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. Slide 13-1
Chapter 13
Structure and Function

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

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)

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)

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

Chapter 13
Structure and Function, cont.
Lymph Nodes of the Head and Neck

 Preauricular  Jugulodigastric
 Posterior auricular  Superficial cervical
(mastoid)
 Deep cervical
 Occipital
 Posterior cervical
 Submental
 Supraclavicular
 Submandibular
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

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

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

Chapter 13
Subjective Data—
 Headache
 Head injury
 Dizziness
 Neck pain and/or limitation of motion
 Lumps or swelling
 History of head or neck surgery
Subjective Data—
 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

Subjective Data—
 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

Subjective Data—
 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 forcep-
caput succedaneum, cephalohematoma and bell’s palsy
 Additional history for the aging adult

– Assess self- care and potential of injury

Chapter 13
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)
 Head – Inspect the Face

 Facial structures
Chapter 13
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
Palpating the supraclavicular node
Normal nodes feel movable, discrete, soft and nontender
Objective Data—
The Physical Exam, (cont.)
 Trachea
 Thyroid gland
– Posterior approach
– Anterior approach
– Auscultate (if enlarged)

Trachea is midline
Posterior approach

Anterior approach
Chapter 13
Abnormal Findings
Abnormalities in Head Size
and Contour
 Hydrocephalus  Craniosynostosis
Paget’s
disease of bone
(osteitis
deformans)

Acromegaly
Chapter 13
Abnormal Findings
Swellings on the Head and Neck
 Torticollis (wryneck)
 Thyroid-multiple nodules
 Thyroid-single nodule
 Pilar cyst (Wen)
 Parotid gland enlargement
Torticollis (wryneck)
A hematom in one sternomastoid muscle
Thyroid- Multiple Nodules
Parotid Gland Enlargement

Chapter 13
Abnormal Findings
 Pediatric facial abnormalities
– Fetal alcohol syndrome
– Congenital hypothyroidism
– Down syndrome
 Facial features with chronic allergies

– Atopic (allergic) facies
– Allergic salute and crease
Fetal Alcohol Syndrome
Down Syndrome
Chromosomal
Carolyn Jarvis Physical Examination and aberration
Health Assessment Fourth Edition. (trisomy 21)
Chapter 13
Abnormal Findings
Abnormal Facial Appearances with
Chronic Illnesses
 Parkinson’s syndrome
 Cushing’s syndrome
 Hyperthyroidism
 Myxedema (hypothyroidism)
 Bell’s palsy
 Brain attack or cerebrovascular accident
 Cachectic appearance
 Scleroderma
Parkinson’s syndrome- expressionless, “mastlike” , drooling

Cushing Syndrome
•Excessive secretion of coticotropin hormone (ACTH)
•Moonlike face
Cerebrovascular Accident
Cachectic appearance- cancer, dehydration and starvation
Sunken eyes, hollow cheeks and exhausted an defeated expression

Head and Neck Pre

Загружено:

Сведения о документе

Авторское право

Доступные форматы

Поделиться этим документом

Поделиться или встроить документ

Параметры публикации

Этот документ был вам полезен?

Это неприемлемый материал?

Авторское право:

Доступные форматы

Head and Neck Pre

Загружено:

Авторское право:

Доступные форматы

Chapter 13

Head and Neck,

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

 Structure and Function

Structure and Function

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

 Internal and external carotid arteries and veins

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

Structure and Function, cont.

Lymph Nodes of the Head and Neck

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

 The pregnant female

 The aging adult

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

 Additional history for the aging adult

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

 Head – Inspect the Face

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

 Facial features with chronic allergies

Carolyn Jarvis Physical Examination and Health Assessment Fourth Edition.

Вам также может понравиться