When palpating the client’s neck for lymphadenopathy, where should the nurse position himself?

A lymph node evaluation should be included in all new patients as part of the oral cancer triage.  Below is a video showing the proper technique and a written explanation of what is expected from dentists when performing a lymph node and thyroid gland examination.

NOTE: Video recorded previous to COVID-19 pandemic.  The PPE does not reflect the actual requirements for patient care.

1. Anterior Cervical Lymph Node Examination

The lymph node examination is performed with circular motion, identifying pain, and swollen ganglia or induration.

For the anterior cervical lymph node exam, palpate the lymph nodes in the neck using circular motion over the underlying tissues in each area.  If a palpable node is located, describe it with detail (painful, hard, indurated).

2. Posterior Cervical Lymph Node Examination

With the tips of the fingers, move the ECM muscle to the front, and follow the posterior line with gentle but firm pressure.  Again, if a palpable node is located, describe it with detail (painful, hard, indurated).

3. Supraclavicular Lymph Node Examination

Palpate the supraclavicular lymph nodes, placing the fingers above the clavicle using firm pressure in small circular movements and feel for gland across the top and slightly behind this bone.

4. Submandibular Lymph Node Examination

Follow the lower border of the mandible with the tips of the finger.

Thyroid Gland Palpation

Inspect the thyroid gland from the front and from the side and then palpate the thyroid gland using both hands from front or behind the patient.  Examine the thyroid gland while having the patient swallow and by pushing the thyroid gland from one side while palpating with the other hand.