Whilst dental healthcare professionals naturally focus on assessment of the teeth and the supporting tissues, they also have an important role in assessing the whole oro-facial complex and the neck. Assessment of the neck is particularly important, not least, because it contains the regional lymph nodes that are involved in immune surveillance of the head and neck region. The neck also contains the major salivary glands: the submandibular gland and the tail of the parotid gland. Mid-line structures include the hyoid bone, larynx, and trachea, along with the thyroid gland and parathyroid glands. The assessment of these anatomical structures should form part of the routine clinical examination. The discovery of an abnormality in the neck, which may not have been noticed by the patient, may expedite the diagnosis of significant disease and facilitate a timely intervention. A through understanding of the anatomy of the neck is essential and informs the clinical examination. It is also important to understand the concept of the anatomical levels that map out the lymph node groups of the neck (Chapter 1; Fig. 1.2). Accurate assessment of the neck is usually best achieved by a combination of visual inspection and palpation, with the patient in a slightly reclined position, the clinician standing behind the patient. Any lumps, e.g. enlarged lymph nodes, are described by anatomical site, size, consistency (cystic, soft, rubbery, hard), whether the lump is mobile or fixed to the underlying tissue, and if palpation elicits pain or discomfort. The combination of these parameters will help to formulate the differential diagnosis; for example, an isolated hard lump that is fixed to underlying structures is likely to represent metastatic cancer, whereas, bilateral soft lumps that are mobile and painful to palpation are likely to represent lymphadenitis as a consequence of systemic infection. Ultrasound examination can be used to ascertain important information about a neck lump such as the site (precise anatomical location, superficial or deep), size, consistency (solid or cystic), and multi-focality. Doppler settings can help to establish the vascularity of a lesion and its proximity to major vessels.
