[An enlarged lymph node in the neck; what to do?].

A swelling in the neck is often caused by one or more enlarged lymph nodes, usually due to a harmless disorder. Particularly in adults, a swelling in the neck may represent a metastasis of a malignancy in the head and neck region, for instance a squamous cell carcinoma arising from the oral mucosa. Palpation of the neck can provide valuable information, although its reliability is restricted, even when executed by an experienced clinician. Therefore, additional examination is required,for instance by fine needle aspiration cytology, ultrasound examination with or without guided fine needle aspiration, computer tomography and magnetic resonance imaging. In case a malignant tumour has been diagnosed in the upper aerodigestive tract, a sentinel node procedure may be performed. The question arises whether general practicing dentists should examine routinely every patient's neck, or only the necks of patients older than 40 years of age.