Head And Neck Pre

Chapter 13

Head and Neck, Including Re gional Lymphatics

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Chapter 13 Head and Neck, Including Regional Lymphatics



Structure and Function



Subjective Data—Health History Questions



Objective Data—The Physical Exam



Abnormal Findings

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Slide 13-1

Chapter 13 Head and Neck, Including Regional Lymphatics

Structure and Function 

Head – Cranial bones – Sutures – Facial bones – Facial muscles – Salivary glands • Parotid • Submandibular • Sublingual

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Slide 13-2

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

The Head 

Skull – a rigid bony box that protects the brain and special sense organs – Cranium and the face – Cranial bones: • Frontal • Parietal • Occipital • temporal – Sutures • Coronal • Parietal • Sagittal • lambdoid

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

The head 

Skull – 14 facial bones – Move up and down, sideway from the temporomandibular joint which is anterior to the ear – Cranium is supported by the cervical vetebra (C1-C7) – Facial muscle (cranial nerve VII)- symmetric bilaterally – Facial structure are symmetric – Facial sensation- cranial nerve V (trigeminal nerve)

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

The Neck 

Internal and external carotid arteries and veins



Thyroid gland – – – – – – – –

Highly vascularized Synthesizes & secrets thyroxine (T4) and triiodothyronine (T3) 2 lobes- both conical in shape Curving posteriorly between the trachea and sternomastoid muscle Hyoid bone Thyroid cartilage- Adam’s apple Cricoid cartilage Thyroid isthmus (2nd to 3rd tracheal rings)

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

The Neck 

Neck muscles – Sternocleidomastoid muscle • carotid artery and internal jugular vein lie beneath this muscle • External jugular vein runs diagonally across • Head rotation and head flexion – Trapezius – Spinal accessory (CN XI) – Anterior and posterior triangle

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Chapter 13 Head and Neck, Including Regional Lymphatics

Structure and Function, cont. Lymph Nodes of the Head and Neck 

Preauricular

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Jugulodigastric

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Posterior auricular (mastoid)



Superficial cervical

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Deep cervical

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Posterior cervical

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Supraclavicular

  

Occipital Submental Submandibular

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Slide 13-3

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Developmental consideration 

Infants and children – Fontanels • Posterior fontanel is closed by 1-2 months • Diamond-shape anterior fontanel closes between 9 months and 2 years – Head circumference Vs chest circumference – Lymphoid tissue

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Developmental consideration 

Adolescence – Acne – Facial hair – Enlargement of the thyroid cartilage- voice deepens



The pregnant female – Thyroid gland hyperplasia and increase vascularity



The aging adult – Facial bones and orbits appear more prominent

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Subjective Data— Health History Questions 

PQRSTU



Provocative/ palliative



Quality and quantity



Region and radiation



Severity scale



Timing- onset, duration and frequency



Understand patient’s perception

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Chapter 13 Head and Neck, Including Regional Lymphatics

Subjective Data— Health History Questions 

Headache



Head injury



Dizziness



Neck pain and/or limitation of motion

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Lumps or swelling



History of head or neck surgery

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Slide 13-4

Subjective Data— Health History Questions 

Headache – – – – – –

Any unusual frequent or unusual severe headaches? Alcohol ingestion, stress Nausea vomitting Hypertension Family history Tension headache • Occipital or frontal with bandlike tightness – Migraines headache (diltation of the blood vessels) • Supraorbital, retroorbital or frontotemporal, throbbing, occur about twice / months, unilateral – Cluster headache • Pain aroud the eye, temple forehead and cheek, • Unilateral, excruciting pain, piority men, histamin release

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Subjective Data— Health History Questions 

Head Injury – Any LOC before/ after a fall?( cardiovascular problem, neurologic deficit)



Dizziness – Lightheaded, swimming sensation, a feeling of fall – Vertigo- true rotational spinning



