EXAMINATION OF LYMPH NODES

CONTENTS
Introduction Protocol of lymph node examination Types of Lymph nodes Types of Infections and features related to Lymph nodes Procedure of lymph node examination Causes of lymph node enlargement

INTRODUCTION
A lymph node is an oval shape organ of the immune system ,distributed widely throughout the body and are linked by lymphatic vessels. Lymph nodes are acts as filters or trapes for foreign particles and are important in the proper functioning of the immune system. They are packed tightly with white blood cells called lymphocytes and macrophages.

Functions Of Lymphatic System:

a) Helping to defend the body against disease. b) Collect and return interstitial fluid ,including plasma protein to the blood and thus help to maintain food procedure. c) To absorb lipids from the intestine and transport them to the blood.

PROTOCOL OF LYMPH NODE EXAMINATION:

SITE- localized to one region or generalized. SIZE- large nodes are usually abnormal. CONSISTENCY Hard nodes suggest carcinoma. Soft-may be normal.

Rubbery due to lymphoma. TENDERNESSImplies acute inflammation or infection. FIXATIONNodes that are fixed to underlying structure are more likely to be carcinoma . When examine one area always compare to the another area.

TYPES OF LYMPHNODES IN HEAD AND NECK REGION:

CLASSIFICATION:

LEVEL-1- Submandibular lymph node and submental lymph node. LEVEL 2- Lymph nodes in upper deep cervical region. It extends from base of skull to hyoid bone and from lateral margin of sternothyroid to posterior margin of sternomastoid muscle. LEVEL-3-Lymph node in middle cervical region -From hyoid bone to omohyoid muscle or cricothyroid membrane. LEVEL-4-Lymph node in lower cervical region. -From omohyoid muscle to clavicle. LEVEL-5-Lymph nodes in posterior triangle including supraclavicular region. LEVEL-6-Lymphnodes in the middle neck-pre-tracheal and pre-laryngeal.

TYPES OF INFECTION AND FEATURES RELATED TO LYMPH NODE: Acute Infections: Tender Mobile

Enlarged Chronic Infections: Non-Tender Mobile Enlarged Tuberculosis: Matted Non-Tender Squamous cell Carcinoma: Fixed Enlarged Lymphoma: Rubbery Enlarged

PROCEDURE OF LYMPH NODE EXAMINATION: Inspection: Inspect the normal anatomic locations of for any enlargement of nodes. If the nodes are obviously enlarged described the location, the approximate dimension and no of nodes. Look for any surface changes such as ulcerations or discharge from the site. PALPATION: Most of the lymph nodes are best palpated with the clinician standing behind the patient who is seated on the dental chair. Nodes are palpated to assess whether they are tender or non-tender. The consistency and size. The fixity of the node to the underlying structure should also be assessed.

SUBMENTAL LYMPH NODES

Submental lymph nodes are palpated under the chin. The clinician can stand behind the seated patient to palpate the submental nodes. The patient is instructed to bend his/her neck .This helps in relaxing the muscles and fascia of neck.

 Fingers of both the hands can be placed just below the chin, under the lower border of the mandible and the submental lymph node should be attempted. Two chains of lymph nodes are present in either side of the sternocleoid muscle. The anterior cervical chain located anterior to the muscle and posterior cervical chain located posteriorly.

SUBMANDIBULAR LYMPH NODES:

Submandibular nodes are palpated at lower border of the body of the mandible approximating the angle. To examine the lymph nodes of the submandibular region, the patient is instructed to passively flex the neck towards the side that is being examined.

 The clinician should his/her fingers laterally to draw outwards and trap them against the lower border of the mandible. The clinician should note tenderness , size, mobility, and attachment to the surrounding tissue.

ANTERIOR CERVICAL LYMPH NODES

Lie over the sterno-mastoid muscles . Palpate anterior border of the sterno-mastoid muscles.

DEEP CERVICAL NODESPalpate below the sterno-mastoid muscles and over the cervical fascia.

POSTERIOR CERVICAL LYMPH NODES

Palpated in the posterior triangle of the neck close to the anterior border of the trapezius muscle. Examination of the cervical nodes can be accomplished by instructed the patient to hyperextend the neck and turn the neck away from the side to be examined. Finger tips of the palpating hand are placed along the posterior border of the muscles , while the thumb provides counter pressure from the anterior aspect of the muscles.

SUPRACLAVICULAR LYMPH NODES

Supraclavicular nodes are examined just above the clavicle ,lateral to the sternomastoid muscle . The supraclavicular nodes are palpated in the supraclavicular fossa. The supraclavicular fossa can be palpated standing in the front of patient.

OCCIPITAL LYMPH NODE:

They are palpated at the base of the skull posteriorly.

TONSILLAR LYMPH NODE:

They are palpated at the angle of mandible.

PREAURICULAR LYMPH NODE:

They are palpated anterior to or in front of the Ear.

POSTERIOR AURICULAR LYMPH NODE:

Palpated at the mastoid process or anterior to the mastoid.

CAUSES OF LYMPH NODE ENLARGEMEMNT

a) InflammatoryAcute lymphadenitis, chronic lymphadenitis, tuberculosis, septic etc.

b) Neoplastic-

Primary (lymphosarcoma),secondary (carcinoma, sarcoma,

malignant melanoma ). c) HematologicalHodgkins disease,Non-hodgkins lymphoma.

d) Immunological AIDS Serum sickness Drug reaction Rheumatoid artheritis.

REFERENCES:
SRBs Surgery For Dental Students - Sriram Bhat M Oral Diagnosis , Oral Medicine and Treatment Planning

- Steven L. Bricker , Robert P.Langlais Burkits Oral Medicine , Diagnosis and Treatment www.google.com www.wikipedia.com