Clinical examination of neck swellings

• expose the patient's neck - loosen their shirt collar
• it is necessary to define information relating to the:
  • site
  • relation to muscles
  • relation to trachea
  • relation to hyoid cartilage
• examination of swelling of the neck includes (1)
  • examination of skin on the head and neck
    • to look for premalignant or malignant lesions caused by chronic exposure to sun
  • examination of the anterior and posterior triangles of the neck
    • to define the site of the lump
  • palpation of the neck during swallowing
    • this may identify pathology of the thyroid gland.
  • otologic examination (1)
    • to look for a sinus or fistula associated with a branchial anomaly
  • examination mucosal surfaces ( needs wearing of gloves) (1)
    • dental appliances like dentures may have to be removed first
    • pharyngitis suggests reactive adenopathy
    • in the tonsillar fossa, look for the following features:
      • ulcerations
      • submucosal swelling
      • asymmetry
    • palpate the tongue and the base of the tongue
  • examination of the larynx and pharynx (1)
    • this is done using an indirect or flexible laryngoscopy

References:

• (1) Eric Schwetschenau, The Adult Neck Mass, American Family Physician®, 2002;66:831-8.