Anatomy: Head, Neck, Veins & Salivary Glands

Head and Neck Anatomy: Bones

• The head's bony structures include the frontal, parietal, temporal, sphenoid and occipital bones
• The coronal, squamous, and lambdoidal sutures exist

Muscles of The Neck

• The sternomastoid and trapezius are major muscles here
• The sternomastoid facilitates head rotation and flexion

Veins of The Neck

• Problems with the jugular vein are linked to heart disorders

Salivary Glands

• Include the preauricular, submandibular, submental, posterior auricular, occipital, jugulodigastric, superficial cervical, posterior cervical, and supraclavicular

Subjective Data Collection: Head and Neck Pain

• Onset: Determine if the pain starts in the morning, during the day, or at night, and if it begins increasingly or suddenly
• Duration: Note the length in minutes, hours, days, or weeks and how sleep or medication affects it
• Location: Establish if it is in the head, side of the head, neck, sinuses, or behind the eyes
• Type: Note if the pain is a continuous pressure
• Severity: Use 1-10 pain scale to measure and assess how it changes in the morning/night or when awake/asleep

Subjective Data Collection: Vision Problems and Related Symptoms

• Ask about vision problems, like hemianopsia, or changes in the shape, size, and placement of objects visually
• Ask if the episode is the same or has increased
• Determine whether there are other symptoms like nausea, vomiting, diarrhea, photophobia, visual changes, inability to fall asleep, increased tears, increased nasal discharge, ringing in the ears, paresthesia, or lack of movement
• It is important to determine if there is a change in consciousness with pain to evaluate a Glasgow Coma Scale

Subjective Data Collection: Factors Influencing Head and Neck Pain

• Factors like fever, fatigue, stress, food, alcohol, seasonal allergies, menstruation, intercourse, caffeine and oral contraceptives can increase pain
• Pain reduced by sleeping, avoiding medication, or maintaining a daily routine
• Medications such as anticonvulsives, antiarrhythmics, beta-blockers, calcium channel blockers, oral contraceptives, antidepressants, and caffeine should be recorded as this can increase or decrease pain

Subjective Data Collection: Dizziness and Fainting

• Key to ascertain the occurrence of seizures and loss of consciousness
• When do these episodes occur
• How long do they last
• How often do they happen
• What factors increase or reduce?

Subjective Data Collection: Swelling and Tenderness

• Check for notable, unusual formations in the head or the hair that could indicate masses
• Also check if there are swellings or masses on the exterior head or neck
• Note any pain or tenderness with focus on the location, type, duration, and factors

Subjective Data Collection: Thyroid Issues

• Inquire about any neck swelling, pain when touching the area, or difficulty swallowing
• Ask about any change in hair, nails and skin health
• Ask about heat preference, whether they prefer or dislike heat or cold, and if they are dressing appropriately for external temperature
• Also record any emotional state changes
• Find out whether the patient takes thyroid medication

Subjective Data Collection: Head and Neck Injury

• Note consciousness state after possible injury
• Record other symptoms such as seizures, hypoglycemia, visual impairment, syncope, head and neck pain, local tenderness, change in breathing, double or blurred vision, nose or ear fluid discharge, nausea and vomiting, urinary/fecal incontinence, or any movement loss in extremities

Subjective Data Collection: Neck Stiffness

• Identify any neck/head trauma or swelling
• Check for bacterial or viral diseases
• Pain characteristics such as movement limitation, pain during movement or cramping
• Loss of unilateral vision/hearing, or working position
• Note heat, physical therapy, or medications

Subjective Data Collection: Medical History Related to Head and Neck Complaints

• Diagnosed head injuries, subdural hematoma, or lumbar puncture
• Exposure to radiotherapy
• Migraines or vascular headaches of any kind
• History of seizures or thyroid issues
• Family history of similar headaches or thyroid problems

Social Considerations

• Determine any possibility of head injuries or exposure to chemical substances at their workplace
• Record stress levels and pressure
• Any sports the patient participates in like the use of seatbelts where relevant
• Note the use of nutrition, weight fluctuations and/or alcohol use

Head Inspection Analysis

• Note position of the head and face symmetry to examine relevant symmetry

Facial Deformities

• Faces are evaluated for exophthalmia, Acromegaly, Cushing Syndrome, Myxedema, Hyperthyroidism, facial paralysis, Down Syndrome, or hydrocephalus
• Facial expressions are evaluated (e.g. happy, sad, angry, or uneasy)
• Sensitivities, lesions, parasites, or hair loss in the scalp
• Note hair, texture, color, or changes in pigmentation

Head Palpation Exam

• Very important for confirming data such as masses
• Patient's head should be slightly bent forward to determine if an area is sensitive
• Color, structure, quality and distribution of the hair
  • Dry or dull hair indicates hypothyroidism, or shiny hair indicate hyperthyroidism

Palpation: Temporal Mandibular Joint and Arteries

• Key things to observe regarding swelling or asymmetry and the temporal artery for pulsation

Neck Inspection and Thyroid Exam

• The neck is examined in a hyperextended state to detect symmetry
• Check the shortness of the neck and visible formation and abnormalities while detecting sensitivity
• The midline is palpated during both hands alongside the trachea to gauge the midline
• Move the hands to various parts of the trachea to determine the presence of masses under the tissues
• Be sure to inquire about whether the thyroid is midline or not if palpable
• Always consider conducting ROM examination with regards to the head and neck to determine sensitivity problems with movement
• The lymphatic and thyroid nodes are examined for growth and ROM

The Lymph Nodes Exam

• The following masses are examined through a circular motion with the finger tips
• Occipital, Posterior airicular, Anterior airicular, Parotid, Retropharyngeal, Submandibular, Submental, Superficial cervical, Supraclavicular and Deep cervical nodes

Growths in the Thyroid

• Causes could be from iodine deficiency, infections, autoimmune diseases or cancer.
• Growth can cause interference with venous airflow with the head and neck