HEAD AND NECK

ASSESSMENT

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STRUCTURE AND FUNCTIONS
•HEAD
•CRANIUM
•FACE
•NECK
•MUSCLES
•CERVICAL VERTEBRAE
•TRACHEA
•ESOPHAGUS
•BLOOD VESSELS
•THYROID GLANDS
•LYMPH NODES
HEAD

DIVIDED INTO TWO (2)

SUBSYSTEMS:
CRANIUM
•Protects the brain and the major
sensory organs of the head
•Composed of (8) bones:
FRONTAL (1), PARIETAL (2),
TEMPORAL (2), OCCIPITAL (1),
ETHMOID (1), SPHENOID (1)
Cranial bones are joined
together by (4) immovable
sutures: SAGITTAL,
CORONAL, SQUAMOSAL,
and LAMBDOID
FACE
•Gives shape, expression, and
movement.
•Consists of (14) bones: MAXILLA(2),
ZYGOMATIC CHEEK(2), INFERIOR
CONCHAE (2), NASAL (2), LACRIMAL
(2), PALATINE (2), VOMER (1),
MANDIBLE aka JAW (1)
•ALL BONES ARE IMMOVABLE
EXCEPT FOR THE MANDIBLE
•Muscles that give expression and
movement.
•Salivary Glands
NECK
•Muscles of the neck – allows
movement and provide support of
head and neck.
•Sternocleidomastoid muscle –
rotates and flexes
•Trapezius muscles- extends
head and move shoulders
oCN 11 – responsible for
movement
•Cervical Vertebrae- supports cranium
•C1-C7
•C7- prominent upon neck
flexion
•Trachea
•Airway
•Composed of C-shaped
cartilages – anatomical
landmarks for other
anatomical parts located on
the neck.
oCricoids cartilage – small
bone attached to and
below the…
oThyroid cartilage
(Adam’s apple)-
connected to the hyoid
bone (where tongue is
attached)
•Thyroid Glands
•Largest endocrine glands
•Produces thyroid
hormones that increased
metabolic rate of most
body cells.
•Two lobes (curves
posterior to both sides of
trachea and esophagus)
•Isthmus – connects both
lobes (lies anterior to
trachea).
•Covered by
sternocleidomastoid
muscle.
Sternocleidomastoid muscle

Trapezius muscle
•Lymph Nodes (10)
•Filters lymph – after collected by
lymphatic vessels before it returns to
vascular system.
•Removes bacteria and tumor cells.
•Produces lymphocytes and antibodies
that fight off foreign substances
(infection) that invades the body
systems.
•Normally non-palpable (becomes
palpable and inflamed with infection).
•Preauricular
•Postauricular
•Tonsillar
•Occipital
•Submandibular
•Submental
•Superficial cervical
•Posterior cervical
•Deep cervical
•Supraclavicular
•History taking (Review of System) – thorough to
detect cause of possible underlying systematic
problems

•Evaluate ADLs that may affect the condition of

client’s HEAD and NECK
E.g. stress, tension, poor posture and lack of
exercise may be contributory factors for head and
neck discomforts

•Self-image may be influenced by client’s facial

structures
•FOCUS QUESTIONS:
oLumps (onset, location, size, texture)?
oLimited movement of the neck? Describe.
oFacial pain/ neck pain/ headaches (COLDSPA)
o Prior neck injury (date, related to work,
recreation, treatment)?
o Prior radiation therapy to head or neck?
Prior thyroid surgery?
oFamily History of head/ neck cancer, migraines?
oHead and neck self-care: posture, use of helmet,
seat belts, tobacco products?
•RISK FACTORS:
oHEAD INJURY
▪High-risk sports
▪Lack of protective devices
(eg. helmet, seatbelts)
oTHYROID DISEASE
▪Radiation to upper body
▪Family history
oLYMPHATIC ENLARGEMENT
▪Immunosuppression
▪Chronic disease
▪Malnutrition
CLIENT PREPARATION

•Instruct to remove any wig. Hat, ornaments, pins,

rubber bands, jewelry, and head or neck scarves.

