Head and Neck Assessment

• During a head and neck assessment, structures including the head and neck are assessed.

Head

• Includes the face, hair, eyes, nose, mouth, ears, temporal artery, sinuses, temporomandibular joint, and cranial nerves.

Neck

• Includes lymph nodes, carotid artery, cranial nerves, thyroid gland, and trachea.

Inspecting the Face and Hair

• Facial appearance is assessed, ensuring eyes and ears are at the same level.
• Head size is checked for appropriate proportion to the body.
• Facial symmetry is evaluated, noting any drooping, which can indicate Bell's palsy or stroke.
• Facial expressions should be symmetrical without involuntary movements.
• Assess for any lesions.
• Cranial nerve VII (facial nerve) is tested by having the patient close their eyes tightly, smile, frown, and puff out their cheeks.

Palpating the Cranium and Inspecting Hair

• Palpate the cranium for masses or indentations.
• Check for skin breakdown, especially on the back of the head in immobile patients.
• Inspect the hair for infestations (lice) and conditions like alopecia areata.

Palpating the Temporal Artery Bilaterally

• Cranial Nerve V (trigeminal nerve), responsible for many functions with mastication as one.
• Patients bite down to feel the masseter and temporal muscle.
• Patients then try to open their mouth against resistance.

Palpating the Temporomandibular Joint

• Check for grating or clicking by having the patient open and close their mouth.

Palpating Frontal and Maxillary Sinuses

• Assess for tenderness.

Inspecting Eyes, Eyelids, Pupils, Sclera, and Conjunctiva

• Check for swelling of the eyelids.
• The sclera should be white and shiny, not yellow which may indicate jaundice.
• Conjunctiva should be pink, not red or swollen.
• Assess for strabismus (misalignment of eyes) and aniscoria (unequal pupil size).
• Pupils should be clear, not cloudy, and normally 3 to 5 mm and equal in size.

Testing Cranial Nerves III (Oculomotor), IV (Trochlear), VI (Abducens)

• Have the patient follow a penlight 12-14 inches from their face in six cardinal fields of gaze.
• Watch for nystagmus (involuntary eye movements).
• Dim the lights and have the patient look at a distant object to dilate pupils and shine the light in from the side of each eye.
• Note the pupil constriction and dilation size and response in both eyes.

Accommodation

• Pupils should constrict and equally move to cross as a penlight moves closer to the patient's nose.

Inspecting Ears

• Check for drainage (ear wax) or abnormalities.

Palpating Ears

• Ask the patient about tenderness and palpate the pinna and tragus.
• Palpate the mastoid process for swelling or tenderness.
• Test Cranial Nerve VIII (vestibulocochlear nerve) by testing hearing by occluding one ear and whispering two words and have the patient repeat them back.

Inspecting the Tympanic Membrane

• Use an otoscope.
• The tympanic membrane should appear pearly gray, translucent, and shiny.
• For adults, pull the pinna up and back, while for children, pull it down and back.
• The cone of light should be at the 5:00 position in the right ear and 7:00 position in the left ear.

Inspecting the Nose

• The nose should be symmetrical (midline), and the septum checked for any deviation.
• Note any drainage and use a penlight to check for lesions, redness, or polyps.
• Assess patency by having the patient close one nostril and breathe out of the other.
• Test Cranial Nerve I (olfactory nerve) by having the patient identify a pleasant smell with their eyes closed.

Inspecting the Mouth

• Inspect lips, which should be pink, not dusky, blue/cyanotic, or cracked, and free from lesions.
• Mucous membranes and gums should be pink and shiny, and teeth should be white and free from cavities.

Inspecting the Tongue

• The tongue should be moist and pink, not dry, cracked, or beefy red (may indicate pernicious anemia).
• Check the underside of the tongue for lesions or sores.
• Inspect the hard and soft palate and tonsils for exudate, and the uvula should be midline.

Testing Cranial Nerves

• Cranial Nerve XII (hypoglossal): Patient sticks tongue out and moves it side to side.
• Cranial Nerves IX (glossopharyngeal) and X (vagus): Have patient say "ah," uvula moves up (cranial nerve IX intact), and patient swallows easily without hoarseness (cranial nerve X intact).

Inspecting the Neck

• Trachea should be midline.
• Check for lesions, lumps (goiter), or enlarged lymph nodes (have patient extend the neck up).
• Test Cranial Nerve XI (accessory nerve) by having the patient move their head from side to side and up and down, and shrug shoulders against resistance.

Inspecting for Jugular Vein Distention

• Place the patient supine at a 45-degree angle, have them turn the head to the side, and note any enlargement of the jugular vein.

Palpating Lymph Nodes

• Use pads of fingers to feel for lumps, hard nodules, or tenderness.
• Palpate preauricular, postauricular, occipital, parotid, jugulodiagastric (tonsillar), submandibular, submental, superficial cervical, deep cervical chain, posterior cervical, and supraclavicular lymph nodes.
• Palpate the trachea to confirm it is midline.

Palpating the Thyroid Gland

• From the back check for nodules, tenderness, or enlargement; normally, it can't be palpated.
• Palpate carotid artery one side at a time and grade it (0 to 4+, 2+ is normal).

Auscultating Carotid Artery

• Use the bell of the stethoscope, listen for a swooshing sound (bruit), and have the patient breathe in and out and hold their breath.