Head and Neck Examination PDF

**HEAD and NECK EXAMINATION/EXTRAORAL EXAMINATION** **[The Purpose of a Comprehensive Head and Neck Examination]:** **SAVES LIVES** **[Examination Techniques:]** A. **Inspection**: systematic **visual** examination of a patient's general appearance of a patient's general appearance, skin, or...

**HEAD and NECK EXAMINATION/EXTRAORAL EXAMINATION** **[The Purpose of a Comprehensive Head and Neck Examination]:** **SAVES LIVES** **[Examination Techniques:]** A. **Inspection**: systematic **visual** examination of a patient's general appearance of a patient's general appearance, skin, or a part of the body to observe its condition. B. **Palpation**: examination of a part of the body by using the **fingertips** to **move** or **compress** a structure against the underlying tissue. 1. Compression techniques: detects abnormalities such as swelling, tumors, or enlarged lymph nodes Two basic compression techniques: a. Compressing soft tissue between clinician's fingertips b. Compressing soft tissue against underlying structures or tissues of the head and neck **[Keys to an Effective Examination Technique:]** **[S.]** Consistent **Sequence**: consistently follow the **same** **sequence** with every patient. A clinician chooses a particular sequence and keeps the same examination sequence every time to ensure thoroughness. **[I.]** Always **Inspect** regions/structures first. **[P]**. Good **Palpation** technique: critical to a successful examination. **[D]**. Careful D**ocumentation**: Documented All Findings / utilizing an intraoral camera **[Head and Neck Structures assessed are organized into four (4) subgroups:]** \[Subgroup 1\] Overall Appraisal of the Head and Neck, Face, Ears, and Skin \[Subgroup 2\] Lymph Nodes of the Head and Neck \[Subgroup 3\] Salivary and Thyroid Gland \[Subgroup 4\] Temporomandibular Joint (TMJ) **Script:** The script information provided coincides with the Head and Neck Examination Video from the book, Patient Assessment Tutorials (4^th^ Edition) by Jill S. Gehrig (student resources: Module 13, Ancillary Content). The video is approximately 15 minutes long. **Equipment for Head and Neck Examination** \[1\] PPE {2\] small cup of water for patient during thyroid gland exam **Explain the procedure to the patient** Always provide an explanation of the Head and Neck Examination to the patient. Patient's acceptance for a head and neck examination begins with a through explanation. Definition of a Head and Neck Examination from Gehrig (2018): Head and neck examination is a "physical examination technique consisting of a systemic visual inspection and palpation of the structure". Script Examples for the patient: Example (Boyd, Mallonee, & Wyche, 2020): "I am going to perform an extraoral examination to look for abnormalities that can affect your oral and overall health". Example (Gehrig, 2018): "I am going to perform a physical examination technique consisting of a systematic visual inspection of the skin of your head and neck combined with palpation of the lymph nodes, salivary glands, thyroid glands, and temporomandibular joint". **Note: Clinicians tailor their own explanation of the head and neck examination utilizing the principle words above.** **Preparation for Head and Neck Examination** \[1\] Height of the patient's chair positioned to easily reach all the structures to be examined. \[2\] Remove patient's eyeglasses and removal of partial dental prostheses (RPD) or dentures prosthesis. \[3\] Position patient in an upright-seated position. \[4\] Patient's head in an upright positon (not resting against the headrest). **Note: Always perform the same systematic sequence. Conducting an examination with routine order minimizes excluding areas and details of importance.** **[Sequence for the Head and Neck Examination / Extraoral Examination ]** **[Subgroup 1: Overall Appraisal of the Head and Neck, Face, and Skin]** a. Inspect the skin and facial symmetry of the face and neck area. Always scan the face and neck from left to right. Divide the face and neck into imaginary zones: Scan the hair and forehead, eye range, checks, nose, lips, and neck. Document: signs of asymmetry; hair loss; dilated or unequal pupils; changes in color, presence of scars or lesions. **[Subgroup 2: Lymph Nodes of the Head and Neck]** **Occipital Lymph Nodes** (located at the base of the skull) a. Clinician's position: Stand behind the patient. b. Patient's position: Patient's head tipped slightly forward (long hair to be held up so that the patient's neck is visible to the clinician). c. Palpation technique: Place your fingers near the base of the skull. Begin at the midline of the neck and bilaterally palpate by applying circular compressions outward along the hairline until you reach the sternocleidomastoid muscle. You must palpate the areas slightly above and below the hairline because the location of lymph nodes may vary among patients. a. Clinician's position: Stand behind the patient. b. Patient's position: Head in an upright position/Inspect each ear separately. c. Bring the ear forward to visually inspect the back of the ear and skin behind the ear. d. Palpation technique: Begin to bilaterally palpate by applying steady, gentle circular motions with your fingertips starting at the top of the back of the ear on the posterior auricular lymph nodes. a. Clinician's position: Stand behind the patient. b. Patient's position: Head in an upright position. c. Palpation technique: Begin to bilaterally palpate by applying steady, gentle circular motions with your fingertips against the underlying bone starting at the top of the front of the ear on the preauricular lymph nodes. a. Clinician's position: Stand behind the patient or to the side of the patient. b. Patient's position: Head in an upright position. c. Palpation technique: Apply compression between your thumb and index finger to the area behind and beneath the symphysis (midline area) of the mandible. **Submandibular Lymph Nodes** (located under the jaw, along the side of the mandible) a. Clinician's position: Stand behind the patient. b. Patient's position: Head in an upright position. c. Palpation technique: Use one hand to move the tissue under the chin toward one side of the neck (example: use your left hand to move