Neck pain – Acute onset- meningeal inflammation



Lumps or swelling – Radiation history – Persistant? – Smoking/ alcohol consumption



History of head or neck surgery

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Subjective Data— Health History Questions 

Additional history for infants and children – Maternal alcoholism- fetal alcohol syndrome – Maternal cocaine abuse- neurological, developmental and emotional problems – Vaginal delivery or cesarean section, any use of forcepcaput succedaneum, cephalohematoma and bell’s palsy



Additional history for the aging adult – Assess self- care and potential of injury

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Chapter 13 Head and Neck, Including Regional Lymphatics

Objective Data— The Physical Exam Head – Inspect and Palpate the Skull 

Size and shape – Microcephaly- small head – Macrocephaly- abnormally large head e.g. hydrocephaly, acromegaly and Paget’s disease



Temporal area – Temporol arteritis (toruous, harden and tender of the artery)

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Head – Inspect the Face

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Facial structures

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Slide 13-5

Chapter 13 Head and Neck, Including Regional Lymphatics

Objective Data— The Physical Exam, (cont.) 

Neck – inspect and palpate



Symmetry



Range of motion (ROM)



Lymph nodes – Lymphadenopathy- enlargement of the lymph nodes (> 1 cm) due to infection, allergy or neoplasm – Acute infection- bilateral, warm, tenderm firm but freely movable – Chronic inflammation- nodes are clumped, e.g. T.B. – HIV infection- occipital nodeenlargement, firm, nontender and mobile – Virchow’s node (single, enlarge and nontender, hard left supraclvicular node)- neoplasm in thorax or abdomen – Hodgkin’s lymphoma

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Slide 13-6

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Palpating the supraclavicular node Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Normal nodes feel movable, discrete, soft and nontender

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Objective Data— The Physical Exam, (cont.) 

Trachea



Thyroid gland – Posterior approach – Anterior approach – Auscultate (if enlarged)

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Trachea is midline Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Posterior approach Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Anterior approach

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Chapter 13 Head and Neck, Including Regional Lymphatics

Abnormal Findings

Abnormalities in Head Size and Contour 

Hydrocephalus

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.



Craniosynostosis

Slide 13-7

Paget’s

disease of bone (osteitis deformans) Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Acromegaly Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Chapter 13 Head and Neck, Including Regional Lymphatics

Abnormal Findings

Swellings on the Head and Neck 

Torticollis (wryneck)

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Thyroid-multiple nodules

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Thyroid-single nodule

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Pilar cyst (Wen)

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Parotid gland enlargement

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Slide 13-8

Torticollis A

(wryneck)

hematom in one sternomastoid muscle

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Thyroid- Multiple Nodules Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Parotid Gland Enlargement Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Chapter 13 Head and Neck, Including Regional Lymphatics

Abnormal Findings 

Pediatric facial abnormalities – Fetal alcohol syndrome – Congenital hypothyroidism – Down syndrome



Facial features with chronic allergies – Atopic (allergic) facies – Allergic salute and crease

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Slide 13-9

Fetal Alcohol Syndrome

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Down Syndrome Chromosomal aberration (trisomy 21) Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Chapter 13 Head and Neck, Including Regional Lymphatics

Abnormal Findings

Abnormal Facial Appearances with Chronic Illnesses 

Parkinson’s syndrome

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Cushing’s syndrome

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Hyperthyroidism

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Myxedema (hypothyroidism)

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Bell’s palsy

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Brain attack or cerebrovascular accident

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Cachectic appearance

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Scleroderma

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Slide 13-10

Parkinson’s syndrome- expressionless, “mastlike” , drooling Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Cushing Syndrome •Excessive secretion of coticotropin hormone (ACTH) •Moonlike face Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Cerebrovascular Accident

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.

Cachectic appearance- cancer, dehydration and starvation Sunken eyes, hollow cheeks and exhausted an defeated expression Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition. Copyright © 2003, Elsevier Science (USA). All rights reserved.