1. HEAD AND NECK
REGIONAL LYMPHATICS

2. BONES OF FACE AND
CRANIUM
• SKULL
– Rigid bony box
– Protects brain
and special
sense organs
– Includes bones
of the cranium
and the face

4. CRANIAL BONES
( (Cranium = Bone Case
• FRONTAL-Forms the forehead and roofs of orbit
• PARIETAL-Two form the sides and roof of
cranial cavity
• TEMPORAL- Two form the inferior lateral
aspects of cranium; has mastoid process
posterior to external auditory canal
• OCCIPITAL- Forms the posterior part and most
of base

5. SUTURES
SUTURES- Meshed immovable joints where the
adjacent cranial bones unite
CORONAL- Crowns the head from ear to ear*
at the junction of frontal and parietal bones
SAGITAL- Separates lengthwise between the*
parietal bones
LAMBDOID- Separates parietal bones crosswise*
from the occipital bone

7. FACIAL BONES
• 14 Facial Bones articulate at sutures except for
the mandible
– NASAL-forms part of bridge of nose
– PAIRED MAXILLAE- Unite to form upper jaw
bone
– ZYGOMATIC- Commonly called cheekbones
– MANDIBLE- Lower jawbone; largest,
strongest facial bone; only skull bone that
moves
– LACRIMAL- Smallest bones in face; lateral to

8. FONTANELS
((fontenelle= little fountain
• At birth, membrane-covered soft spots
between cranial bones
• These soft spots will eventually ossify-replaced
by bone
• Allow for growth of the brain during the first
year
• Posterior or occipital will ossify by 2 months
• Anterior or frontal will ossify by 18-24 months

9. FACIAL MUSCLES
• Facial expressions are formed by the
facial muscles
• Mediated by cranial nerve VII, the facial
nerve
• Facial muscle is symmetrical bilaterally,
except for an occasional quirk or wry
expression

10. Figure 13-2 pg 273

11. SYMMETRICAL FACIAL
STRUCTURES
• PALPEBRAL FISSURES- Opening
between eyelids
• NASOLABIAL FOLDS- Creases from nose
to corner of mouth

12. Salivary glands and neck vessels
Salivary Glands and Neck Vessels •
Figure13-3 p 273

13. SALIVARY GLANDS
• Two pairs of salivary glands are
accessible to examination on the face
– PAROTID-In the cheeks over the mandible
located near the ears; largest and not
normally palpable
– SUBMANDIBULAR- Beneath the base of the
tongue
– SUBLINGUAL- Lie in the floor of the mouth

14. NECK VESSELS
• TEMPORAL ARTERY-Lies superior to the
temporalis muscle, and its pulsation is palpable
anterior to the ear
• CAROTID ARTERY-Right and left arise from the
aorta and are the principal blood supply to the
head and neck; each of these two arteries
divide to form the external and internal carotid
arteries
• JUGULAR VEIN- External -Lies superficial to
the sternocleidomastoid muscle as it passes
down the neck to join the subclavian vein;
receives blood from the exterior of the cranium
and the deep parts of the face ; INTERNAL -
Directly continuous with the transverse sinus,
accompanying the internal carotid as it passes
down the neck; Receives blood from the brain
and superficial parts of the face and neck

15. Salivary Glands and Neck Vessels •
.
3

16. LANDMARKS
• Vertebra Prominens-C7 vertebra; has a
long spinous process that can be felt when
the neck is flexed
• Temporal Artery-Pulsation is palpable
anterior to ear

17. MUSCLES OF THE NECK
Muscles of the Neck •
Figure 13-4. p 274.

18. NECK MUSCLES
• STERNOMASTOID- Arises from the sternum
and the medial part of the clavicle and extends
diagonally across the neck to the mastoid
process behind the ear; Accomplishes head
rotation and flexion
• TRAPEZIUS- Two muscles that form a trapezoid
shape on the upper back arising from the
occipital bone and extends fanning out to the
clavicle and scapula; moves the shoulders and
extends and turns the head

19. TRIANGLES
• The sternomastoid muscle divides each
side of the neck into two triangles:
– Anterior triangle -Formed by medial borders of
sternocleidomastoid muscle and mandible;
Inside has hyoid, cricoids cartilage, trachea,
thyroid, anterior cervical lymph nodes
– Posterior triangle - Formed by trapezius,
sternocleidomastoid muscles and clavicle;
contains posterior cervical lymph nodes

