HEAD & NECK

ASSESSMENT
INSPECTION OF THE
SHAPE OF THE HEAD
Steps:
 Have the patient sit in a comfortable
position
 Face the patient, with your head at the
same level as the patient‘s head
 Inspect the head for shape and symmetry
Normal
 Normocephalic and symmetrical
 Head is symmetric, round, erect & in
midlline
 Abnormalities
Abnormality Pathophysiology

Enlargement of head without Hydrocephalus – abnormal

enlargement of facial structures accumulation of fluid

Enlargement of the skull and bony Acromegaly – caused y excessive

facial structure secretion of growth hormone

Abnormal shape of the skull or bone Craniosynostosis – caused y

growth premature closure of one or more
sutures of the skull before brain
growth is complete
Palpation of the Head
Steps:
 Place finger pads on the scalp and palpate
all of its surface, beginning in the frontal
area and continuing over the parietal,
temporal, and occipital areas
 Assess for contour, masses, depression,
and tenderness
 Palpate the superficial temporal artery,
which is located anterior to the tragus of
the ear
Normal
 Skull: smooth, nontender, without masses
or tenderness
 Temporal artery: weaker peripheral pulse
than the other peripheral pulses in the
body; nontender , smooth and readily
compressible
 Abnormalities
Abnormality Pathophysiology

Masses in cranial bones carcinomatous metastasis from other

Localized edema
Softening of the outer bone layer
Hard in consistency and tender
temporal artery
regions,; lymphoma; multiple myeloma
Osteomyelitis of the skull
Craniotabes – softening of the cranial
boones d/t hydrocephalus, rickets
Temporal arteritis
Inspection and palpation of the scalp
 Normal: shiny, intact and without masses
abnormalities
Abnormality Pathophysiology
Lacerations Trauma
Gaping laceration Deep wound
Localized, easily Hematoma
movable accumulation
of blood in SQ tissue
Single or multiple Sebaceous cysts
masses – from skin or
sq
Nonmobile, fatty Lipomas –fatty tumors
masses, with circular
edges
Inspection of the face
 Symmetry
 Shape and features
Inspection of face (symmetry)
Steps:
 Have the patient sit in a comfortable
position facing you
 Observe the face of the patient, along
with expression, shape, symmetry of the
ff: eyebrows, eyes, nose, mouth ears
Normal findings:
 Facial feature: symmetrical
 Palpebral fissures: equal
 Nasolabial fold: bilateral
Note: slight variations in symmetry is normal
Slanted eyes with inner epicanthal folds are
normal with Asian decent
 Abnormality
Abnormality Pathophysiology

Absent or deformed structures; Stroke

Definite asymmetry bell‘s palsy
Inspection of the face (shape and
features)
Steps:
 Face the patient
 Observe the shape of the face of the
patient
 Note any swelling, abnormal features, or
unusual movement
Normal findings
 Shape: oval, round or slightly square
 No edema, disproportionate structures
or involuntary movement
 Abnormal findings
Abnormality Pathophysiology
Slanted eyes with inner epicanthal Down‘s syndrome
folds; short flat nose; thick protruding
tongue
Wide distance between eyes Hypertolorism – congenital anomaly
Facial skin is shiny, contracted and hard Scleroderma –a collagen disease with
UK cause
Thin face, sharply defined features and Grave‘s disease
prominent eyes (exopthalmos)
Face is round, swollen with periorbital Myxedema – a/w hypothyroidism
edema, dry an dull skin
Sunken eyes an cheeks Cachexia – profound state of tissue
wasting a/w malnutrition, DHN, and
CA
Face is immobile and expression less Parkinson‘s dse.
 Abnormal Findings
Abnormality Pathophysiology
Allergic shiners – dusky blue Chronic allergies
discoloration beneath the eyes
(Caucasians); Dennie‘s lines –
creases below the lower
eyelids
Transverse crease across the Allergic rhinitis; ellergies
nose (nasal salute)
Moon face w/ red cheeks and Cushing's disease
excess hair on jaw and upper
lip
 Findings (headache)
Sinus Cluster h/a Tension h/a Migraine h/a Tumor
headache related h/a
Deep constant Stabbing pain Dull, tight With n/v Steady aching
throbbing pain with tearing diffuse sensitivity to
eyelid drooping light or noise
reddened eye
runny nose
Occurs after a Sudden onset No prodromal May have No prodromal
cold stage prodromal stage stage
Occur in one Localized in the Frontal, Around eyes Varies with the
area of the face eye and orbit temporal, cheeks location of
radiating to the occipital region forehead, one tumor
facial and side of the face
temporal
regions
Lasts until Occurs late Days, months, 3 days Morning and
associated evening years lasts for several
symptoms is hours
improved
Sinus Cluster h/a Tension h/a Migraine h/a Tumor
headache related h/a
Moderate to Intense Aching Throbbing. Variable
severe Severe
Worsen with Movement may Relief may be Rest may bring Subsides later in
sudden relieve obtained y local relief days
movement discomfort heat, massage
Associated with Occur more in Affect women Affect women
sinusitis young males more more
Palpation and auscultation of the
Mandible
 Use fingertips of both index and middle fingers to
locate the temporomandibular joint anterior to
the tragus of the ear on both sides
 Hold the fingertips firmly and ask the patient to
open and close the mouth
 As the patient open and closes mouth, observe
the relative smoothness of the movement and
whether or not the patient notices any
discomfort
 Remove hands, hold the bell of the stethoscope
over the joint
 Listen for any sound while the patient opens and
closes mouth
Normal Findings
 No discomfort with movement
 TMJ – should articulate smoothly w/o
clicking or crepitus
 Abnormal Findings
Abnormality Pathophysiology
Tenderness (opening and Inflammation of migratory
closing of mouth); arthritis
clicking/crepitus (auscultation)
Mouth remains open and fixed TMJ syndrome
position; (limited ROM)
crepitus, tenderness
 TMJ syndrome-
limited ROM,
swelling, tenderness
or crepitation.
The neck
Inspection of neck
Steps
 Have the patient sit facing you with the
head held in a central position
 Inspect for symmetry anteriorly and
posteriorly
 Have the patient touch the chin to the
chest. To each side, and to each shoulder
 Assess for ROM
 Note the presence of stoma or
tracheaostomy
Normal
 Muscles are symmetrical with the head in
central position
 Able to move the head through a full
range of motion w/o complaints or
discomfort
 Maybe breathing through the stoma or
tracheostomy
 Abnormalities
Abnormal findings Cause/pathophysiology
Asymmetry Asymmetrical masses can be
malignant
Pain on flexion or rotation Spasm d/t meningitis
Dses.of vertebrae
Slight or prominent lateral Torticollis
deviation
Reduced ROM Degenerative changes from
osteoarthritis
Palpation of neck
Steps:
 Stand in front of the patient
 With the finger pads, palpate the
sternocleidomastoid
 Note the presence of masses or
tenderness
 Palpate the trapezius
 Note the presence of masses or
tenderness
normal
 Muscles - symmetrical w/o palpable
masses or spasm
 abnormalities
Abnormal findings Cause/pathophysiology
Palpated mass Tumor
Spasms Infections, trauma,
infections
Inspection of thyroid Gland
Steps:
 Secure tangential lighting and shine at an oblique
angle on the patient‘s anterior neck
 Face the patient
 Ask the pt.to look straight with the head slightly
extended
 Have the pt.drink a sip of water and swallow
twice
 As the patient swallow, observe the front of the
neck in the area of the thyroid and the isthmus
for masses and symmetrical movement
 normal:
Thyroid tissues moves up
with swallowing  Findings:
Thyroid cartilage (Adam‘s Masses or enlargement
apple) – more prominent of thyroid - goiters
in men than in women
Inspect cervical vertebrae.
 Ask patient to flex  Prominence or
neck. swellings other than
 ( chin to chest, ear to the C7 vertebrae
shoulder, twist left to may be ABNORMAL.
right & right to left,
backward & forward)

