9. Head-facial muscles
Facial expressions are formed by
facial muscles
Facial structures should be
symmetric.
Facial muscles are innervated by
cranial nerve VII
10. Note major Neck
muscles.
Sternocleidomastoids and
trapezii muscles
(each side of neck form
2 triangles- anterior &
posterior cervical )
11.
12. Thyroid gland and
other landmarks
Thyroid gland - largest endocrine gland
-secretes T3 & T4 to regulate cellular
metabolism
-flattened butterfly shape structure
- 2 lateral lobes connected by isthmus
- isthmus rest on trachea, inferior to
the criocoid cartilage (highest point
Adam’s Apple)
13.
14. Note location of lymphatics
1. Preauricular,
2. post. auricular,
3. occipital,
4. submental,
5. submandibular,
6. Jugulodigastric or tonsillar,
7. superficial cervical chain,
8. deep cervical chain,
9. post. cervical,
10. supraclavicular.
15. Lymph Nodes
Usuallyless than 1 cm
round or ovid in shape
smooth in consistency
when enlarged or tender - assess for
infection or maligancy and the area
the node drains ( see p322 example)
16.
17. BLOOD SUPPLY
Major arteries to head and neck
– common carotids bifurcate into
– internal & external carotids
Major veins from head and neck
– internal an external jugular veins
– and subclavian veins
18. Head and Neck &
Regional Lymphatics
Health History
Subjective Data
19. Head and Neck & Regional
Lymphatics- Health Hx
• facial or neck surgery
• history of headaches or dizziness
• allergies
• Neck pain, limitation of movement
• Lumps or swelling, difficulty
swallowing or chewing, history of
smoking
• head injuries
21. Head: Inspect and palpate the
skull
Size and Shape
(I)Normocephalic: round, symmetric
and approximated to body size.
(P)Shape: symmetric and smooth, no
tenderness reported.
– Use finger pads on scalp & palpate all surfaces
– Assess contour, masses, depressions,tenderness
– Note deformities lumps and tenderness.
22. Head: Inspect and palpate the
scalp
(I)
Scalp should be shiny, intact and
without lesions or masses.
– Part hair repeatedly and inspect scalp
(P)palpate with finger pads on the
scalp for lesions or masses
23. Head: Inspection of the face
(I) Symmetry of facial features:
– Observe facial expression, shape and
symmetry of nose, eyes, eyebrows, mouth,
ears
(I) Shape and features of face
– Note shape of face
– Note swelling (edema) , abnormal features,
disproportionate structures (stroke, Bell’s Palsy
= cranial nerve 7 damage -facial nerve), and
involuntary movement (the presence of tics
-normally none occur)
(I) Facial expression: emotions
– Note appropriateness to verbal and nonverbal
24. Head: Palpate and
Auscultation of Mandible
Temporal Area
(P)Temporal artery: above the cheek bone, between
the eye and the top of ear.
– Palpate with finger pads for pulse
(P)Temporomandibular joint: articulates smoothly
with no limitation, no crepitus, no clicking
– use index and middle finger to palpate anterior to
tragus of ear on both sides
– ask pt to open & close mouth
– observe smoothness of movement, any discomfort
– clicking/crepitus could indicate arthritis or
dislocation
26. The Neck- Inspect and palpate
What position do you ask the client to
assume while you inspect the neck?
Head erect and still, sitting up
straight, head at your eye level
27. The Neck- Inspect and palpate
Symmetry
Head position: centered, midline, erect, still
Symmetry of the Sternocleidomastoid & trapezii
muscles
ROM of neck (flexion, lateral rotation, lateral
bending, extension, test muscle strength:Touch chin
to chest, ear to shoulder
Turn head left to right
Extend head backwards
Motions should be smooth and controlled.
resists movement of shoulder shrug and head turn side to
side
limited ROM with meningitis, muscle spasm, osteoarthritis
28. The Neck- Inspect and palpate
(P) Muscles - should be symmetrical &
without palpable masses or spasms
– palpate Sternocleidomastoid and trapezii muscles
for tenderness, masses, spasms
– spasms due to infections, trauma, chronic
inflammation, neoplasm
29. The Neck- Inspect and palpate
Lymph Nodes
(P) Lymph nodes - should not be palpable, but
small discrete , movable nodes are often
present
Begin with preauricular lymph nodes and proceed
in a systematic fashion (1 to 10)
Use gentle pressure
Deep cervical chain: tip head toward side
Supraclavicular Node: hunch shoulders & elbows
forward
tender nodes = inflamed due to infection
firm, non movable nodes may be = malignancy
30.
31. The Neck- Inspect and palpate
Trachea
Midline normal (note deviations)
Palpate for tracheal shift: space
should be symmetric on both sides.
32. The Neck- Inspect, palpate,
auscultate
Thyroid Gland
inspect for swelling using lamp (ask to
sip and swallow water)
– thyroid tissue moves up with swallowing
observe for goiter - enlarged thyroid
palpate -anterior/posterior approaches
– have pt slightly lower head to relax neck muscles
– palpate isthmus for nodules, masses, tenderness or
enlargement while swallowing
– then displace/stabilize lobe on one side and palpate the
other side while pt swallows
gland is smooth, soft, & no tenderness/enlrgmt/masses
33. The Neck- Inspect, palpate,
auscultate
auscultate lobes for bruit
– (use bell)
– no bruit should be present
bruits indicate blood supply r/t tumor or toxic
goiter.
34.
35. Developmental Considerations
Infant/Children
Skull and fontanels
Pregnant Female
Cholasma on face = pregnancy mask
Aging Adult
Temporal arteries twisted and visible
Rhythmic tremor of head may be present
Perform ROM slowly to prevent dizziness