The major lymph nodes of the head and neck area should be palpated with the patient in an upright position. Findings which should be noted in the patient record include enlarged palpable nodes, fixed nodes, tender nodes and whether the palpable nodes are single or present in groups. Single or multiple non-tender, and fixed nodes are very suspicious for malignancy. Groups of tender nodes usually occur in conjunction with some type of acute infection. Occasionally nodes will remain enlarged and palpable after an infection. This is a relatively common occurrence especially within the submandibular group of lymph nodes. When examined, these nodes should be small (less than 1 cm), non-tender and mobile. Remember to correlate findings from the medical history and general appraisal of the patient to the observations made during the head and neck examination. For example, a previous history of cancer should cause the clinician to be more suspicious of newly appearing palpable nodes than if there is no history of cancer. If suspicious nodes are discovered, the patient should be referred to a physician for immediate evaluation. Figures 11 through 18 depict the examination techniques for the following lymph nodes.
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