Neck Exam

Question 1

Summarise look, feel and mouth exam for neck

Answer 1

Neck Examination
Introduction
Wash hands, introduce self, identify patient. Explanation, consent.

Inspection of neck
Erythema, swelling, scars, discharge.
Inspect neck for masses and asymmetry, including during swallow (ask patient to take a mouthful of water, hold, then swallow).
Palpation of neck
From behind patient, use fingertips of both hands to examine neck nodes, working systematically through the different regions, and comparing sides – submental, submandibular, anterior triangle, posterior triangle, pre-auricular, post-auricular, occipital, supraclavicular, scalene.
Do not palpate Level 2 lymph nodes on both sides at the same time as this can cause a vasovagal episode in some patients.

Oral cavity and throat
Outer mouth, lips, dentition, oral mucosa.
Surface of tongue and hard palate – asking patient to open mouth wide and using tongue depressor if needed; ask patient to move tongue to left to inspect right side of tongue, and vice versa. Buccal area (lateral, superior, inferior walls) and gingivolabial/gingivobuccal sulcus.
Floor of mouth – asking patient to lift up tongue, and using tongue
depressor if needed.
Uvula, soft palate, tonsillar tissue, tonsil fossae, palatal folds, posterior pharyngeal wall.
Getting patient to breathe through mouth or phonate can help lower tongue.
Additional observations Closure
Listen to voice. Swallow. Stridor. Stertor.
Thank patient. Wash hands. Discuss and document findings.