Chapter 14-Head, Face, & Neck, including Regional Lymphatics

Question 1

Head

Answer 1

-cranial bones
-sutures
-facial bones
-facial muscles
-salivary glands

Question 2

neck

Answer 2

neck muscles-CN XI (11)
-sternomastoid
-trapezius

anterior and posterior triangles

thyroid gland
-endocrine gland synthesizes and secretes t4/t3 (regulates endocrine system)

thyroid cartilage
-small notch (Adam’s apple), cricoid cartilage, and isthmus (thyroid gland)

Question 3

lymphatics

Answer 3

-preauricular
-posterior auricular (mastoid)
-occipital
-submental (palpate with 1 hand)
-submandibular
-jugulodigastric
-superficial cervical
-deep cervical
-posterior cervical
-supraclavicular

Question 4

structure & function: lymphatics

Answer 4

major part of immune system
-detects and eliminates foreign substances from body (viruses; bacteria)

rich supply of lymph nodes
-greatest supply is in head and neck (axillary/inguinal)

lymphatic drainage
-helps to prevent potentially harmful substances from entering the circulation
-you should be familiar with direction of drainage patterns of lymph nodes

Question 5

subjective data: health history questions

Answer 5

-headache: leading cause of acute pain
-ask PQRST
-head injury
-onset, setting, injury description, symptoms
-dizziness (vertigo)
-description in patients own words
-neck pain or limitation of motion
-location, onset, ROM, precipitating factors
-lumps or swelling
-history of head or neck surgery
-radiation=increased risk for vascular (atherosclerosis)

Question 6

additional history for aging adult

Answer 6

dizziness
neck pain

Question 7

objective data: physical exam

Answer 7

-head: inspect & palpate the skull
-size and shape
-normocephalic: round and symmetric
-temporal area
-palpate temporal artery above cheek bone (zygomatic)

head: inspect the face
-facial structures: assess symmetric, mood, any involuntary movements (tics)

neck: inspect & palpate
-symmetry
-range of motion
-lymph nodes (gently palpate; look if visible)

Question 8

examining lymph nodes

Answer 8

-using a gentle circular motion of finger pads, palpate lymph nodes (palpate together)
-beginning with pre auricular lymph nodes in front of ear, palpate the 10 groups of lymph nodes in routine order
-many nodes are closely packed, so you must be systematic and thorough in your examination
-do not vary sequence or you may miss some small nodes

Question 9

objective data: neck

Answer 9

inspect & palpate
-trachea: midline (note any deviation)
-thyroid gland
-posterior approach (primary)
-anterior approach (alternate)
-auscultate thyroid if enlarged (bruit)

Question 10

abnormal findings: primary headaches

Answer 10

-diagnosed by patient history with no abnormal findings on exam or laboratory results

-types of headaches
-tension (band), migraine (ipsilateral), and cluster

factors to review
-definition, location, character, duration, quantity and severity, and timing
-aggravating symptoms or triggers, associated symptoms and relieving factors, effort to treat

Question 11

abnormal findings: swellings of head and neck

Answer 11

congenital torticollis
-hematoma in one sternomastoid muscle, probably injured by intrauterine malposition, results in head tilt to one side and limited neck ROM to opposite side

simple diffuse goiter (SDG)
-endemic goiter due to iodine deficiency that results in chronic enlargement of the thyroid gland

thyroid-multinodular goiter (mng)
-multiple nodules usually indicate inflammation or multinodular goiter rather than a neoplasm: however, suspect any rapidly enlarging or firm nodule

pilar cyst (wen)
-benign growth that presents as smooth, fluctuant swelling on scalp

parotid gland enlargement
-rapid painful enlargement seen in response to mumps, blockage of duct, abscess, or tumor

Question 12

thyroid disorders: graves disease

Answer 12

-physical presentation neck and face
-goiter
-eyelid retraction
-exophthalmos (bulging eyes)

hyperthyroidism; hot; tachycardia; sudden weight loss

Question 13

thyroid disorders: hypothyroidism

Answer 13

physical presentation neck and face
-puffy edematous face
-periorbital edema
-coarse facial features (enlarged; pronounced)
-coarse hair & eyebrows

Question 14

abnormal facial appearances: associated with chronic illnesses

Answer 14

acromegaly (big head)
-elongated head, massive face, overgrowth of nose, lower jaw, heavy eyebrow ridge, & coarse facial features

Cushing syndrome (long term steroids, transplant pts, autoimmune)
-classic moonlike face, red cheeks, hirsutism

bell palsy (CN 7-facial nerve)
-paralysis on one side of the face as a result of LMN lesion

stroke or brain attack
-umn lesion leading to paralysis of lower facial muscles

parkinson syndrome
-classic ‘maskline’ appearance, elevated eyebrows, staring gaze, oily skin and drooling due to dopamine deficiency

cachectic appearance (very thin; chronic wasting disease)
-sunken eyes, hollow cheeks, and defeated expression that accompanies chronic wasting disease (failure to thrive)

Question 15

look at chart on slide 22

Question 16

summary checklist

Answer 16

inspect and palpate the skin
-general size and contour
-note any deformities
-palpate temporal artery and temporomandibular join (tmj) joint

inspect and palpate the face
-observe facial expression
-cranial nerve VII: symmetry of movement
-observe for any abnormal movements

inspect and palpate the neck
-active ROM, potential enlargement and position of trachea

auscultate thyroid (if enlarged) for bruit