From the Guidelines
When describing swollen lymph nodes along the neck and jaw on physical exam, it is crucial to document their location, size, consistency, mobility, tenderness, and any associated symptoms to determine the likely etiology of lymphadenopathy. To do this effectively, begin by specifying the exact location using cervical lymph node chains (anterior cervical, posterior cervical, submandibular, submental, supraclavicular) or levels (I-VI) 1. Note the size using a ruler when possible, describing whether nodes are discrete or matted together. Document consistency by palpation, with rubbery or hard nodes raising more concern than soft ones, as indicated in the evaluation of neck masses in adults 1. Mobile nodes are typically less concerning than fixed nodes that adhere to surrounding tissues. Record tenderness on palpation and any skin changes like erythema or warmth. Include bilateral comparison and associated symptoms such as fever, night sweats, or weight loss. Some key characteristics to consider when evaluating swollen lymph nodes include:
- Age greater than 40 years, which is associated with a greater risk of head and neck squamous cell carcinoma (HNSCC) 1
- Tobacco and alcohol use, which are synergistic risk factors for HNSCC 1
- Symptoms such as pharyngitis, dysphagia, otalgia, and recent voice change, which may indicate a malignancy 1
- Unexplained weight loss, which is common in cancer patients 1
- History of treatment for head and neck malignancy, which places a patient at risk for local or regional recurrence or a second malignancy 1
- Nontender neck mass, which is less likely to be infectious or inflammatory and more likely to be neoplastic 1 By considering these factors and systematically documenting the characteristics of swollen lymph nodes, healthcare providers can better determine the underlying cause and develop an appropriate treatment plan, prioritizing the reduction of morbidity, mortality, and improvement of quality of life.
From the Research
Description of Swollen Lymph Nodes
To describe swollen lymph nodes along the neck and jaw on physical exam, consider the following characteristics:
- Location: Note the specific areas where the lymph nodes are swollen, such as the neck, jaw, or supraclavicular region 2, 3.
- Size: Measure the diameter of the lymph nodes, as nodes greater than 1 cm in diameter are considered abnormal 3.
- Tenderness: Assess whether the lymph nodes are tender to the touch, which can indicate infection or inflammation 2.
- Mobility: Check if the lymph nodes are fixed in place or mobile, as fixed nodes can be a sign of malignancy 2.
- Consistency: Evaluate the texture of the lymph nodes, such as whether they are soft, firm, or hard 2.
Associated Symptoms
When describing swollen lymph nodes, also consider any associated symptoms, such as:
- Systemic symptoms: Fever, night sweats, and unexplained weight loss can indicate underlying systemic disease or malignancy 4, 2.
- Local symptoms: Pain or discomfort in the neck or jaw, or difficulty swallowing or breathing 2.
Differential Diagnosis
The differential diagnosis for swollen lymph nodes is broad and includes:
- Infections: Bacterial, viral, or fungal infections can cause lymphadenopathy 2, 3.
- Autoimmune disorders: Conditions such as rheumatoid arthritis or lupus can cause lymphadenopathy 2.
- Malignancy: Lymphoma or other cancers can cause lymphadenopathy, particularly in older adults or those with risk factors 4, 2.
- Medications: Certain medications can cause lymphadenopathy as a side effect 2.