Cochlear Implant and Hearing Impairment – Dr Akbar Abbas in Talks with Dr Ikram
March 23, 2025
Professional video on Types of Hearing Loss
March 23, 2025Cochlear Implant and Hearing Impairment – Dr Akbar Abbas in Talks with Dr Ikram
March 23, 2025Professional video on Types of Hearing Loss
March 23, 2025Clinical Examination of Throat And Neck for undergraduate and post graduate students.
As part of a thorough clinical examination, assessing the submandibular glands, lymph nodes, and oral cavity is critical in identifying underlying health issues. Below is a step-by-step guide on how to conduct a systematic examination, as demonstrated by Dr. Akbar Abbas.
Bimanual Palpation of the Submandibular Gland
The bimanual palpation technique is essential to assess the submandibular gland for enlargement or masses.
- Positioning: One finger is placed on the floor of the mouth inside (intraorally) and the other hand palpates externally beneath the mandible.
- Repeat this process on both the right and left submandibular glands to ensure a bilateral assessment.
Why is this important?
Bimanual palpation helps in early detection of salivary gland pathologies like sialadenitis or neoplasms. Learn more about submandibular gland examination here.
Using the Indirect Laryngoscopy Mirror
Dr. Abbas demonstrates the proper use of the indirect laryngoscopy mirror, an essential tool for examining the larynx and pharyngeal structures.
- Identification: The ideal mirror features a straight shaft with a circular mirror at the tip.
- Preparation: Always wear gloves (preferably on the left hand) and use a gauze to gently hold the patient’s tongue.
- Warming the Mirror: Use a flame to gently warm the mirror surface (mirror-side only) to reduce fogging when placed inside the mouth.
- Examination: Evaluate the posterior tongue, vallecular space, vocal cord movement, and pharyngeal structures.
For a detailed understanding, refer to this BMJ article on indirect laryngoscopy.
Systematic Neck Examination
Lymph Node Examination (Levels I-V)
Dr. Abbas emphasizes the systematic approach to lymph node palpation:
- Level I: Submental and submandibular lymph nodes (under the chin).
- Level II: Deep cervical lymph nodes located anterior to the sternocleidomastoid (SCM) muscle.
- Level III & IV: Continue down the anterior cervical chain along the SCM.
- Level V: Supraclavicular and posterior cervical triangle nodes.
- Occipital & Parotid Nodes: Palpate the occipital region and pre-auricular (parotid) area for additional lymphadenopathy.
Key Tip: Always palpate both in front of and behind the SCM to thoroughly assess hidden lymph nodes.
For further clinical insight, read this guide on cervical lymph node examination.
Supraclavicular Fossa Examination
Ask the patient to shrug their shoulders to assess the supraclavicular fossa, particularly important for identifying Virchow’s node, which can indicate intra-abdominal or thoracic malignancies.
Best Practices During Examination
- Examiner Position: Always sit on the left-hand side of the patient at eye level.
- Lighting: Use a headlight or head mirror as per clinical guidelines to ensure optimal visualization.
- Patient Comfort: After examination, re-drape the patient and assist with buttoning their shirt.
Mirror Confusion Explained
Students often confuse two types of mirrors:
- Indirect Laryngoscopy Mirror: Straight shaft with a mirror at the tip – for examining the larynx.
- Nasopharyngeal Mirror: Curved shaft with an upward-angled mirror – for visualizing the nasopharynx and fornices of the tonsillar pillars.
For clarification on laryngoscopy instruments, visit this ENT UK guide on laryngoscopy tools.
Conclusion
Dr. Abbas’ step-by-step method ensures a comprehensive head and neck assessment, which is vital in detecting a wide range of pathologies early. Whether you are a medical student or a clinician refreshing your skills, adhering to these protocols can significantly improve diagnostic accuracy.
