandibular: Along the underside of the jaw on either side. Drainage: The
structures in the floor of the mouth.
5. Sub-Mental: Just below the chin. Drainage: The teeth and intra-oral cavity.
6. Supra-clavicular: In the hollow above the clavicle, just lateral to where it
joins the sternum. Drainage: Part of the throacic cavity, abdomen.
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