Head and Neck

By O.Krekhovska-Lepyavko, MD,
Institute of Nursing, TSMU

Anatomy review

Anatomy

Anatomy Salivary Glands

Anterior and Posterior Triangles

Anatomy

Lymphatics

Anatomy - Lymphatics

History

Headaches?

Any unusually frequent or unusually severe headaches?

A severe headache for a person whos never had headaches
should warrant further attention
When - onset, duration
Where

Character

Throbbing (pounding, shooting) migraine

Aching (constant pressure, dull) tension headache

Intensity - mild, moderate, or severe

Precipitating factors
Associated factors

Tension headaches tend to be occipital or frontal

Migraine headaches supraorbital, retro orbital, or frontotemporal
Cluster headaches pain around the eye, temple, forehead, and cheek.
Pain unilateral.

Vision changes, N&V, pain with bright light, neck stiffness, fever,

Alleviating factors
Other illnesses
Medications

History

Head injury?

When
History of head injuries or other medical conditions?
Location
LOC Loss of Consciousness?

Dizziness?

Lightheadedness or spinning?
Vertigo is true rotational spinning due to neurologic dysfunction (vestibular
apparatus)

Neck pain?

When, where, precipitating and alleviating factors

Objective perception that room spins

Subjective perception that person is spinning

Acute onset of stiffness along with headache and fever occurs with meningeal
inflammation

Limitations to ROM?

Lumps or swelling?

Tenderness?

Lumps

Acute infection
If over 40, suspect malignancy until proven otherwise

Smoker? How long? Packs per day? Chew tobacco?

Increased risk of tumors

Assessment - Head

Size and shape

Normocephalic
Hydrocephalus

Pagets disease

abnormal enlargement of skull and

facial bones

acromegaly

Temporal artery

Enlargement and softening of bone

Acromegaly

enlargement of head, increased

circumference

Palpate above zygomatic bone,

between eye and top of ear

Temporomandibular joint

Anterior of ear, between mandible and

temporal bone
Palpate joint as person opens mouth.

Normally smooth movement

Abnormal crepitations, limited
ROM, tenderness

TMJ

Assessment - Face

Symmetry of
eyebrows, mouth
Changes in skin
Tics or twitches
Tightened facial
muscles - pain

Stroke vs Bells Palsy

Bells Palsy

CN VII paralysis
Unilateral
Thought to happen due
to herpes simplex virus
Person cannot wrinkle
forehead, raise
eyebrow, close eye, or
show teeth on affected
side

Stroke

Acute neurological deficit due to obstruction of

cerebral vessel, as in atherosclerosis, or rupture
in a cerebral vessel
Paralysis of lower facial muscles, but upper half of
face not affected.
Still able to wrinkle forehead and close eyes

Fetal Alcohol Syndrome

Down Syndrome

Trisomy 21
Characteristics

Upslanting eyes
Flat nasal bridge and
nose
Protruding tongue
Short broad neck with
webbing
Small hands

Assessment - Neck

Symmetry head and

neck muscles
ROM

Muscle strength

Ask person to touch chin to

chest, turn head to right
and left, try to touch each
ear to shoulder, extend
head backwards
Note limitation of
movement
Test strength by resisting
movement
CN XI Accessory n.
Trapezius m.

Thyroid gland

Enlargement of lower neck

may be bilateral or a
unilateral lump
Diffuse enlargement or
nodular lump

Palpating the Thyroid Gland

Posterior approach
Anterior approach

Place fingers inferior

and lateral of thyroid
cartilage and ask the
person to swallow

Usually, you cannot

palpate the normal
adult thyroid
Enlarged lobes are also
tender to palpation

Hypothyroidism

Mild deficiency called

hypothyroidism. Severe
deficiency called
myxedema. In infancy
called cretinism.
S/S:

Face is pale, puffy, and

expressionless
Skin is cold and dry
Hair is brittle, hair loss
Lowered heart rate and
temp
Lethargy, fatigue,
intolerance to gold
Impaired mentality
Goiter!

Cause

Hashimotos disease

Autoimmune disease
where antithyroid
antibodies block thyroid
hormone production

Iodine deficiency in diet

Surgical removal of
thyroid

Hyperthyroidism

Graves disease

Exophthalmos

Most common. More common in women.

S/S
Rapid heartbeat, dysrhythmias, angina
Rapid thought flow and rapid speech,
nervousness, and insomnia
Increased BMR, appetite
Goiter + Exophthalmos
Cause
Thyroid Stimulating Immunoglobulins (TSIs)
mimic the effects of TSH on thyroid function

Toxic nodular goiter (Plummers disease)

Result of thyroid adenoma

Exophthalmos is missing

Lymph
Nodes

Lymph nodes

Beginning with the preauricular lymph nodes, palpate

the 10 groups of lymph nodes in a routine order
Lymphadenopathy - enlargement of lymph nodes due to
infection, allergy, or neoplasm

Trachea

Normally, the trachea is

midline
Palpate for any tracheal
shift by placing index
finger in the sternal notch

Trachea pushed to
unaffected side in aortic
aneurism, a tumor,
pneumothorax
Trachea pushed to
affected side with large
atelectasis, pleural
adhesions, fibrosis
Tracheal tug is a rhythmic
downward pull that is
synchronous with systole
and that occurs with
aortic arch aneurysms

Developmental Considerations Infants

Skull

Should be round and

symmetrical
Caput succedaneum
elongation of skull at birth
resolves
Cephalohematoma
hemorrhage due to trauma at
birth resolves in few weeks
(Fig 13-17)
Fontanels anterior and
posterior. Normally close by 2
years

Depressed dehydration
Bulging increased ICP

Transillumination done if
abnormal head size or
intracranial lesion is suspected

Hydranencephaly thinning
or absence or cerebral cortex

transillumination

cephalohematoma