Module 2_Examination 1 (Head and neck Exam) Flashcards
What consists of the first part of the examination?
- Head, jaw, neck (general appearance)
- Muscles of mastication
- Jaw opening
- TMJ
- Blood vessels
- Salivary Glands
- Lymph system
second part= cranial nerves
What are the steps to the exam?
-Look at the head and neck in both frontal and sagittal views–>check for abnormalities and asymmetries
Where should you look to differentiate between Crouzon’s and Apert’s syndrome?
Hands
How should the temporalis muscle be palpated extra orally?
- Anteriorly to posteriorly
- Check for tender spots
How should the masseter be palpated extra orally?
-Insertion (zygomatic arch)–>body of muscle with jaws clenched and unclenched–>attachment to angle of mandible
Where is the medial pterygoid palpated extra orally?
Under the angle of the mandible
Where is the temporalis palpated intra orally?
Coronoid process
Where is the medial pterygoid palpated intra-orally?
Ramus of the mandible
Where is the lateral pterygoid palpated?
Behind the maxilla
What technique should be used in palpating muscles? Why?
- Bilaterally simultaneously
- Allows patient to tell you if any difference between right and left side
What aspects should be measured in terms of jaw opening?
-Patient should open as wide as they can
-Then close
-Then swing left
-Then swing right
(movements should be smooth and symmetrical)
Jaw opening distance should be measured (by using ruler to measure interincisal gap)
Lateral movement distance measured using the mx and md midlines as landmarks
What is the normal range of jaw movement? When should you refer a patient?
Opening: 45mm +
Lateral: 6-8mm +
*Refer if opening less than 25mm
Patient who can’t open more than 5mm is in life threatening situation
10mm: serious difficulty
20mm: difficult to eat or dental treatment
How should TMJ Examination be performed?
- Palpate TMJ on opening and closing–>should feel rotation and translation
- Normally symmetrical
- Note any crepitus or catching
- Stretch test
- Get pt to open halfway
- Push sharply downwards on chin
- If muscles cramped will feel soreness along muscle lines
- If TMJ inflamed will hurt in TMJ and ears
Neck muscle evaluation
- Palpate sternocleidomastoid
- Palpate occipital muscles
- Get patient to rotate head left and right–>should be symmetrical and pain free
- Get them to also tilt up and down with head in the midline
What blood vessels should be checked?
Facial artery (including superior and inferior labial arteries)
Facial vein
Auriculotemporal/superfical temporal artery (note runs deep and posterior to TMJ, can be palpated as it crosses zygomatic arch between external acoustic meatus and condyle))
External carotid (bit above Sternocleidomastoid)
Visually examine if another discoloration or swelling following facial vessels
Palpate arteries for abnormalities and pulses
What should be checked on salviary gland exam? What technique shoudl be used?
- Parotid (behind masster and mandibular ramus)
- Submandibular gland (near angle of the jaw)
- Sublingual gland (floor of the mouth)
Bimanual palpation One hand on outside of mouth push gland up one hand inside and push down Feel gland between two fingers *Compare both sides