•Take care to consider cultural norms for touch when

assessing the head. Some cultures prohibit touching
the head or touching the feet before touching the
head.
CLIENT PREPARATION

•Position client in a sitting position: with back and

shoulders held back and straight. (Explain that they
may need to keep still in some areas of the
examination or may be requested to move and bend
neck during palpation of neck muscles and thyroid
glands.

•To prevent anxiety assure client he/she will be

informed of assessment findings and what is
performed during the course of the assessment.
 EQUIPMENT:

GLOVES
SMALL CUP OF WATER (thyroid exam)
STETHOSCOPE
PROCEDURE NORMAL DEVIATION
FINDINGS FROM NORMAL
Inspect and palpate scalp for the following:
Size May vary Extremely large
or small. Scalp is
thick in
acromegaly
(increase in
growth
hormones);
large, acorn
shape in Paget
disease.
PROCEDURE NORMAL DEVIATION FROM
FINDINGS NORMAL
Inspect and palpate scalp for the following:
Shape Symmetrical Asymmetrical
and round

PROCEDURE NORMAL DEVIATION FROM

FINDINGS NORMAL
Inspect and palpate scalp for the following:
Consistency Hard and Bumpy or soft.
smooth Lumps or lesions
are seen in cancer
and trauma.
PROCEDURE NORMAL DEVIATION FROM NORMAL
FINDINGS
Observe the face for the following:
Symmetry Symmetrical Asymmetrical. Face is asymmetrical
with parotid gland enlargement or
Bell palsy, mask face in Parkinson’s
disease.
Moon face with reddened cheeks
and increased facial hair may
indicate Cushing’s syndrome.
PROCEDURE NORMAL FINDINGS DEVIATION FROM
NORMAL
Observe the face for the following:
Facial Features vary Distorted features: mask
features Symmetrical, centered head face in Parkinson
position disease; tightened, hard
GERIATRIC VARIATIONS: face in scleroderma;
Facial wrinkles are prominent sunken, hollow face in
Bones of face and nose are more cachexia; swollen face in
angular in appearance. nyphrotic syndrome;
Face may shrink and the mouth moon face with red
may be drawn inward as a result cheeks, facial hair in
of resorption of mandibular Cushing syndrome.
bones, also an age related
process.
SCLERODERMA CACHEXIA/STARVATION
PROCEDURE NORMAL FINDINGS DEVIATION FROM NORMAL
Observe the neck for the following:
Appearance and Smooth, controlled Asymmetrical head position, masses
Movement movements; range of or scars present. Swelling is seen in
motion (ROM) from cancer, enlarged thyroid, or inflamed
upright position: lymph nodes.
Flexion- 45˚ Rigid, jerky movements; ROM less
Extension- 55˚ than normal values; pain on
Lateral Abduction- 40˚ movement. Limited ROM, stiffness,
Rotation - 70˚ rigidity are seen with muscle spasms,
GERIATRIC VARIATION: inflammation, meningitis, cervical
Muscle atrophy and loss of arthtitis.
fat cause shortening of the
neck
Older clients usually have
somewhat decreased
flexion, extension, lateral
bending, and rotation of
the neck. Usually due to
arthritis.
PROCEDURE NORMAL FINDINGS DEVIATION FROM NORMAL
Observe the neck for the following:
Inspect Cervical C7 is usually visible Swelling or prominence
vertebrae. Ask and palpable other that C7 may be
client to flex the abnormal.
neck (chin to
chest, ear to
shoulder; twist left
to right and right
to left; backward
and forward.
PROCEDURE NORMAL DEVIATION FROM
FINDINGS NORMAL
Palpate Temporal artery for the following:

