Head and Neck Examination

PREPARATION

  • Clean your hands 
  • Prepare your equipment
  • Introduce yourself (full name and job) and confirm the patient’s identity
  • Explain you want to perform an examination of the neck, to include looking inside the mouth, feeling for any neck lumps and flexible nasolaryngoscopy
  • Check whether there is any pain in the head or neck
  • Obtain verbal consent
  • Position the patient: sitting upright and slightly away from the back of the chair allows full access to the neck
  • Check the patient's allergy status and, if using, spray local anaesthetic into the nose, providing an explanation and tissues
  • Avoid using anaesthetic if you want to assess someone's swallowing

 

INSPECTION

Look anteroposteriorly and laterally 

In particular, note: 

  • Radiotherapy skin changes
  • Scars (collar; peri-auricular; neck dissection; skin excisions; flaps or grafts; tracheostomy or tracheal stoma)
  • Masses (size, colour, punctum, neck level location)
  • Have them take a sip of water, hold it in their mouth and watch for movement of the mass as they swallow on command
  • Test whether the mass moves on tongue protrusion
  • Functional/motor abnormalities (cranial nerve function; torticollis; trismus)

 

MOUTH EXAMINATION

  • Inspect all mucosal surfaces using a Lack’s tongue depressor; do not forget the floor of the mouth, fauces and retromolar trigones
  • Note the condition of teeth and gums – note any dental pain
  • Bimanually palpate the floor of mouth and cheeks, including salivary glands
  • Palpate the base of tongue if able (warn the patient that they might gag)

 

PALPATION

  • Warn the patient that this can be uncomfortable
  • Systematically swipe gently from the midline to laterally, following the levels of the neck, in particular noting:
  • The area of abnormality (see lump-specific features below)
  • Repeat swallow and tongue protrusion tests with palpation
  • Lymph nodes (levels of the neck)
  • Thyroid (all lobes)
  • Tracheal position
  • Presence of laryngeal crepitus

Lump-specific features: Site, Size, Surface, Consistency, Contour, Colour, Tethering, Temperature, Transillumination, Tenderness, Punctum, Pulsatile

 

PERCUSSION

Percuss for retrosternal dullness if there is an anterior neck lump

 

AUSCULTATION

A bruit could indicate hyperthyroidism or carotid body tumour

 

OTOSCOPY

Perform otoscopy

 

FLEXIBLE NASOLARYNGOSCOPY

The head and neck examination is not complete without a fibreoptic examination of the upper aerodigestive tract.

If indicated, and if a speech and language therapist is present, you could jointly perform a flexible endoscopic examination of swallow (FEES).

 

OTHER EXAMINATIONS IF INDICATED

Full thyroid status examination

Examination of the chest

 

POSSIBLE INVESTIGATIONS

Bedside tests: weight and nutritional status; swallowing; voice quality etc.

Blood tests: thyroid function; calcium status etc.

Radiology: ultrasound of palpable neck lumps with needle aspirate/biopsy; barium swallow for dysphagia; CXR for hoarseness etc.

Assessment of general status and anaesthetic risk

 

 

 Page last reviewed: 23 September 2016