Anatomy Quiz: Thyroid and Neck Structures

Learning Objectives

• Identify pertinent head, face, and neck history questions
• Obtain a specific history for head, face, and neck
• Perform a physical assessment of the head, face, and neck
• Document findings from the head, face, and neck assessment
• Differentiate between normal and abnormal head, face, and neck assessment findings

Introduction

• Head and neck assessment focuses on the cranium, face, thyroid gland, and lymph nodes within the head and neck.
• The skull (framework of the head) is divided into two sections: cranium and face.

Cranium

• The cranium houses and protects the brain.
• It is composed of six bones: frontal, parietal (2), temporal (2), occipital, and sphenoid.
• Cranial bones are connected by immovable sutures (e.g., sagittal, coronal, and lambdoid).
• The cranium is supported by cervical vertebrae (C1 "atlas", C2 "axis", and down to C7).
• The C7 vertebra has a palpable spinous process when the head is flexed.

Face

• Facial bones give shape to the face.
• The face consists of 14 bones: two maxillae, two zygomatics (cheekbones), two inferior conchae, two nasal bones, two lacrimals, two palatines, one vomer, and one mandible (jaw).
• All facial bones, except for the mandible, are immovable
• The mandible moves (up, down, & sideways) via the temporomandibular joint.
• Facial structures include muscles for movement and expressions.
• The temporal artery lies above the temporalis muscle and can be palpated in front of the ear.
• Important facial structures include the parotid (largest salivary gland), submandibular, and sublingual glands.

The Neck

• The neck is composed of blood vessels, muscles, and cervical vertebrae.
• Structures within the neck include the hyoid bone, larynx, trachea, and thyroid gland.
• Blood vessels of the neck include the internal and external carotid arteries, and internal and external jugular veins.
• Major neck muscles include the sternomastoid (dividing the neck into anterior and posterior triangles) and trapezius muscles.

Thyroid Gland

• The thyroid gland is located in the middle of the neck, straddling the trachea.
• It produces thyroxine (T4) and triiodothyronine (T3) hormones.
• The thyroid gland has two lobes connected by an isthmus.
• The thyroid cartilage (Adam's apple) sits above the cricoid cartilage.

Lymph Nodes

• Lymph nodes are small, oval clusters of lymphatic tissue along lymph vessels.
• They filter lymph and engulf pathogens, preventing harmful substances from entering circulation.
• Lymph nodes vary in size and shape, but most are less than 1 cm.
• Specific groupings in the head and neck include: preauricular, posterior auricular, occipital, submental, submandibular, jugulodigastric, superficial cervical, deep cervical, posterior cervical, and supraclavicular.

Subjective Data

• Headache: Ask about frequency, severity, onset/duration, location, character (throbbing, aching), intensity, associated factors (nausea, vomiting, visual disturbances, anxiety/stress, nuchal rigidity, fever).
• Head injury: Ask about history, onset, loss of consciousness (duration), location, any symptoms afterward (headache, vomiting), associated symptoms (pain in head/neck, vision changes, discharge), and pattern/changes since injury, and medications.
• Dizziness: Ask about onset (abrupt or gradual), associated factors (nausea, vomiting, pallor, decreased hearing acuity, tinnitus), and circumstances (standing). Dizziness can be classified into presyncope, vertigo (subjective or objective), or disequilibrium.
• Neck pain: Ask about onset, location, associated symptoms (limitations in range of motion, numbness/tingling in arms/shoulders/hands), and any precipitating factors (which movements cause the pain).
• Lumps/swellings: Ask about recent infection, tenderness, prior irradiation of head/neck/upper chest, difficulty swallowing, smoking history, thyroid problems (over/under-functioning), history of thyroid treatment (surgery, irradiation, medications) and history of head or neck surgery.

Objective Data: Head

• Inspection: Assess head size and shape (normocephalic), presence of lesions. Palpate the scalp and cranial bones for tenderness. Palpate temporal arteries for tenderness and firmness. Palpate the temporomandibular joint for smooth movement without limitation/tenderness.
• Abnormal findings: microcephaly (small head size), macrocephaly (large head size), temporal arteritis (tenderness and a hard band to palpation), TMJ crepitation, limited range of motion, tenderness. Identify types of headache (tension, migraine, cluster).

Objective Data: Face

• Inspection: Observe facial expression for symmetry and appropriateness to behavior/mood. Note symmetry of eyebrows and mouth. Examine for abnormal swelling, exophthalmos (bulging eyes), or involuntary movements.
• Abnormal findings: Tense rigid muscles (anxiety/pain), flat affect (depression), asymmetry (stroke, Bell's palsy)

Objective Data: Neck

• Inspection: Assess for symmetry, lumps/masses. Assess range of motion (chin-to-chest, turning head, ear-to-shoulder, extending backward). Note any enlargement of salivary glands, lymph nodes, or thyroid gland.
• Palpation: Palpate lymph nodes for location, size, shape, mobility, and tenderness. Palpate the trachea for midline position and symmetry. Use anterior and posterior approaches to palpate the thyroid gland (while listening for bruits) and note movement during swallowing.
• Abnormal findings: Congenital torticollis, arthritic neck, goiter (enlarged thyroid gland), lymphadenopathy (enlarged lymph nodes), trachea deviation (tumor/infection), bruits.

Sample Charting (Example) (Subjective/Objective Data)

• Subjective: Patient complains of dizziness, feeling of light-headedness, and fear of falling, no history of previous dizziness, no neck pain, lumps, or swelling.
• Objective: Head is normocephalic, no lumps, lesions, or tenderness. Face is symmetric. Neck is supple with full range of motion and no pain. Trachea is midline, thyroid is not palpable. No bruits heard, no lymphadenopathy.