20. THYROID GLAND
• Important endocrine gland with a rich blood
supply
• Straddles the trachea in the middle of neck
• Synthesizes and secretes thyroxine (T4) and
triiodothyronine (T3), hormones that stimulate
the rate of cellular metabolism
• Has 2 lobes, conical in shape connected in the
middle by a thin isthmus lying over the 2nd and 3rd
tracheal rings
• Sometimes a 3rd lobe (pyramidal) is present and
is cone shaped

21. Neck
• CRICOID- Above the thyroid isthmus
within about 1cm is the cricoid cartilage or
upper tracheal ring
• THYROID CARTILAGE- Above the cricoid
with a small palpable notch in its upper
edge-the Adam’s Apple-forms anterior wall
of larynx
• HYOID- Highest is the hyoid bone,
palpated at the level of the floor of the
mouth

22. Location of Thyroid Gland •
Figure 13-5 p. 274.

23. LYMPH NODES
Major part of immune system detecting and
eliminating foreign substances from the body
Oval structures located along the length of
lymphatic vessels
Scattered throughout the body
Packed with lymphocytes
Lymph (clear, watery fluid) flows in one direction
thru node
Filters lymph of foreign substances as passes
back into bloodstream
Foreign substances are trapped by reticular fibers
and destroyed by phagocytosis and
lymphocytes

24. Location of Lymph Nodes •
Figure 13-6 p. 275.

25. DRAINAGE PATTERNS OF
LYMPH NODES
Figure 13-7. p. 276

26. Order of Palpation of Lymph Nodes •

27. Accessible Lymph Nodes to Locate
• Submental
• Sub mandibular
• Supraclavicular
• Superficial Anterior Cervical
• Preauricular and Postauricular
• Occipital
• Superficial Posterior Cervical

28. Subjective Data
• Headache-unusually frequent or severe,
onset-gradual or sudden, locaton,
character, course or duration, precipitating
factors, associated factors,
aggravating/alleviating factors, meds?,
other illnesses?, pattern, effort to treat;
migraines, tension, cluster
• HEAD Injury-Loss of consciousness or
change in level of consciousness

29. SUBJECTIVE DATA
• Dizziness -lightheaded feeling vs. vertigo
which is rotational spinning
• Neck Pain -Limitations to range of motion
• Lumps or Swelling-tenderness indicates
infection while persistent lump arouses
malignancy suspicion
• Hx of head or neck surgery

30. Objective Data
• Normocephalic-round symmetrical skull
• Microcephalic-abnormally small head
• Macrocephalic-abnormally large head
• Hydrocephalic-obstruction of drainage of
cerebrospinal fluid in the head resulting in
enlargement

31. Abnormal Facial Features
• TICS- Abnormal facial movements
• Exophthalmos- bulging eyeballs
• Acromegaly- Gradual enlargement of the
bones of the face and jaws

32. INFANT HEAD FINDINGS
• MOLDING- Bones overlap due to passing
through the birth canal
• CEPHALHEMATOMA- collection of blood
under the scalp due to trauma
• DEPRESSED FONTANELS- Due to
dehydration
• BULGING FONTANELS- May indicate
increase in intracranial pressure

33. Palpating Lymph Nodes
• USE A FIRM DELIBERATE YET GENTLE
TOUCH
• INFECTION - May be indicated when
nodes are palpable bilaterally, feel large,
warm, tender, firm but freely movable
• MALIGNANCY - May be indicated when
nodes are unilateral, hard, discrete,
asymmetric, fixed, and nontender
• Abnormal Nodes- Explore the area
proximal (upstream) to the location of the
abnormal node

34. Palpate Deep Cervical Chain

35. Palpate supraclavicular node

36. Palpate cervical nodes

37. Palpate Trachea

38. Palpate Thyroid; Posterior appraoch
.

39. Palpate Thyroid: Anterior appraoch

40. HEAD & NECK
• Skull palpation
• Face/jaw
• Head Position
• Neck ROM and strength
• Trachea
• Cricoid cartilage
• Thyroid cartilage
• Thyroid