Clinical Examination of Neck

Introduction:

Before beginning to examine the patient, the clinician should wash the hands. He / She should first introduce themselves to the patient. The neck step should be aimed at confirming the identity of the patient by seeking the patient’s name age etc. The entire process of examination should be explained to the patient. The consent of the patient should be sought before proceeding with the examination. The patient should be comfortably seated with the neck slightly flexed forwards to facilitate examination of the neck. This position ensures that the neck muscles are in a relaxed state ensuring perfect examination conditions. To be noted:

Patient’s voice should be listened for abnormalities like hoarseness / change in voice. Dyspnea / stridor should be looked out for Presence of scars in the neck – Due to previous surgery (thyroid etc.), Radiotherapy related scarring and discoloration.

Presence of obvious neck masses.

In the presence of midline lump:

1. The patient should be asked to sip from a glass of water. The mass should be observed for the presence of movement (up and down) during the process of swallowing. Thyroid masses and thyroglossal cyst move up and down when water is being swallowed. 2. The patient is asked to protrude the tongue. Thyroglossal cyst will move upwards while thyroid mass will not show any movement Central neck masses: 1. Mass arising from isthmus of thyroid gland 2. Thyroglossal cyst 3. Cervical adenopathy involving prelaryngeal node 4. Midline neck abscess 5. Ludwig’s angina (upper neck in the midline)

Lateral neck mass:

1. Cervical adenitis (tender mobile nodes) Acute in nature. 2. Secondary deposits (Node is nontender, hard and fixed to underlying structures) 3. Carotid body tumors 4. Laryngocele 5. Lipoma (mobile, discrete, with slippery edges) 6. Dermoid cyst 7. Salivary gland tumors 8. Acute sialadenitis (acute in nature) 9. Hematoma due to trauma 10. Inflammatory pseudotumor 11. Kimura disease 12. Castleman disease