Lecture 5: Head, Neck, Mouth, Nose, Throat (Including Regional Lymphatics) Flashcards
Learning Objectives
Learn the location and function of structures in the head, neck, nose, mouth, and throat
Learn to perform inspection and palpation of the head, neck, nose, mouth, and throat
Differentiate between normal and abnormal objective and subjective findings
Assessing Head and Neck
Cranium, face, thyroid gland, and lymph nodes contained within the head and neck
Sensory organs- eyes and ears are discussed in separate lectures
Structure and Function:
skull and cranial bones
Skull is rigid structure that protects brain and major sensory organs
Supported by cervical vertebra
Cranial bones:
Frontal
Parietal
Occipital
Temporal
Sphenoid
Ethmoid
Structure and Function
Facial bones
Facial bones:
Maxilla
Zygomatic (cheek)
Inferior conchae
Nasal
Lacrimal
Palatine
Volmer
Mandible (jaw)
All immovable except mandible
Structure and Function:
facial expression, muscles, and structures
Facial expressions are mediated by CN VII Facial Nerve
Facial muscles should be symmetric bilaterally
Palprebral fissures
Nasolabial folds (FAST-CVA)
The facial structures should also be symmetric:
eyes
nose
mouth
Structure and Function:
temporal artery and salivary glands
Temporal artery
- Between eye and top of ear
Salivary glands
-Parotid glands
-Submandibular glands
-Sublingual glands
Structure and Function: salivary glands
Salivary glands- produce saliva (watery, serous fluid containing salts, mucus and salivary amylase)
Lubricates food bolus and starts digestion
Parotid glands:
- Largest of the three main parts of salivary glands, located on either side of face, just below and in front of ears
Submandibular glands
- beneath mandible at angle of jaw
Sublingual glands
- Salivary gland on either side of tongue
Structure and Function:
salivary gland ducts
Parotid:
Stensen’s
- Located in buccal mucosa
Submandibular:
Wharton’s
-Located at either side of the frenulum
Sublingual:
Located within floor of mouth and has 8-20 openings under tongue
Structure and Function:
Thyroid gland and Trachea
Thyroid gland:
- Synthesizes and secretes thyroid hormones
- The gland has two lobes, connected in middle by a thin isthmus and above that by the cricoid cartilage or upper tracheal ring
Trachea:
-through which air enters the lungs
-Located superior to sternal notch
Hypo and Hyperthyroidism
see chart q
Structure and Function:
Neck
Neck composed of muscles ligaments and cervical vertebrae
Major neck muscles are innervated by CN XI (11)-Spinal Accessory Nerve
Contraction permits shrugging of shoulders by the trapezius muscles and turning head against resistance
- Sternomastoid:
Enables head rotation and flexion
-Trapezius :
Moves shoulders, and extends and turns head
These 2 major muscles form two triangles that provide important LMs for assessment
- Anterior triangle- under the mandible, anterior to the sternomastoid muscle
- Posterior triangle- between the trapezius and sternomastoid
Range of motion- have patient touch chin to chest, look up to the sky. Turn head to right, left, have patient touch right ear to right shoulder, touch left ear to left shoulder
Structure and Function:
Lymph Nodes
- Filter lymph (clear substance composed of excess tissue fluid, after lymphatic vessels collect, before returned to vascular system
-Filtering removes bacteria and tumor cells
-Produces lymphocytes and antibodies (defend against invasion of foreign substances
- < 1 cm in length (buried deep in connective tissue)
- Normally non palpable (with infection or cancer, they enlarge and may become painful to palpation- mononucleosis or strep pharyngitis)
Location of Lymph Nodes:
Preauricular
Postauricular
Tonsillar
Occipital
Submental
Submandibular
Anterior (superficial) cervical
Posterior cervical
Supraclavicular
Structure and Function: Nose
- External nose
- Nasal cavity
*Septum
*Turbinates
-Blood vessels and
mucous membranes: warm, humidify, and filter inhaled air
-Middle and inferior accessible to examination with otoscope
Abnormalities: Sinuses
Allergic rhinitis
Subjective data:
Itchy, watery eyes
Rhinorrhea
Nasal cåongestion
Objective data:
Bluish-gray turbinates, swollen, boggy
Structure and Function: sinuses
Frontal
Maxillary
Ethmoid
Sphenoid
Structure and Function: Mouth
Health Hx : Nose and Sinuses
Discharge
Frequent colds
Sinus pain
Trauma
Epistaxis (nosebleeds)
Allergies- watery and itchy eyes/throat
Altered smell (CN I Olfactory Nerve)
Health HX: Mouth and Throat
Sores or lesions
Pharyngitis (sore throat)
Bleeding gums
Toothache
Hoarseness
Dysphagia (difficulty swallowing)
Altered taste
Smoking, chewing tobacco
Inspection and Palpation: Head
Skull & scalp-mobility, normocephalic, lesions, symmetry
Hair
Face-
-Expression- relaxed, anxious
-Symmetry
Eyes, ears and nose
Nasolabial folds
Palpation & Auscultation
Palpate temporal artery (above cheek bone between the eye and top of ear)
Palpate temporomandibular joints:
- Place fingers in the depression anterior to tragus of ear and palpate as client opens mouth
- Normal-smooth movement
- Abnormal- clicking, crepitation, locking and popping of jaw- TMJ Dysfunction
Palpate and auscultate carotid artery (CV/PVS)
Inspection and Palpation: Neck and Lymphatics
Trachea-position midline
Thyroid-
Position (symmetrical)
Swallow (rises and falls with swallowing)
Lymph glands-
normally non-palpable
move the skin lightly over the tissue with the pads of the fingers
ROM, shoulder shrug, resistance to turning head (muscle strength- CN XI 11 Spinal Accessory)
Palpate Cerviaal Nodes
Lymph node exam in this order:
Preauricular
Posterior auricular (mastoid)
Occipital
Submental
Submandibular
Tonsillar (jugulodiagastric or parotid)
Anterior (superficial) cervical
Posterior cervical
Supraclavicular
Palpate Trachea
Place finger in sternal notch
Feel each side of the notch and palpate tracheal rings
Normal-midline
Abnormal
Pulled to affected- atelectasis, fibrosis or pulmonary adhesions
Pushed to unaffected side- tumor, enlarged thyroid lobe, pneumothorax, aortic aneurysm
Palpate Supraclavicular Node
Nose and Sinuses
Tenderness
Patency-nostrils
Palpate sinuses:
-Frontal
Below eyebrows
-Maxillary
Below cheekbones
Should feel pressure but no pain or tenderness
Frontal and Maxillary Sinuses
Air-filed cavities
Resonance chambers for speech
Only frontal and maxillary accessible to examination
Common source of infection
Fifth most common reason for antibiotic prescription
Follow evidence-based guidelines such as Infectious Diseases Society of America (IDSA)
- “My stuffy head”
Moraxella Catarrhalis
Streptococcus Pneumoniae
Hameophilus Influenzae
`
Mouth & Throat
Tongue movement & characteristics (CN XII )-use gloves
Color, moisture, drainage
Teeth and gums
Buccal mucosa
Palate and Uvula
Lips-inspection & palpation
Inspect Mouth and Throat
.
Grading Tonsils
1+: Visible
2+: halfway between tonsillar pillars and the uvula
3+: nearly touching the uvula
4+: touching each other
