1. CLINICAL SKILLS UNIT EDUCATIONAL LOOPS BY CHSE

2. EXAMINATION OF LYMPH NODES SITE – which anatomical areas are drained by the lymph node SIZE – large palpable nodes are by definition abnormal (usually > 1cm) CONSISTENCY – firm, rubbery, matted TENDERNESS – painless or painful on palpation FIXATION – are the nodes mobile or fixed OVERLYING SKIN – inflammation, tethering Important features to remember when examining and palpating lymph nodes are:

3. LYMPH NODE GROUPS OF HEAD AND NECK WE ROUTINELY EXAMINE 1.Submental 2.Submandibular 3.Pre-auricular 4.Post-auricular 5.Occipital 6.Posterior triangle 7.Cervical chain – superficial & deep 8.Supraclavicular nodes

4. DETAILED: LYMPH NODE GROUPS AND LYMPH DRAINAGE OF HEAD AND NECK 1.Submental 2.Submandibular 3.Pre-auricular 4.Post-auricular 5.Occipital 6.Tonsillar - jugulodigastric 7.Superficial cervical 8.Deep cervical 9.Supraclavicular 10.Infraclavicular 11.Posterior triangle

5. 1.Lower central lip, lower canine teeth and lower anterior part of oral cavity 2.Lateral end of lower lip whole upper, upper and lower premolars, upper canines, hard palate, forehead, cheek and anterior face 3.Lateral part of face and eyelids 4.Lateral scalp area 5.Occipital and sub-occipital region of scalp 6.Tonsillar and pharyngeal area 7.Cheek and lateral face around angle of the jaw 8.Superficial nodes of head and neck region, tongue, 9.Lung and breast 10.Lung and breast 11.From the occipital nodes and the retropharyngeal / parapharyngeal nodes LYMPH DRAINAGE OF HEAD AND NECK Note: Posterior triangle not shown on this picture

6. LYMPH NODES OF AXILLA 1.Lateral or brachial 2.Apical or central 3.Medial or pectoral 4.Posterior or sub-scapular 1.Upper limb 2.Final common pathway 3.Breast 4.Sub-scapular region LYMPH DRAINAGE OF AXILLARY REGION

7. 1.Horizontal or inguinal group –From buttocks and back, Lower abdomen, umbilical region, penis, perineum, lower vagina and anus 2.Femoral or vertical group –The lower limb LYMPH DRAINAGE OF GROIN REGION