Lecture 5: Head, Neck, Mouth, Nose, Throat (Including Regional Lymphatics)

Question 1

Learning Objectives

Answer 1

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

Question 2

Assessing Head and Neck

Answer 2

Cranium, face, thyroid gland, and lymph nodes contained within the head and neck

Sensory organs- eyes and ears are discussed in separate lectures

Question 3

Structure and Function:

skull and cranial bones

Answer 3

Skull is rigid structure that protects brain and major sensory organs

Supported by cervical vertebra

Cranial bones:
Frontal
Parietal
Occipital
Temporal
Sphenoid
Ethmoid

Question 4

Structure and Function
Facial bones

Answer 4

Facial bones:
Maxilla
Zygomatic (cheek)
Inferior conchae
Nasal
Lacrimal
Palatine
Volmer
Mandible (jaw)
All immovable except mandible

Question 5

Structure and Function:

facial expression, muscles, and structures

Answer 5

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

Question 6

Structure and Function:

temporal artery and salivary glands

Answer 6

Temporal artery
- Between eye and top of ear

Salivary glands
-Parotid glands
-Submandibular glands
-Sublingual glands

Question 7

Structure and Function: salivary glands

Answer 7

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

Question 8

Structure and Function:
salivary gland ducts

Answer 8

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

Question 9

Structure and Function:

Thyroid gland and Trachea

Answer 9

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

Question 10

Hypo and Hyperthyroidism

Answer 10

see chart q

Question 11

Structure and Function:

Neck

Answer 11

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

Question 12

Structure and Function:

Lymph Nodes

Answer 12

• 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

Question 13

Structure and Function: Nose

Answer 13

• 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

Question 14

Abnormalities: Sinuses

Allergic rhinitis

Answer 14

Subjective data:
Itchy, watery eyes
Rhinorrhea
Nasal cåongestion

Objective data:
Bluish-gray turbinates, swollen, boggy

Question 15

Structure and Function: sinuses

Answer 15

Frontal
Maxillary
Ethmoid
Sphenoid

Question 16

Structure and Function: Mouth

Answer 16

Question 17

Health Hx : Nose and Sinuses

Answer 17

Discharge
Frequent colds
Sinus pain
Trauma
Epistaxis (nosebleeds)
Allergies- watery and itchy eyes/throat
Altered smell (CN I Olfactory Nerve)

Question 18

Health HX: Mouth and Throat

Answer 18

Sores or lesions
Pharyngitis (sore throat)
Bleeding gums
Toothache
Hoarseness
Dysphagia (difficulty swallowing)
Altered taste
Smoking, chewing tobacco

Question 19

Inspection and Palpation: Head

Answer 19

Skull & scalp-mobility, normocephalic, lesions, symmetry

Hair

Face-
-Expression- relaxed, anxious
-Symmetry
Eyes, ears and nose
Nasolabial folds

Question 20

Palpation & Auscultation

Answer 20

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)

Question 21

Inspection and Palpation: Neck and Lymphatics

Answer 21

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)

Question 22

Palpate Cerviaal Nodes

Answer 22

Lymph node exam in this order:
Preauricular
Posterior auricular (mastoid)
Occipital
Submental
Submandibular
Tonsillar (jugulodiagastric or parotid)
Anterior (superficial) cervical
Posterior cervical
Supraclavicular

Question 23

Palpate Trachea

Answer 23

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

Question 24

Palpate Supraclavicular Node

Answer 24

Question 25

Nose and Sinuses

Answer 25

Tenderness
Patency-nostrils
Palpate sinuses:
-Frontal
Below eyebrows
-Maxillary
Below cheekbones

Should feel pressure but no pain or tenderness

Question 26

Frontal and Maxillary Sinuses

Answer 26

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
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Question 27

Mouth & Throat

Answer 27

Tongue movement & characteristics (CN XII )-use gloves
Color, moisture, drainage
Teeth and gums
Buccal mucosa
Palate and Uvula
Lips-inspection & palpation

Question 28

Inspect Mouth and Throat

Answer 28

.

Question 29

Grading Tonsils

Answer 29

1+: Visible
2+: halfway between tonsillar pillars and the uvula
3+: nearly touching the uvula
4+: touching each other