Anatomy and Physiology of the Head and Neck

Anatomy of the Head: Bones

• The head consists of bones including the frontal, parietal, temporal, sphenoid, and occipital bones.
• Important bone structures also include the coronal suture, squamous suture, lambdoidal suture, lacrimal bone, nasal bone, zygomatic bone, maxilla, mandible, mastoid process, condyloid process, styloid process, zygomatic arch and coronoid process.

Physiology of the Head: Muscles

• Key facial muscles include the frontalis, temporalis, orbicularis oculi, zygomaticus, buccinator, masseter, sternomastoid, and trapezius.
• The orbicularis oris is an important muscle for facial expressions.

Salivary Glands

• Salivary glands include the preauricular, submandibular, submental, posterior auricular, occipital, jugulodigastric, superficial cervical, posterior cervical, and supraclavicular glands.
• The deep cervical chain is a major lymphatic pathway.

Neck Muscles

• The sternomastoid and trapezius are the major muscles of the neck.
• The sternomastoid facilitates rotation and flexion of the head.

Neck Anatomy

• Key anatomical structures in the neck include the hyoid bone, thyroid cartilage, internal and external carotid arteries, carotid sinus, pyramidal lobe of the thyroid gland, trachea, lymph nodes, internal and external jugular veins, and subclavian arteries and veins.
• Jugular vein issues can indicate potential heart disorders.
• Main arteries include internal and external carotid arteries, and also the common carotid artery and the intenal jugular vein.

Head and Neck Examination: Subjective Data - Pain

• Key pain-related questions involve onset, duration, location, type, and severity.
• Determine if the pain is linked to specific times, activities, or altered with medications.

Vision and Neurological Symptoms

• Symptoms of vision problems include hemianopsia, changes in the shape or size of objects and neuronal or emotional fluctuations.
• Episodes of pain and altered levels of consciousness need to be assessed.
• Watch for other symptoms such as nausea, vomiting, diarrhea, photophobia, visual disturbances, inability to sleep, increased tearing, nasal discharge, tinnitus, paresthesia, or lack of movement.

Factors Influencing Head and Neck Pain

• Factors that can increase pain include fever, fatigue, stress, certain foods or alcohol, seasonal allergies, menstrual cycles, intercourse, and oral contraceptives or caffeine.
• Reducing factors include sleep and routine medication use.
• Drugs like anticonvulsives, antiarrhythmics, beta-blockers, calcium channel blockers, antidepressants, and caffeine-containing drugs can play a role.
• Excessive analgesic use can be dangerous and can actually increase pain.

Dizziness and Fainting

• Dizziness and fainting can indicate seizures and should investigate details of triggers and duration along with reducing factors.

Swelling and Masses

• Swelling, masses, and nodules in the head and neck warrant investigation to rule out dangerous conditions.
• Pain and/or tenderness presence of should be noted.

Thyroid Issues

• The assessment investigates thyroid-related symptoms such as swelling in the neck, pain, changes in hair or skin, emotional changes, heart palpitations, and bowel and menstrual changes.
• Determine if the patient uses thyroid medications and note their medication type.

Head and Neck Injury

• Assess the patient's state of consciousness post-injury, including any seizures, hypoglycemia, altered vision, or syncope.
• Evaluate co-existing symptoms such as pain, tenderness, lacerations, breathing changes, vision disturbances, fluid discharge, nausea, vomiting, incontinence, or mobility issues.
• Gather information about head and neck injury from witnesses.

Neck Stiffness

• Assess for trauma, swelling, fever, as well as factors such as continuous or cramp-like discomfort that can affect the arms and shoulders.
• Assess too how vision and hearing loss, or stationary work environments can contribute.
• Heat, physical therapy, and medications have shown to be relieving measures.

Relevant Background and Family History

• Key areas of inquiry: previous head injuries, radiotherapy, migraines, and seizures.
• Determine if there is a family history of headaches or thyroid problems.

Personal and Social Factors

• Inquire about job-related risks, exposure to toxins, and levels of stress.
• Note lifestyle influences such as sports, seat belt usage, nutrition habits, and alcohol consumption.

Head and Neck Examination: Observation

• Position the patient upright when being examined.
• Facial symmetry should be assessed, specifically when looking at eyebrows, eyes, nose, ears, and mouth.
• Assess for any muscle spasms.

Facial Shapes and Syndromes

• Changes to facial shape may imply exophthalmia, acromegaly, Cushing's syndrome, myxedema, hyperthyroidism, facial paralysis, Down syndrome or hydrocephalus.

Skin and Hair Assessment

• Evaluate facial expression, skin sensitivity, lesions, masses, parasites, and hair loss.
• Assess hair color, structure, thickness, pigmentation and consistency.
• Note edema location since it can signify other issues.

Head and Neck Examination: Palpation

• Palpation assists in confirming data that was obtained though inspection.
• The head is held bent forward to check sensitivity and any presence of mass.
• All areas of the head are checked for tenderness, swelling, and collapse.
• Hair is checked for color, structure, distribution, and quality; dry and dull hair is indication of hypothyroidism, while shiny hair suggests hyperthyroidism.

Temporal Artery and Salivary Glands

• Examine the temporal arteries bilaterally, and assess fullness.
• Any asymmetry can indicate underlying issues.
• Determine if there is swelling of the salivary glands, or if there any presence of infections or masses.

Neck Inspection

• Assess neck structures for asymmetry and look for scarring, swelling or masses.
• Examine superficial veins, carotid artery and lymph nodes.
• Range of movement (ROM) should also be assessed.

Trachea and Neck Structures Palpation

• The trachea is palpated to confirm if it is in line with the midline.
• The thumbs of both hands are placed on the lower part of the neck and any shift can indicate issues.
• Palpate the hyoid bone, thyroid, and cricoid cartilage, and note sensitivity, or slippage.

Lymph Node Examination

• Circulate fingertips to check lymph nodes.
• Lymph nodes examined include the occipital, posterior and anterior auricular, parotid and retropharyngeal, submandibular, submental, superficial and posterior cervical, deep cervical, and supraclavicular regions.

Thyroid Gland Evaluation

• Consistency of tissue, stiffness, softness and any presence of mass are examined.
• Examiner is positioned behind the subject.
• The neck is slightly extended for examination.
• Left hand pushes the trachea slightly to the right as the right hand palpates the thyroid cartilage.
• Same process is repeated by reversing the pushing direction.

Growth of the Thyroid Gland

• Thyroid growth can be caused by iodine deficiency, infection, autoimmune disease, or cancer.
• If growth is excessive, it can restrict venous flow from the head and neck area.
• Airway and vascular obstruction may be symptoms.

Documentation Examples for Head and Neck Examination

• Important findings include patient's subjective experiences with medications and prior symptoms.
• Observations from physical examination are also included, such as facial symmetry, eye and eyebrow movement, movement of temporamandibular joints.
• It's also significant whether the neck is mobile.
• There are also notations if there are lymphadenopathy signs or any kind of thyroid abnormalities.