Head and Neck

This is a reasonably long and complex examination. Take your time to prepare fully. It can be uncomfortable for the patient so be extra cautious. There are different ways to perform an examination of the head and neck. This is one example of a structured examination.

 

Equipment

 

  1. Tongue depressors

  2. Headlight

  3. Gloves

  4. Pot to put patient’s dentures in

 

Introduction

 

  • Wash hands with alcohol gel

  • Introduce yourself to the patient

  • Confirm patient’s name and date of birth

  • Obtain consent to examine the patient and explain what this will involve

  • Ask for a chaperone if required

  • Position patient – sit in chair

  • Ask the patient if they have any pain

  • Ask patient to remove any dentures if present

  • Gather equipment 

 

Oral cavity

 

Inspection

 

  • Tonsils

  • Uvula

  • Pharynx

  • Hard palate

  • Soft palate

  • Dentition

  • Tongue – including underneath and lateral aspects

 

Palpation – use gloves, bimanual technique. 

 

  • Palpate any lumps

  • Lateral wall of mouth – Stenson’s duct

  • Floor of mouth – Warthin’s duct

 

For any lesion comment on size, site, tenderness, consistency, colour, presence of stones

 

Neck

 

Inspection

 

  • Voice – quality – hoarse, breathy, gravelly 

  • Breathing – stridor, stertor

  • Scars

  • Masses – midline, lateral

  • Thyroid/midline mass

  • Ask patient to take sip of water and swallow and assessment movement

  • Ask patient to protrude tongue, look for upwards movement

  • Tracheostomy, laryngectomy

 

Palpation

 

  • Cervical lymph nodes – submental, submandibular. anterior cervical chain, posterior cervical chain, pre and post auricular, occipital

  • Parotid gland

  • Submandibular gland (bimanual palpation)

  • Thyroid

  • Neck lump

  • Describe size, site, shape, consistency, fluctuant, overlying skin changes, auscultate, transilluminate, pulsatility, temperature

 

To complete examination

 

  • Remove and dispose of gloves and tongue depressor

  • Thank the patient

  • Present findings

  • Document any findings

  • Suggest further examination and investigation

    • Full ENT examination

    • Flexible naso-endoscopy

 

Possible investigations that may subsequently be requested

 

  1. Bloods – FBC, U+E, CRP, LFTS, TFTs

  2. Ultrasound of any neck lumps +/- FNA

  3. OPG if poor dentition

  4. CT / MRI if suspecting malignancy

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