Head and Neck Anatomy & Physiology

• The presentation focuses on the evaluation of the head and neck.

Anatomy and Physiology of the Head: Bones

• The head consists of bones including the frontal, parietal, temporal, sphenoid, and occipital bones.
• Sutures include the coronal, squamous, and lambdoidal sutures.
• Other bony structures include the zygomatic bone, maxilla, and mandible.

Facial Muscles

• Key facial muscles include the frontalis, temporalis, orbicularis oculi, zygomaticus, buccinator, masseter, sternomastoid, and trapezius.
• Palpebral fissure, nasolabial fold and orbicularis oris muscles are included.

Anatomy and Physiology of the Head: Salivary Glands

• Key salivary glands include the preauricular, submandibular, and submental glands.
• Lymph node chains include posterior auricular, occipital, jugulodigastric, superficial cervical, posterior cervical, supraclavicular, and deep cervical chains.

Neck Muscles

• The major muscles of the neck are the sternomastoid and trapezius.
• Sternomastoid provides rotation and flexion of the muscular head.

Neck Anatomy

• Important anatomical structures include the hyoid bone, thyroid cartilage, and trachea with the internal and external carotid arteries, carotid sinus, and the pyramidal lobe of the thyroid gland.
• Lymph nodes, jugular veins (internal and external), and subclavian arteries are included.

Head and Neck Examination: Subjective Data (Current Story)

• Subjective Data in a head and neck examination includes acquiring:
  • When head and neck pain started, whether it was early in the morning, during the day, or at night, and if it started increasingly or suddenly.
• Duration of the symptoms including minutes, hours, days and weeks, sleep or medication, the state of spontaneous passing, cluster pain, and how long the painless periods are.
• Place of pain or symptoms, assessing if it is in the head, on the side of the head, in the neck, in the sinuses, behind the eyes.
• Type of pain symptoms such as continuous pressure,.
• Severity of the symptoms, evaluating if it is the same or variable using a 1-10 pain scale and if it increases in the morning or at night, only to be seen when awake or asleep.
• Vision problems, such as hemianopsia, or changes in the shape, size, and place of objects.
• Inquiry if each episode is the same or increasing.
• Evaluation needed if there is change of consciousness with pain.
• Consider accompanying symptoms like nausea, vomiting, diarrhea, photophobia, visual change, inability to fall asleep.
• Review increased tears, nasal discharge, ringing in the ear, paresthesia or lack of limb movement.
• Drug history, whether patient is on anticonvulsives, antiarrhythmics, beta-blockers, calcium channel blockers, oral contraceptives, serotonin antagonists or agonists, antidepressants, non-steroid anti-inflammatories, narcotics or caffeine-containing drugs.
• Factors that increase or decrease the symptoms, and whether use of sleeping aids, medications, or routine daily medication alleviate it.

Dizziness and Fainting

• It's important to assess if there is a loss of consciousness or seizures.
• When the dizziness and or fainting occurs
• How long it lasts.
• How often it is occurring
• Factors that increase the symptoms; head or neck movements
• Factors that reduce the symptoms

Swelling

• Evaluate the presence of mass or nodules:
• Whether there is an abnormal formation in head and hair that the patient notices.
• Inquiry if there are any swellings, masses, nodules on the head and neck.
  • It is important to note that it can that it can be dangerous
• Questioning of presence of pain and tenderness in the head and neck includes taking detail notes of location, type, duration, factors that increase and decrease the symptoms.

Thyroid Problems

• Inquire of thyroid problems such as:
  • Swelling in the neck
  • Pain with touch
  • Pain when swallowing
• Heat preference.
• Dress according to air temperature.
• Changes in hair, nails and skin.
• Emotional changes.
• Tachycardia and/or palpitations, and menstruation or bowel habit changes.
• Inquire if the patient is currently taking thyroid medication.