the tissue under the chin toward the right side of the neck). Use the other hand for palpation. Cup your fingers under the chin; roll the tissue up and over the border of the mandible. Allow the tissue to slowly slide down over the mandible back into its normal position while keeping your fingertips in place. As the tissue slides across the mandible, you can detect the palpable nodes. d. Repeat procedure to palpate the submandible lymph nodes on the other side of the jaw a. Clinician's position: Stand behind the patient. b. Patient's position: Ask the patient to tip his/her chin down slightly and turn the head to one side. Rest the patient's chin in one of your hands. This action is for the patient's support and makes the sternomastoid muscle stand out. c. Palpation technique: Begin palpating the anterior chain of the cervical lymph nodes. With one hand, grasp the body of the muscle between your fingertips and thumb. Rotate your fingertips back and forth over the muscle covering its entire length from behind the ear to the clavicle. Begin palpating the posterior chain of the cervical lymph nodes. Palpate the nodes by positioning the fingertips of your index and middle fingers under (behind) the muscle and applying compression against the underlying tissues along the entire length of the muscle from behind the ear to the clavicle. d. Repeat procedure to palpate the cervical lymph nodes on the other side of the neck a. Clinician's position: Stand behind the patient or to the side of the patient. b. Patient's position: Ask the patient to face forward with his/her chin tipped slightly downward. This position enables palpation by relaxing the muscles in the neck. c. Palpation technique: Place your index and middle fingers above the clavicle on one side of the neck and apply circular compression. d. Repeat procedure to palpate the supraclavicular nodes on the other side using the same technique. **[Subgroup 3: Salivary and Thyroid Gland]** **Parotid Glands** (located between the ear and the jaw) a. Clinician's position: Stand behind the patient or to the side of the patient. b. Patient's position: Head in an upright position. c. Palpation technique: Place the palms of your hands in front of the ears with your fingers extending the full length of the cheek so that you can palpate the entire gland. Use circular compression to compress the tissue against the cheekbones. **Submandibular Glands** (located below the jaw toward the back of the mouth) a. Clinician's position: Stand behind the patient. b. Patient's position: Head in an upright position. c. Locate the Submandibular Gland: Locate the submandibular salivary glands by finding the slight depression in the inferior border of the mandible. Move your fingers under the chin to locate the gland on both sides of the head. Ask the patient to press the tip of his or her tongue against the roof of his or her mouth (This position causes the mylohyiod and tongue muscles to tense, making it easier to palpate the submandibular gland). d. Palpation technique: Bilaterally compress the glands upward against the tensed mylohyoid and tongue muscles. **Thyroid Gland** (located in the middle of the lower neck) a. Locate the Thyroid Gland: Give the patient a cup of water and ask him or her to swallow the water as you watch the region. The thyroid gland, along with the adjacent structures, will move up and down. As the patient swallows, the thyroid gland should move vertically. b. Clinician's position: Stand behind the patient and position your hands with thumbs on the nape of the patient's neck. c. Patient's position: Ask the patient to flex the neck forward and tilt the head slightly to the right. This position relaxes the neck muscles for easier palpation. d. Palpation technique: Use your left hand as a stabilizing hand to displace the trachea slightly to one side. Use your other hand, right, for palpation. Position your fingers of your right hand between the Adams apple and the sternomastoid muscle. Rest your fingers lightly in a stationary position. Ask the patient to take a sip of water and swallow, as the fingers of one hand rest lightly on the neck. The gland slides beneath your fingers as it moves up and down during swallowing. Repeat this process several times. e. Repeat procedure to examine the left lobe of the thyroid gland. **[Subgroup 4: Temporomandibular Joint]** (TMJ) a. Locate TMJ: Stand behind the patient. Patient head in upright position. Place your index fingers in front of the tragus of each ear. Ask the patient to slowly open and close the mouth. As the mouth is opened and closed, your fingertips should drop into the joint spaces. b. Palpation technique: Move to the front of the patient and place your fingertips over the joints. Palpate the joints as the patient slowly opens and closes several times. Document any deviations during opening. c. Lateral excursions (side-to-side movements of the jaw): maintain your hands in the same position, ask the patient to open slightly and move the lower jaw laterally to one side. Repeat with the patient moving to the other side. Finally ask the patient to protrude lower jaw forward. d. Document: abnormal sounds such as popping or clicking. e. Assess Range of Motion: Ask patient to place the index, middle, and ring fingers between the incisal edges of the upper and lower incisors. f. Document all notable findings: patient's own fingers are proportional to his or her jaw. This is a good indication of the adequate range of motion. **Document:** All Normal / Abnormal Finding(s). Use a periodontal probe to record **measurements** for the length, width and height (elevated lesion) of the physical characteristics of a lesion. The image provides the location of the lymph nodes of the head and neck (Gehrig, 2018). http://securedownload.lww.com/vstappcontent/9781496335005\_GehrigPAT4e/image\_bank/content/data/image\_collection/figure\_13-5.jpg References: Gehrig, J. S. (2018). *Patient assessment tutorials: A step-by-step guide for the dental hygienist.* New York, NY: Wolters Kluwer. Gehrig, J.S. (2018). Video. Student resources; Ancillary content, head and neck examination technique. Boyd LD, Mallonee, LF, & Wyche, CJ (2020). Wilkins'c*linical practice of the dental hygienist.* Burlington, MA: Jones & Bartlett Learning.