 C7( vertebrae
prominens) usually
visible & palpable.
Inspect ROM.
 Ask pt. to turn the  Muscle spasms
head to the right & to  Cervical arthitis
the left, touch ear to  Cause stiffness, rigidity
the shoulder, & lift chin & limited movemnt of
to the ceiling. the neck.
 Neck movements
should be smooth &
controlled w/45
degrees flexion, 55
deg.extension, 40deg
lateral abduction, 70
deg.rotation.
Palpate trachea.
 Place finger in the
sternal notch.
 Feel side of notch &
palpate tracheal
rings.
 The first upper ring
above smooth
trachea rings is the
cricoid cartilage.
 Trachea is midline  Tumor
 TG enlargement
 Pneumothorax
 Atelectasis

 Trachea may be
pulled to one side
Palpate thyroid gland.
 Locate landmarks  Cricoid cartilage-
with index fingers & small upper tracheal
thumb. ring under thyroid
 Hyoid bone-arch- gland.
shaped bone);
located high in
anterior neck
 Thyroid bone- under
hyoid bone; known as
Adam’s apple
Palpation of Thyroid Gland
 Posterior approach
Steps:
 Ask the patient to lower the
chin
 Place the thumb at the back
of the patient‘s neck and the
other fingers around the neck
anteriorly with the tips
resting on the lower portion
of the neck
 Use your left fingers to push
the trachea to the right
 Use your right fingers to feel
deeply in front of the
sternomastoid muscle
findings:
Normal:  Abnormal:
Landmarks are midline Masses or abnormal
growth
 Landmarks are  Landmarks deviate
positioned midline from midline or are
obstructed bec. Of
mass or abnormal
growth.
Auscultate the thyroid gland if
enlarged during inspection or
palpation
 Hyperthyroidism-
 Place the BELL of soft,blowing, sound
stethoscope over over thyroid lobes.
lateral lobes of the
TG.
 Ask pt. hold his
breath( obscure
tracheal sounds)

 NO Bruits are
auscultated.
LYMPH NODE ASSESSMENT
 Palpate for the:
-preauricular nodes
-postauricular nodes
- Occipital nodes
- Tonsillar nodes
- Submandibular
- Submental
- Superficial cervical
nodes
- Posterior cervical
nodes
- Deep cervical chain
nodes
- Supraclavicular nodes
Sequence in palpating the lymph
nodes:
 Preauricular—in front of the ear
 Posterior auricular—superficial to the mastoid process
 Occipital—at the base of the skull posteriorly
 Tonsillar—at the angle of the mandible
 Submandibular—midway between the angle and the tip of the
mandible. These nodes are usually smaller and smoother than the
lobulated submandibular gland against which they lie.
 Submental—in the midline a few centimeters behind the tip of the
mandible
 Superficial cervical—superficial to the sternomastoid
 Posterior cervical—along the anterior edge of the trapezius
 Deep cervical chain—deep to the sternomastoid and often
inaccessible to examination. Hook your thumb and fingers around
either side of the sternomastoid muscle to find them.
 Supraclavicular—deep in the angle formed by the clavicle and the
sternomastoid
 No enlargement,  Tender nodes suggest
swelling, hardness, & inflammation; hard or
tenderness present. fixed nodes suggest
malignancy.
 Enlargement of a
supraclavicular node,
especially on the left,
suggests possible
metastasis from a
thoracic or an
abdominal malignancy