Head and Neck Injury

• State of consciousness after the injury and the duration of the unconsciousness.
• Factors such as seizures, hypoglycemia and visual impairment.
• Review the presence of syncope.
• Check for co-existing symptoms like; neck pain, local tenderness, laceration, change in breathing ,double or blurred vision and/or liquid or fluid coming from the nose and/or the ear Evaluate any nausea and vomiting, urinary and fecal incontinence, or loss of movement in extremities. Report as if unconscious.
• Review the story of a person who witnessed the event.

Neck Stiffness

• Check any neck or head trauma and swelling in the neck
• Evaluate fever, bacterial and viral diseases
• Details of specific characteristics like for instance limitation of movement, continuous or cramp like pain.
• Review Factors of unilateral or vision and hearing loss, or posture while in from of a desktop for long periods of time
• Check for mitigating factors and Heat, such as physical therapy and medications.

Subjective Data: Gathering Background and Family History

• Background:
  • Any diagnosis of head injury or subdural hematoma.
  • Performance of lumbar puncture.
  • Radiotherapy performance on the neck and head.
  • Diagnosis of migraines or vascular headaches.
  • Any prior seizure or thyroid problems.
• Family History:
  • Similarity of patient's headache history to family members.
  • Any family member diagnosis of thyroid problem.

Subjective Data: Personal and Social Information

• Gathering personal and social information includes:
• Enquire occupation of a patient and if exposes of head injuries.
• Check for any pressure from the workplace that cause toxic fumes and substance,
• Check for risk of injuries and if the person participate in any sport.
• Questions of safety when using seatbelts.
• Check the environment in which the patient lives in
• Evaluate any food habits, any food intolerances or loss of appetites.
• Inquire use of alcohol.

Examination of the Head and Neck: Inspection

• Position: Evaluate in upright position.
  • Standard: Head aligned in a symmetrical posture.
• symmetry: symmetry in eyebrows, eyes, nose, ears and Mouth.. - Standard: head and face are Symmetrical(in resting ,moving and mimic movements. Cranial nerves. Muscles spasm in the face , neck or involuntary movements.

Objective data: Facial Shapes Observation

• Observation:
  • Evaluating the face shape looks for signs of exophthalmia, acromegaly, Cushing's syndrome or thyroid disorders and if there are sign of fluid. -Acromegaly. -cushings face is puffy the face of the moon
    • Hyperthyroidism Exophthalmos
    • Downs syndrome. -Hydrocephalus increased brain fluid Other facial symptoms: -Exophthalmia ,blood test confirm

Examination of the Head and Neck: Palpation

• The examiner confirms the data obtained by doing the palpation after inspection
• Areas where the head is palpated are for sensitivity and assessment of the mass and.

Palpated Areas for structure and Sensitivity

• Area the palated, no swelling or tenderness collapses as the color,structure , quality of the hair.
• Dry hair or shinny hair
• The part of the head bent slightly forward between examiners hands while palpate it.

Palpation: Temporal Arteries

• Assess the the temporal arteries is by palating pulse bilaterally.
• Check for symmetry or swelling of any salivary glands

Neck Inspection

• Inspect with patient with normal position or with slightly hyperextension: -Assess if any scars and masses of any formation of the next:
• Lymph nodes .
• Thyroid glands(mass, enlarged superficial bone, tenderness, asymmetry ,mass)

Neck Palpation

• Palpated with gentle rotation and movements.
• Palpate the front the neck while extending .
• Move traches laterally and ask swallow-Thyroid
• The lymph node areas are palpated using with finger pads.
• Supraclavicular Lymph gland need is to palpate from back in front (behind pt as pt is breathing.

Thyroid Testing

• The normal position of the trachea is in the midline.
• Use 2 hands place on the lower part of the neck on eather side of the trachea to assess.
• Palpate for the hyoid bone,swallowing , thyroid and critical cartilages should slide ,no pain.

Palpation Thyroid Structure

• The consistency .
• Examiner position.
• Hand Position technique.
• The position of the patient
• Positioning of trachea is important

GROWTH IN THYROID GLAND

• The causes for growth is if there is low iodine autoimmune problem infection.

Documentation

• Some of documentation and information contain private patient background.