Head and Neck Assessment

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HEAD AND NECK ASSESSMENT

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A. Structure & function

HEAD Cranium

Cranium houses & protects the brain and major sensory organs

Consist of 8 bones:1 frontal

2 temporal

2 parietal

1 occipital

1 ethmoid

1 sphenoid

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FaceFacial bones (14 bones)All facial bones are immovable

except the mandible which has a free movement at the temporomandibular joint.

Consists of many muscles that produce facial movement & expression

Temporal artery

Parotid glands

Submandibular salivary glands

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NECKCompose of muscles,

ligaments and the cervical vetebrae.

Contained within the neck are:

Hyoid bone

Several major blood vessels

The larynx

Trachea

Thyroid gland

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Muscles and Cervical Vertebrae

Sternocleidomastoid rotates and flexes the head

Trapezius extends the head and moves the shoulders

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Two major muscles also forms triangles that provide important landmarks for assessment;

Anterior triangle under the mandible

Posterior triangle between the trapezius and sternomastoid muscles.

C1 - C7 located in the posterior neck and support the cranium

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Blood vessels

Internal jugular veins Carotid arteriesExternal jugular veins

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Thyroid glandLargest endocrine gland

Produces thyroid hormones

Landmark structure for

accurate palpation:

Trachea

Cricoid cartilage

Thyroid cartilage (Adams apple)

larger, located just above the

cricoid cartilage.

Hyoid bone

Consist of 2 lateral lobes that curve posteriorly on both sides of the trachea & esophagus.

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Lymph nodes of the head & neck

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Collecting subjective data

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Health historyUse COLDSPA

Pain

Do you experience neck pain?

Do you experience headache? Describe.

Do you have any facial pain? Describe.

Do you have difficulty moving your head or neck?

Other symptomsHave you noticed any lumps or lesions on your

head or neck that do not heal or disappear? Describe their appearance and location.

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Have you experienced any dizziness, lightheadedness, spinning sensation, or loss of consciousness? Describe.Have you noticed a change in the

texture of your skin, hair or nails.Have you noticed a change in your

energy level, sleep habits or emotional stability?

Have you experienced any palpitations, blurred vision or changes in bowel habits?

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Past health history

Described any previous head or neck problems you have had? treatment?, Results?Have you ever undergone radiation therapy for problem in your neck region?

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Family history

History of head and neck cancer in your family?History of migraine headaches in your family?


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Collecting objective data

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Physical examination

Head and FaceInspection

1. Inspect the head. For size, shape & configuration.

Normal: Symmetrical, round & erect and in midline. No lesions visible.

Abn : Skull & facial bones are larger & thicker

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2. Inspect for involuntary movement. Normal : Head is still and

upright Abn : Tremors, involuntary

nodding, head tilted to one side

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3. Inspect the face. For symmetry, features, movement, expression & skin conditions Normal : Symmetric with a round and

oval, elongated or square appearance. No abnormal movements.

Abn : Asymmetry in front of the earlobes (parotid enlargement), Unusual or asymmetric orofacial movements, drooping on one side of the face, Mask-like face, Sunken face with depressed eyes and hallow cheeks, swollen face

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Palpation1. Palpate the head. Palpate for

consistency. Normal : Hard and smooth without

lesions

Abn : Lesions or lumps on the head

2. Palpate temporal artery Normal : Elastic and non-tender

Abn : Hard, thick, and tender with inflammation

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3. Palpate the Temporomandibular joint (TMJ) Normal : (-) swelling, tenderness, or

crepitation, mouth opens & closes fully, lower jaw moves laterally

Abn : Limited ROM, swelling, tenderness, or crepitation

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NECK

InspectionInspect the neck.Normal : symmetric with head centered and

without bulging masses.

Abn : Swelling, enlarged masses, or nodules

Inspect movement of neck structuresNormal : thyroid & cricoid cartilage, and

thyroid gland move upward symmetrically.

Abn : Asymmetric and generalized enlargement

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Inspect the cervical vertebrae. Normal : C7 or vertebrae prominence is

visible and palpable.

Abn : Prominence or swelling other than C7.

Inspect ROM.Normal : smooth and controlled with 45

degree flexion, 55 degree extension, 40 degree lateral abduction, 70 degree rotation.

Abn : Stiffness, rigidity. Limited ROM (inflammation, spasms, arthritis)

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Neck Palpation

Palpate the tracheaNormal : midline

Abn : Pulled to one side

Palpate the thyroid gland. Normal : if palpable, smooth, firm,

nontender, nodule free. Right lobe 25% larger than left lobe

Abn : enlargement, (+) nodules

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Lymph nodes of the head and neck Palpate the:

1. Preauricular nodes

2. Postauricular nodes

3. Occipital nodes

4. Palpate the tosillar nodes

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5. Palpate the submandibular

6. Palpate the submental

7. Palpate the superficial cervical nodes

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8. Palpate the posterior cervical nodes

9. Palpate the deep cervical chain nodes

10.Palpate the supraclavicular nodes

11. Infraclavicular nodes

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Differentiating Lymph NodesCHARACTERISTICS NORMAL INFECTION MALIGNANCY

Size 1 cm Enlarged Enlarged

Shape Round Round Irregular

Consistency Soft to rubbery Boggy Hard

Delimitation Well defined Well defined Irregular borders

Mobility Mobile Mobile Immobile

Tenderness Nontender Tender Nontender

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Normal : (-) swelling, tenderness, hardness, enlargementAbn : (+) swelling, tenderness, hardness,

enlargement, immobility.

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Neck Auscultation

Auscultate the thyroid only if you find an enlarged thyroid gland.Normal : No sound

Abn : a soft, blowing, swishing sound (bruit) auscultated over thyroid lobes is often heard in hyperthyroidism.

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Head and Neck Assessment