Head and Neck Anatomy

• Evaluation of head and neck involves anatomy, physiology of head bones, salivary glands, and neck.

Head: Bones

• Key bones include Frontal, Parietal, Temporal, Sphenoid, and Occipital bones.

Facial Muscles

• Significant facial muscles include Frontalis, Temporalis, Orbicularis oculi, Nasolabial fold, Orbicularis oris, Zygomaticus, Buccinator, Masseter, Sternomastoid, and Trapezius.

Salivary Glands

• Salivary glands include the parotid, submandibular, and sublingual glands, playing a crucial role in saliva production
• Lymph nodes related to salivary glands: Preauricular, Submandibular, Submental, Posterior auricular, Occipital, Jugulodigastric, Superficial cervical, Posterior cervical, Supraclavicular, and Deep cervical chain

Neck Muscles

• Major neck muscles consist of the Sternomastoid in the front and the Trapezeus Muscle on the back side of the neck.
• The sternomastoid facilitates rotation and flexion of the head.

Neck Anatomy

• Key structures are the internal carotid artery, external carotid artery, carotid sinus, and Pyramidal lobe (thyroid gland)
• Other structures are trachea, lymph node, external jugular vein, left subclavian artery, and left subclavian vein
• The hyoid bone, thyroid cartilage, and thyroid gland also have clinical significance.

Subjective Data (Current story)

• Asking about head and neck pain is crucial, including its start, duration, and location
• The type and severity of pain should also be assessed, and any factors that increase or reduce the pain need recording
• Note any vision problems
• Details about episodes must be collected to understand if there has been an increase in severity
• Check for changes in the level of consciousness
• Ask about other concurrent symptoms such as nausea, vomiting, diarrhea and whether that is from photophobia, visual field changes, increased tears, nasal discharge, ringing in the ears, paresthesia or lack of movement.
• Determine whether vision problems affect the person
• Assess the factors that increase pain such as fever, stress & fatigue
• Alcohol consumption should be documented
• Oral contraceptives can increase pain
• Note the factors that reduce pain such as sleep and medication usage
• Note all medications including, Anticonvulsives, antiarrhythmics, beta-blockers, calcium channel blockers, oral contraceptives, serotonin antagonists/agonists, antidepressants, non-steroid anti-inflammatories, narcotics or caffeine

Dizziness and Fainting

• Ascertain also if there is any loss of consciousness with dizziness and/or seizures
• Specifically ask if there has been a loss of consciousness, when these events occur, how long they last, and how often they happen
• Determine the factors that increase the frequency of such things happening, such as specific head or neck movements.

Swelling in Head and Neck

• Enquire whether the person has detected any recent abnormal lumps, nodules or any swelling on their head or neck.
• Ask about any pain and tenderness around the head and neck
• Find out what increases and reduces the swelling or associated mass and/or tenderness on the head and neck so you can take appropriate actions.
• The factors that increase or decrease are of clinical importance to establish whether there could be cancer

Thyroid Problems

• Note whether the patient has identified problems with their thyroid
• Check for swelling in the neck, pain around the thyroid, pain during swallowing
• Ask about their heat preference and whether they prefer to be warm or cold & note any clothing adjustments
• Review any changes to their current hair type, nails or changes to skin
• Is there a change in their normal emotions - for example, are they overly energetic, irritable, or unmotivated in anything?
• Does he/she feel their heart beating faster than it should?
• Change in menstruation or bowel habits?
• Note all medication types the patient takes, including the popular drug “Levothyroxine” used to treat thyroid conditions

Head and Neck Injury

• Record their level of consciousness following any incident
• Check the time the loss of consciousness happened + if the conciseness has returned since the event.
• Evaluate if the person has had any seizures, is hypoglycemic and any changes in their eyesight
• Head injuries can range from, pain to the head and neck, damage to the tissue in the injury site, breathing difficulties + double or blurred vision.
• Check for any discharge from the ear or nose as well as periods of nausea, vomiting as well as control issues over their bladder
• Record the events from any witnesses to get a good picture of what happened

Neck/Back Stiffness

• Record any traumatic injuries to the head and neck
• Enquire as to any diseases that affect the spine and neck, specifically asking about meningitis
• Note any neck ache that distributes to the spine or down the spinal cord
• Assess any restrictions and/or pain from movement together with factors that reduce them, such as heat treatment or treatment from physiotherapy
• Note also any medication taken to control back/neck pain.

Background and Family Information

• Note the personal history, asking:
• Has the patient been diagnosed with a serious injury?
• Did they get lumbar punctures and why?
• Did they get any radiotherapy to the neck?
• Document known history of migraines/vascular headaches
• Has the patient been diagnosed with fits or seizure episodes?
• Is there a recorded history of a thyroid problem?
• Ask about family history related to the patient’s personal information

Personal/Social Info

• Note any workplace history of head injuries (relevant for worker compo reasons)
• Note any exposure to toxic substances.
• Record their lifestyle, whether they are exposed to stress
• Note details of injuries sustained when participating in sports
• Record information on diet, including intolerances/allergies
• Note alcohol usage

Inspection of Head

• Start the process of physical examination - asking the patient to keep their head upright
• Compare both sides of their face, looking at the formation of each feature (eyes, nose, eyebrows)
• Examine the formation/symmetry of a smile
• Note whether the facial muscles function equally
• Document symmetry (or asymmetry) whilst the person moves various aspects of the face (mimic movements)

Inspection of head outside symmetry

• Use of exophthalmia, which refers to when the patient eyeballs stick out abnormally
• Acromegaly - abnormal hormonal growth

Palpation of the Head

• Palpating helps confirm data obtained by inspection
• The patient must be relaxed throughout this activity
• The hands must be clean
• The patient must bend their head forward slightly, enabling full access
• Is there a known tumour?
• Is the head susceptible to any sensitivity (tenderness/pain)?
• Is there swelling?
• Is there edema?

Key palpation points

• Palpate the masseter muscle/temporalis muscles
• Inspect the temporal artery
• Review saliva production from the salivary glands
• Note lymph nodes by inspecting then palpating

Neck Palpation

• Examine and document the trachea (asking the patient to swallow can help assess symmetry)
• Record any enlargement of vesicles in the neck
• Record any scarring or injuries to the neck
• Check if there is any sensitivity, and/or if the person experiences pain and if any are found, document the following:
• Mobility
• Boundary location
• Size
• Consistency
• Tenderness/sensitivity + pain
• Skin features (or any redness/inflammation)
• Any restrictions regarding neck movement

Lymph Node Palpation

• Circulate the fingertips over the nodes for review.
• If any nodes are swollen, take appropriate actions
• Inspect the lymph nodes of the anterior, posterior + supraclavicular sections, assessing their state

Thyroid Palpation

• Identify if a problem even exists and whether these indications can be physically felt
• There is likely to be issues if any features are apparent to the touch during an examination, therefore;
• The examiner should carry out the process of ‘touching’ from behind the patient for effective location, using both hands and fingers to locate the sternomastoid muscles
• Palpation should be gentle whilst the patient swallows to ascertain an accurate confirmation
• Palpate the thyroid to determine:
• Location
• Node state or if it is nodule-filled
• Tissue description

Things that can affect the thyroid

• Autoimmune conditions
• Cancer
• Iodine deficiency
• Infections
• Document growth in thyroid gland if grown into blood vessels of airways