Head, Face, and Neck Anatomy PDF

Learning Objectives On completion of this lecture, the student will be able to: ❑ Identify pertinent head, face, and neck history questions ❑ Obtain a history specific for head, face, and neck ❑ Perform head, face and neck physical assessment ❑ Document head, face, and neck assessment findings...

Learning Objectives On completion of this lecture, the student will be able to: ❑ Identify pertinent head, face, and neck history questions ❑ Obtain a history specific for head, face, and neck ❑ Perform head, face and neck physical assessment ❑ Document head, face, and neck assessment findings ❑ Differentiate between normal and abnormal head, face, and neck assessment findings  Introduction Head & neck Framework of head is assessment focuses on skull, which can be cranium, face, thyroid divided into two gland & lymph nodes subsections: cranium contained within head and face &neck  Cranium The cranium houses & protects the brain It consists of six bones: frontal (1), parietal (2), occipital (1) & temporal (2) Cranial bones are joined together by immovable sutures: sagittal, coronal and lambdoid sutures  Cranium (Cont….) ❑ Cranium is supported by cervical vertebrae: C1 “atlas”; C2 “axis”; and down to C7 ❑ C7 vertebra has a long spinous process that is palpable when head is flexed  Face ❑Facial bones give shape to the face ❑ The face consists of 14 bones Maxilla (2) Zygomatic (cheek) (2) Inferior conchae (2) Nasal (2) Lacrimal (2) Palatine (2) Vomer (1) Mandible (jaw) (1) ❑ All facial bones are immovable except for mandible, which has free movement (up, down & sideways) at temporomandibular joint  Face (Cont….) ❑ Face consists of many muscles that produce facial movement & expressions ❑ Temporal artery, a major artery, lies superior to temporalis muscle; palpable at anterior to ear ❑ Other important structures located in facial region: 1) Parotid glands are in cheeks over mandible, anterior to and below ear (the largest of salivary glands) 2) Submandibular glands beneath mandible at angle of jaw 3) Sublingual glands, lie in floor of mouth Face (Cont….)  The Neck ❑ Composed of major blood vessels, muscles & cervical vertebrae ❑ Contained within neck are: hyoid bone, larynx, trachea & thyroid gland ❑ Blood vessels include: 1) internal and external carotid arteries, 2) internal and external jugular vein  The Neck (Cont….) ❑ Major neck muscles are: 1) Sternomastoid (divides each side of the neck into two triangles; anterior and posterior) 2) Trapezius  Thyroid Gland ❑ It straddles the trachea in the middle of neck ❑ Secretes thyroxine (T4) & triiodothyronine (T3) hormones ❑ Gland has two lobes are connected by a thin isthmus ❑ Thyroid cartilage (“Adam’s apple”) is larger and located above cricoid cartilage  Lymph Nodes ❑ Are small, oval clusters of lymphatic tissue that are set at intervals along lymph vessels ❑ Filter lymph, engulf pathogens and preventing harmful substances from entering circulation ❑ Size and shape of lymph nodes vary, but most are less than 1 cm Lymph Nodes (Cont….)  Subjective Data ❑Headache? Any unusually frequent or unusually severe headache? Onset and duration Location: Where? ▪ Cluster headaches ▪ Tension headaches ▪ Migraine headaches  Subjective Data (Cont….) ❑Headache (Cont….) Character ▪ Throbbing (pounding, shooting) – migraine ▪ Aching (constant pressure, dull) – tension headache Intensity- mild, moderate, or severe Associated factors ▪ Nausea, vomiting & visual disturbances are associated with migraines ▪ Anxiety & stress are associated with tension headaches ▪ Nuchal rigidity & fever are associated with meningitis or encephalitis  Subjective Data (Cont….) ❑Head injury? History of head injuries? Onset. When? Loss of Consciousness?. How long were you unconscious? Location and duration? Any symptoms afterward—headache, vomiting, projectile vomiting? Associated symptoms. Any pain in the head or neck, vision change, discharge from ear or nose? Pattern. Are symptoms worse, better, unchanged since injury? Any medications?  Subjective Data (Cont….) ❑Dizziness? Onset. Abrupt or gradual? After a change in position such as sudden standing? Associated factors. Any nausea and vomiting, pallor, decreased hearing acuity, or tinnitus along with dizziness?  Subjective Data (Cont….) ❑Dizziness? Dizziness includes: ▪ Presyncope, a light-headed, feeling of fainting or falling caused by decreased blood flow to brain or decreased cardiac output ▪ Vertigo is true rotational spinning often from disorder in inner ear: i. Subjective vertigo the person feels like he or she is spinning ii. Objective vertigo the person feels like the room is spinning ▪ Disequilibrium is a shakiness or instability when walking related to musculoskeletal disorder or multisensory deficits  Subjective Data (Cont….) ❑ Neck pain? Onset Location Associated symptoms. Any limitations to range of motion, numbness or tingling in shoulders, arms, or hands? Precipitating factors. Which movements cause pain?  Subjective Data (Cont….) ❑Lumps or swelling? Any recent infection? Any tenderness? Any history of prior irradiation of head, neck, upper chest? Any difficulty swallowing (Dysphagia)? Do you smoke? For how long? How many packs a day? Thyroid problem? Overfunctioning or underfunctioning? How was it treated: surgery, irradiation, any medication? ❑ Any history of head or neck surgery?  