During palpation they feel like elastic marbles (8). A normal lymph node in the neck is barely perceptible. Performing of the examination (Photo’s by Daan Bredewout) (1)Ī normal lymph node is small, approximately 3-7 mm, usually spool-shaped, smooth, sharply edged, elastic in consistency, not fused with the skin or underlying tissues and is not painful during palpation. Palpation might be painful, therefore pay close attention to the patient's reactions (8). The fingers are stretched and make a rubbing or a somewhat twisting movement. Hold the hands and fingers flat and begin parallel to the skin. It is therefore time-saving to first investigate sub mentally, then towards the angulus mandibularis, through anterocranial to the Sternocleidomastoid muscle (Jugular), the supraclavicular space and then along the edge of the Trapezius muscle (pars descendens) in the direction of the occiput (Nuchal) (1). The palpation is performed with both hands for a comparison of both sides. The therapist stands behind the patient, who is sitting in an upright position with the cervical spine in 20-30 degrees flexion. (7) is usually sufficient to detect abnormalities and to consider referring the patient to a specialist. Other than this classification, Classification according to the American Society of Head and Neck Surgery, as mentioned below, according to Berghaus et al. Level VI, Lymph node group of the anterior neck triangle. Level III, Middle jugular lymph node group. Level II, Upper jugular lymph node group. Level I, Submental and submandibular lymph node group. The drainage area of the lymph glands is at the base of this (5, 6). A uniform description of the lymph node locations is important for diagnostics there is often a relationship between the localization of enlarged lymph nodes and the cause of swelling. It is customary to follow the classification of lymph nodes stations in the neck as practiced by the American Society of Head and Neck Surgery (4). Assessment of the cervical and neck Lymph nodes by palpation from dorsal. Palpation, for example, is a good tool to reveal lymph node pathology of the head and neck area and can be classified in several ways: Picture 1. Knowledge of the lymphatic system has to be an important clinical standard practice (3). doctor or another specialist, the therapist can perform an global palpation examination on the lymph nodes (1). When there are no clear indications of a craniomandibular and facial dysfunctions in a subjective examination, but a clear dominant asymmetry in the soft tissue is observed and this discomfort is not observed by an E.N.T.
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