Head & Neck

Bones:
The facial skeleton is composed of: mandible; maxilla; nasal;
palatine; lacrimal; vomer; zygoma; bones.
The cranial skeleton includes: frontal; temporal; parietal; occipital
bones.

Triangles of the Neck

Ant. & Post. -
Sternocleidomastoid M. – action,
relations – triangles
relations – Maj. Vessels
relations – Deep L. N.

The sternocleidomastoid muscle overlies the carotid sheath. The carotid sheath lies
lateral to the larynx. This sheath contains the common carotid artery, the internal jugular
vein, and the vagus nerve.

Important structures in the neck:

- Larynx – thy. & cric. Cart. - sites , details
- Thyroid G.
 - Salivary Gs.
- Cervical L. N. – In details:

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Notes about Lymphadenopathy :-

➔ Lymphadenopathy is either Generalized or local – each is either due to
infection or malignancy [primary or secondary], other causes are rare like
autoimmune dis., storage dis.
➔ Examination of lymph nodes involves inspection and palpation.
Inflammation of the overlying skin and associated pain usually implies an
infective aetiology, whereas malignant lymphadenopathy is usually non-
tender.
➔ Determine the position, size, shape, consistency, mobility, tenderness
and whether it is an isolated lymph node or whether several coalesce. For the
Cervical & Axillary nodes, it is often helpful to relax overlying muscles during
their examination.
➔ It has been estimated that the neck contains more than 75 L. N. on each
side.
These are grouped in superficial & deep - longitudinal & circular L.N.s

➢ Sites:

Bruise = contusion = ecchymosis = ‫كدمة‬

Abrasion = scratch = erosion = ‫سحجة‬

Bad Body Odour

Main Causes of Bad Body Odour:
• Poor personal hygiene / Excessive sweating
• Extreme old age
• Major mental illness
• Alcohol or drug misuse
• Physical disability preventing normal hygiene

Bad Smell:
1. Halitosis (bad breath) is caused by decomposing food wedged between
the teeth, gingivitis, stomatitis, atrophic rhinitis and tumours of nasal
passages.
2. Tobacco, Alcohol
3. Foetor Hepaticus: ‘ammonia’ like smell in patients with liver failure.
4. Acetone like smell as in diabetic ketoacidosis or starvation
5. Uraemic foetor: fishy like smell as in uraemia
6. putrid or fetid smell of chronic anaerobic suppuration due to
bronchiectasis or lung abscess
7. foul-smelling belching in patients with gastric outlet obstruction

Characteristic features
Many disorders have characteristic facial or body features, which may aid
in early correct diagnosis, which is called ‘Spot Diagnosis’ like:
Acromegaly, Cushing syndrome, Down’s syndrome (trisomy 21),
Achondroplasia,

Examination of the Mouth

Always inspect the mouth with a good light and use a spatula.
■ Inspect the external appearance of the lips.
■ Retract the lips to see the buccal mucosa.
■ Push the cheek outwards to see the buccal side of the gum.
■ Push the tongue away from the inside of the gum and the floor of the
mouth.
■ Push the tongue to one side to see the lateral aspect of its posterior
third.
■ Depress the tongue to look at the fauces, tonsils and pharynx.
➔ Always remember to palpate the structures in the mouth bimanually, one
finger
inside and one outside.
➔ Always wear a glove [for protection from possible contagious lesions]
Abnormal Tongue Findings
• Tremor of the Tongue: can be due to anxiety, thyrotoxicosis,
delirium tremens or parkinson. [Fasciculation (irregular twitching of the tongue)
occurs in lower motor neurone disorders, e.g. motor neurone disease].
• Macroglossia (enlargement of the tongue) may occur in acromegaly,
amyloidosis or tumour infiltration.
• Oral thrush = White patches that may be scraped off the tongue are due
to the fungal yeast, Candida. Common causes include inhaled steroids,
immune deficiency, e.g. HIV and terminal illness.
• Glossitis is a smooth reddened tongue due to atrophy of the papillae. It
is common in alcoholics, in nutritional deficiencies of iron, folate and
vitamin B12, and in 30% of patients with coeliac disease. Glossitis may
cause a burning sensation over the tongue but usually a painful tongue is
a symptom of anxiety or depression.
• Leukoplakia is a thickened white patch that cannot be scraped off the
tongue. It may be premalignant.