Palpate The temporal Temporal artery is hard,

temporal artery artery is elastic thick, and tender with
located and non-tender. inflammation as seen
between the with temporal arteritis
top of the ear (inflammation that may
and eyes lead to blindness).
PROCEDURE NORMAL FINDINGS DEVIATION FROM NORMAL
Palpate Temporomandibular joint (TMJ)for the following:
Palpate TMJ. Place No swelling, Limited ROM, swelling,
your index finger tenderness, or tenderness, or crepitition
over the front of crepitation with my indicate TMJ syndrome.
each ear as you movement.
ask client to open Mouth opens and
his or her mouth. closes fully (3 to 6
cm between upper
and lower teeth).
Lower jaw moves
laterally 1-2 cm in
each direction
PROCEDURE NORMAL DEVIATION FROM
FINDINGS NORMAL
Palpate Trachea for the following:
Palpate trachea Midline position; Asymmetrical. Position
for position symmetrical; deviates from the
and landmarks ladmarks midline with tumor,
(tracheal rings, identifiable. enlarged thyroid, aortic
cricoids and aneurysm,
thyroid pneumothorax,
cartilages) atelectasis, or fibrosis.
PROCEDURE NORMAL FINDINGS DEVIATION FROM NORMAL
Palpate thyroid for the following:
NOTE: ability to see or palpate the thyroid varies considerably with
client’s thyroid size and body build.
Position Midline Deviates from the midline if
obscured by masses or
growths.
Characteristics, Smooth, firm, non- Enlarged lobes, irregular
landmarks tender consistency, tender on
palpation. Diffused
enlargement is seen in
hyperthyroidism, Graves
disease, or endemic goiter;
rapid enlargement of a
single nodule suggests
malignancy.
PROCEDURE NORMAL FINDINGS DEVIATION FROM NORMAL
Auscultate the thyroid only if enlarged upon inspection and/or
palpation.
Place the bell of No bruits are A soft, blowing, swishing
the stethoscope auscultated. sound auscultated over
over the lateral thyroid lobes is often heard
lobes of the in hyperthyroidism because
thyroid. Ask the of an increase in blood flow
client to hold his through the thyroid
breath (to obscure arteries.
any tracheal
breath sounds
while you
auscultate).
PROCEDURE NORMAL FINDINGS DEVIATION FROM NORMAL
Palpate cervical lymph nodes for the following:
Size and shape Cervical lymph nodes Enlarged nodes with irregular
are usually not borders. Enlarged nodes
palpable. If palpable, greater than 1cm are seen in
they should be 1cm acute chronic infection,
or less and round. autoimmune disorders, or
metastatic disease; hard,
fixed enlarged, unilateral
nodes seen in metastasis;
tender, enlarged nodes seen
in acute infections; enlarged
occipital nodes seen in HIV
infection.
PROCEDURE NORMAL DEVIATION FROM
FINDINGS NORMAL
Palpate cervical lymph nodes for the following:
Delineation Discrete Confluent
Mobility Mobile Fixed to tissue
Consistency Soft Hard, firm
Tenderness Nontender Pain upon palpation
PROCEDURE NORMAL DEVIATION FROM
FINDINGS NORMAL
Observe and Palpate for the following:
Observe head, Normocephalic Uneven molding,
shape, size, and symmetrical, asymmetrical masses,
and symmetry. features enlarged head.
appropriate for Hydrocephalus is seen
size. Head may with increase
have odd shape cerebrospinal fluid.
due to molding Microcephaly is a head
during birth circumference less than
normal.
PROCEDURE NORMAL DEVIATION FROM
FINDINGS NORMAL
Observe and Palpate for the following:
Observe head Holds head erect Resistant to
control in midline by 4 movement (head lag
months, moves after 6 months seen in
head up and cerebral injury)
down, side to
side
PROCEDURE NORMAL FINDINGS DEVIATION FROM NORMAL
Observe and Palpate for the following:
Palpate skull and Smooth, fused except Ecchymotic areas on scalp: loss
fontanelles fontanelles of hair in spots: Posterior
Fontanelle (triangular) open
after 2 months of age, anterior
fontanelle open after 12-18
months of age.
Bulging fontanelles is seen in
increase ICP; depressed
fontanelles is seen in
dehydration or malnutrition;
delayed fusion of fontanelles
seen with hydrocephalus,
Down syndrome; limited ROM
seen in torticollis (wryneck).
PROCEDURE NORMAL DEVIATION FROM
FINDINGS NORMAL
Observe and Palpate for the following:
Palpate neck Moderate Diffused large lymph
for lymph number of small nodes, asymmetrical
nodes (>3mm),shotty, placement. Enlarging
firm lymph supraclavicular nodes
nodes in children seen with Hodgkin
aged 3-12 yrs. disease.
Old.