Head, Face, and Neck, including Regional Lymphatics

Question 1

Structure and Function: Head: Skull and facial expressions are formed by

Answer 1

-is rigid box that protects brain and is supported by cervical vertebra
-Cranial bones
Frontal
Parietal
Occipital
Temporal
-Facial expressions formed by facial muscles, which are mediated by cranial nerve VII, the facial nerve

Question 2

Structure and Function: Head (Cont.) Two pairs of salivary glands are accessible to examination on the face

Answer 2

-Parotid glands are in cheeks over mandible, anterior to and below ear; the largest of salivary glands, they are not normally palpable
Submandibular glands beneath mandible at angle of jaw
-Third pair, sublingual glands, lie in floor of mouth
-Temporal artery lies superior to temporalis muscle, and pulsation is palpable anterior to ear

Question 3

Structure and Function: Neck

Answer 3

• Neck delimited by base of skull and inferior border of mandible above, and by manubrium sterni, clavicle, first rib, and first thoracic vertebra below
• Think of neck as conduit of many structures
• -Vessels, muscles, nerves, lymphatics, and viscera of respiratory and digestive systems
• -Internal carotid branches off common carotid and runs inward and upward to supply brain
• -External carotid supplies face, salivary glands, and superficial temporal area

Question 4

Structure and Function: Neck Muscles

Answer 4

• Major neck muscles sternomastoid and trapezius are innervated by cranial nerve XI
• Sternomastoid enables head rotation and flexion and divides each side of neck into two triangles: anterior and posterior triangles
• Two trapezius muscles move shoulders and extend and turn head

Question 5

Structure and Function: Thyroid

Answer 5

an important endocrine gland straddles trachea in middle of the neck

• Synthesizes and secretes thyroxine (T4) and triiodothyronine (T3), which are hormones that stimulate rate of cellular metabolism
• The gland has two lobes, connected in middle by a thin isthmus and above that by the cricoid cartilage or upper tracheal ring
• Thyroid cartilage above that, with small palpable notch in upper edge, the “Adam’s apple” in males

Question 6

Lymphatic system:

Answer 6

an extensive vessel system, is major part of immune system, which detects and eliminates foreign substances from body

• Vessels allow flow of clear, watery fluid from tissue spaces into circulation
• Nodes are small, oval clusters of lymphatic tissue that filter lymph and engulf pathogens, preventing potentially harmful substances from entering the circulation
• Greatest supply is in head and neck
• You should be familiar with direction of drainage patterns of lymph nodes

Question 7

Structure and Function: Lymph Nodes:

Answer 7

• Preauricular, in front of ear
• Posterior auricular (mastoid), superficial to mastoid process
• Occipital, at base of skull
• Submental, midline, behind tip of mandible
• Submandibular, halfway between angle and tip of mandible

Question 8

Structure and Function: Lymph Nodes (Cont.)

Answer 8

• Jugulodigastric, under angle of mandible
• Superficial cervical, overlying sternomastoid muscle
• Deep cervical, deep under sternomastoid muscle
• Posterior cervical, in posterior triangle along edge of trapezius muscle
• Supraclavicular, just above and behind clavicle, at sternomastoid muscle

Question 9

Developmental Competence: Aging adult

Answer 9

• Facial bones and orbits appear more prominent, facial skin sags resulting from decreased elasticity, decreased subcutaneous fat, and decreased moisture in skin
• Lower face may look smaller if teeth have been lost

Question 10

Health History Questions: Headaches

Answer 10

• Onset: When did this kind of headache start?
• -Gradual, over hours, or a day?
• -Suddenly over minutes, or less than 1 hour
• Ever had this kind of headache before?
• Location: Where do you feel it: frontal, temporal, behind your eyes, in sinus area, or in occipital area?
• Is pain localized on one side or all over?
• Character: throbbing, aching, mild, moderate, or severe?

Question 11

Health History Questions: Headaches (Cont.)

Answer 11

• Course and duration: When do headaches occur? Do they awaken you from sleep?
• How long do they last? Hours or days?
• Precipitating factors: What brings it on: activity, exercise, work environment, emotional upset, anxiety, alcohol? Note signs of depression

Question 12

Health History Questions: Headaches (Cont.): Associated factors:

Answer 12

• any relation to other symptoms
• -Nausea, vomiting, vision changes, pain with bright lights, neck pain or stiffness, fever, weakness, moodiness, stomach problems?

Question 13

Health History Questions: Headaches (Cont.): coping strategies

Answer 13

Do you have other illness or take any medications?
Pattern: Any family history of headache?
Frequency: Once a week?
For females: When do they occur in relation to your menstrual periods?
What seems to help: sleep, medications?
Coping strategies: How have headaches affected self-care, ability to work, home, and social ability?