Objective Data: Head ❑To assess the head, use inspection and palpation ❑Inspection: Head 1) Size & shape Note general size and shape ▪ Normally- head is symmetric, round, erect in midline & appropriately related to body size (normocephalic) ▪ No lesions are visible Lumps  Objective Data: Head (Cont….) ❑ Palpation: Head 1) Shape Place your fingers in person's hair & palpate scalp ▪ Normally, feels symmetric &smooth without lesion Palpate cranial bones- forehead, side of each parietal bone, occipital bone & mastoid process behind each ear ▪ Normally, no tenderness to palpation  Objective Data: Head (Cont….) ❑ Palpation: Head (Cont….) 2) Temporal artery Palpate above zygomatic bone, between eye and top of ear ▪ Normally, artery feels soft straight 3) Temporomandibular joint (TMJ) Below temporal artery and anterior to tragus Palpate joint as the person opens the mouth ▪ Normally, smooth movement with no limitation or tenderness  Abnormal Findings (Head) ❑ Shape ▪ Microcephaly: small head size ▪ Macrocephaly: large head size ❑ Temporal artery ▪ Temporal arteritis: tenderness and a hard band to palpation ❑TMJ ▪ Crepitation, limited range of motion, tenderness  Abnormal Findings (Head) ❑ Headache  Abnormal Findings (Head) ❑ Headache (Cont….)  Objective Data : Face ❑ To assess the face, use inspection only ❑ Inspection: Face Noting the facial expression and its appropriateness to behavior or reported mood Note symmetry of eyebrows and sides of the mouth Note any abnormal swelling, exophthalmos or involuntary movement (tics) in the facial muscle Normally, none occur  Abnormal Findings (Face) ❑ Tense rigid muscles indicate anxiety or pain ❑ Flat affect may indicate depression ❑ Asymmetry occurs with stroke (central brain lesion) or with cranial nerve VII damage (Bell palsy)  Objective Data: Neck ❑ To assess the neck, use inspection, palpation & auscultation ❑ Inspection: Neck 1) Symmetry Observe the client’s slightly extended neck for position, symmetry, and lumps or masses ▪ Normally, neck is symmetric with head centered, without bulging masses  Objective Data: Neck (Cont….) ❑ Inspection: Neck (Cont….) 2) Range of Motion (ROM) Ask the person: o Touch chin-to-chest o Turn head-to-the right and left o Touch each ear-to-shoulder (without elevating shoulders) o Extend the head backward Note any limitation of movement; note enlargement or swollen of salivary glands, lymph nods & thyroid gland ▪ Normally, motion is smooth, no limitation & controlled. No enlargement is present  Objective Data: Neck (Cont….) ❑ Inspection: Neck (Cont….) 3) Thyroid gland Ask the client to swallow a small sip of water Observe the movement of the thyroid cartilage & thyroid gland ▪ Normally, thyroid tissue move upward symmetrically as the client swallows  Objective Data: Neck (Cont….) ❑ Palpation: Neck 1) Lymph nodes Palpate for location, size, shape, mobility & tenderness Using a gentle circular motion of your finger pads Palpate the 10 groups of lymph nodes ▪ Normally, nodes feel movable, soft non-tender  Objective Data: Neck (Cont….) ❑ Palpation: Neck (Cont….) 2) Trachea Place your index finger on trachea in the sternal notch & slip it off to each side Note any deviation from the midline ▪ Normally, trachea is midline, the space should be symmetric on both sides  Objective Data: Neck (Cont….) ❑ Palpation: Neck (Cont….) 3) Thyroid Gland ❑ Anterior Approach Stand facing the client Placing your thumb 3 cm below thyroid cartilage prominence Ask client to tip head forward and to right Use your right thumb to displace trachea slightly to person's right Hook your left thumb and fingers around the sternomastoid muscle ▪ Normally, no lobe enlargement  Objective Data: Neck (Cont….) ❑ Palpation: Neck (Cont….) 3) Thyroid Gland (Cont….) ❑ Posterior Approach Move behind the client & ask client to sit up straight Bend head slightly forward and to right ??????? Use fingers of your left hand to push trachea slightly to right Ask client to take a sip of water Reverse the procedure for the left side ▪ Normally, thyroid moves up under your palpating fingers with the trachea and larynx as the person swallows  Objective Data: Neck (Cont….) ❑ Auscultation: Neck 1) Thyroid Gland ❑Auscultate with bell of stethoscope over lateral lobes of thyroid gland ❑Ask the client to hold his or her breath ▪ Normally, no bruits are auscultated  Abnormal Findings (Neck) ▪ Congenital Torticollis: A ▪ Arthritic neck: stiffness, hematoma in one rigidity &limited mobility of sternomastoid muscle, results neck, which affect daily in head tilt to one side and functioning; patient turns at limited neck ROM to opposite the shoulders rather than at side the neck  Abnormal Findings (Neck) ❑ Thyroid gland ▪ Goiter: enlargement of gland ▪ Bruit: This is soft, blowing, whooshing sound auscultated over thyroid lobes is often heard in hyperthyroidism  Abnormal Findings (Neck) ❑ Lymph nodes ▪ Lymphadenopathy: enlargement of lymph nodes (>1 cm) from infection or neoplasm ❑Trachea ▪ Trachea is pulled to the affected side (atelectasis) ▪ Trachea is pushed to the unaffected side ( tumor, enlarged thyroid lobe, pneumothorax)  Sample Charting: Subjective Data ❑ The patient complains of dizziness, a light-headed feeling that occurred on standing and cleared on sitting. States, “I'm afraid of falling.” No previous episodes of dizziness. No neck pain, limitation of motion, lumps, or swelling Sample Charting: Objective Data ❑ Head: Normocephalic, no lumps, no lesions, no tenderness, no trauma ❑ Face: Symmetric, no drooping, no weakness, no involuntary movements ❑ Neck: Supple with full ROM, no pain. Symmetric, no cervical lymphadenopathy or masses.Trachea midline, thyroid not palpable. No bruits