Question 14

Health History Questions: Headaches (Cont.): dizziness

Answer 14

Head injury or blow to your head?
Dizziness?
Neck pain or limitation of neck motion?
Lumps or swelling?
History of head or neck surgery?

Question 15

Additional Health History Questions: for aging adults

Answer 15

• Dizziness? How does it affect your daily activities?
• Neck pain? How does it affect your daily activities? Are you able to drive, perform at work, do housework, sleep, and look down when using stairs?

Question 16

Inspection and Palpation of the Skull:

Answer 16

• Note general size and shape

- Assess shape: place fingers in person’s hair and palpate scalp

Question 17

Cranial bones that have normal protrusions are

Answer 17

forehead, lateral edge of parietal bones, occipital bone, and mastoid process behind each ear

Question 18

There is no tenderness to

Answer 18

palpation

Question 19

Palpate what artery and bone between eye and top of ear?

Answer 19

temporal artery above zygomatic (cheek) bone

Question 20

Palpate what joint as the person opens the mouth, and note normally what?

Answer 20

temporomandibular joint as the person opens the mouth, and note normally smooth movement with no limitation or tenderness

Question 21

Inspection of the Face:

Answer 21

Note facial expression and appropriateness to behavior or reported mood
Facial structures always should be symmetric

Question 22

Note symmetry of

Answer 22

eyebrows, palpebral fissures, nasolabial folds, and sides of mouth

Question 23

Note any abnormal facial structures

Answer 23

(coarse facial features, exophthalmos, changes in skin color or pigmentation), or abnormal swellings

Common = swelling of ear

Question 24

Note any involuntary movements

Answer 24

(tics) in facial muscles; normally none occur

Question 25

Head and Neck Symmetry

Answer 25

Head position is centered in midline, and accessory neck muscles should be symmetrical
Head should be held erect and still

Question 26

Range of Motion (ROM):

Answer 26

note any limitations
Test muscle strength and status of cranial nerve XI by trying to resist person’s movements with your hands as person shrugs shoulders and turns head to each side

Question 27

ROM: Look for swelling below

Answer 27

angle of jaw; note thyroid gland enlargement though normally none is present

Question 28

Note any obvious pulsations;

Answer 28

carotid artery creates brisk localized pulsation just below angle of the jaw
Normally, there are no other pulsations while person is in sitting position

Question 29

Lymph Nodes:

Answer 29

normally do not feel them

Normal nodes feel movable, discrete, soft, and nontender

Question 30

If any nodes are palpable, note

Answer 30

location, size, shape, delimitation (discrete or matted together), mobility, consistency, and tenderness

Question 31

If nodes enlarged or tender,

Answer 31

check area they drain for source of the problem; they often relate to inflammation or neoplasm in head and neck

Question 32

Follow up on or refer to what?

Answer 32

your findings; an enlarged lymph node, particularly when you cannot find the source of problem, deserves prompt attention

Question 33

Examining lymph nodes:

Answer 33

Use a systematic order

shrug shoulder to feel some nodes

Question 34

Trachea:

Answer 34

Normally, trachea is midline; palpate for any tracheal shift
Space should be symmetric on both sides
Note any deviation from midline

Question 35

Thyroid gland:

Answer 35

Difficult to palpate; check for enlargement, consistency, symmetry, and presence of nodules

Question 36

If thyroid gland is enlarged,

Answer 36

auscultate thyroid for presence of bruit, which occurs with accelerated or turbulent blood flow, indicating hyperplasia of thyroid (e.g., hyperthyroidism)

Question 37

Physical Examination: Aging Adult

Answer 37

• Temporal arteries may look twisted and prominent
• In some aging adults, a mild rhythmic tremor of head may be normal
• Senile tremors are benign and include head nodding and tongue protrusion
• If some teeth have been lost, lower face looks unusually small, with mouth sunken in

Question 38

Physical Examination: Aging Adult (Cont.):

Answer 38

• Neck may show concave curve when head and jaw are extended forward to compensate for kyphosis of spine
• During examination, direct aging person to perform ROM slowly; he or she may experience dizziness with side movements
• Aging person may have prolapse of submandibular glands, which may be mistaken for a tumor; but drooping submandibular glands will feel soft and be present bilaterally

Question 39

Inspect and palpate the skin

Answer 39

General size and contour
Note any deformities
Palpate temporal artery and temporomandibular join (TMJ) joint

Question 40

Inspect and palpate the face

Answer 40

Observe facial expression
Cranial nerve VII: symmetry of movement
Observe for any abnormal movements

Question 41

Inspect and palpate the neck

Answer 41

Active ROM, potential enlargement and position of trachea