HEAD AND NECK

REGIONAL LYMPHATICS

Prepared by: Jeffrey Esteron

LEARNING OBJECTIVE ONE

Anatomy and Physiology Review

LEARNING OBJECTIVE ONE

Head

Skull

Cranium and face

Cranial bones

Frontal
Parietal
Temporal
Occipital

** The Head:

Skull: a bony box

protects the brain &
special sense
organs.
Cranial bones:
frontal, parietal,
occipital, temporal

Sutures:

immovable joints;
coronal: crowns head
from ear to ear at the
union of the frontal &
parietal bones,
sagittal: separate head
lengthwise between two
parietal bones.

lambdoid suture

separates parietal
bones from occipital
bone.
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FONTANELS
(fontenelle= little fountain)

At birth, membrane-covered soft spots

between cranial bones
These soft spots will eventually ossifyreplaced by bone
Allow for growth of the brain during the first
year
Posterior or occipital will ossify by 2 months
Anterior or frontal will ossify by 18-24 months
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LEARNING OBJECTIVE ONE

Head
Facial bones
Facial muscles

Expression of emotion
Neck movement
Controlled by cranial nerves V and VII

FACIAL BONES

14 Facial Bones articulate at sutures except for the

mandible
NASAL-forms part of bridge of nose
PAIRED MAXILLAE- Unite to form upper jaw bone
ZYGOMATIC- Commonly called cheekbones
MANDIBLE- Lower jawbone; largest, strongest facial
bone; only skull bone that moves
LACRIMAL- Smallest bones in face; lateral to nasal
bones
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10

FACIAL MUSCLES

Facial expressions are formed by the facial

muscles
Mediated by cranial nerve VII, the facial
nerve
Facial muscle is symmetrical bilaterally,
except for an occasional quirk or wry
expression
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Figure 13-2 pg 273

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LEARNING OBJECTIVE

Neck

Carotid and temporal arteries

Supported by vertebra and muscles
Neck muscles

Anterior and posterior triangles

Hyoid bone
Thyroid gland

**The Neck:

from base of the skull to manibrium, clavicle,

1st rib,1st thoracic vertebra below.
Structures are: vessels, muscles, nerves,
lymphatics & viscera of the respiratory and
digestive system.
Carotid artery, jugular vein(internal &
external).

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NECK VESSELS

TEMPORAL ARTERY-Lies superior to the

temporalis muscle, and its pulsation is
palpable anterior to the ear
CAROTID ARTERY-Right and left arise
from the aorta and are the principal
blood supply to the head and neck; each
of these two arteries divide to form the
external and internal carotid arteries

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NECK VESSELS

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NECK VESSELS
JUGULAR VEIN- External-Lies superficial to the
sternocleidomastoid muscle as it passes down the neck to
join the subclavian vein; receives blood from the exterior
of the cranium and the deep parts of the face;
INTERNALDirectly continuous with the transverse sinus,
accompanying the internal carotid as it passes down the
neck; Receives blood from the brain and superficial parts
of the face and neck

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NECK MUSCLES

STERNOMASTOID- Arises from the sternum

and the medial part of the clavicle and
extends diagonally across the neck to the
mastoid process behind the ear;
Accomplishes head rotation and flexion
TRAPEZIUS- Two muscles that form a
trapezoid shape on the upper back arising
from the occipital bone and extends fanning
out to the clavicle and scapula; moves the
shoulders and extends and turns the head
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Muscles :

sternomastoid (
head rotation &
head flexion)&
trapezius( moves
shoulders &extend &
turn head).

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MUSCLES OF THE NECK

Muscles of the Neck

Figure 13-4. p 274.

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LANDMARKS

Vertebra Prominens-C7 vertebra; has a

long spinous process that can be felt
when the neck is flexed
Temporal Artery-Pulsation is palpable
anterior to ear

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Thyroid gland:

in the middle of the

neck, has 2 lobes,
separated by
isthmus, secrete
T3&T4
hormones(stimulate
metabolism)

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Cricoid cartilage:
above thyroid isthmus,
thyroid cartilage
above that(adams
apple) in males,
highest is hyoid
bone.

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* The Lymphatic's
1.

preauricular: in front of
ear
2. posterior auricular:
superficial to mastoid
process
3. occipital: at the base of
the skull
4. submental: midline
5. submandibular: halfway
between the angle & tip
of the mandible.
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The Lymphatic's:

6.

superficial cervical:
overlying sternomastoid
muscle
7. deep cervical: under
sternomastoid muscle
8. posterior cervical: at
the edge of the trapezius
9. supraclavicular: above
clavicle, at sternomastoid

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THANK YOU

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LEARNING OBJECTIVE TWO

Focused Interview

General questions

*Subjective Data:
1. Headache:
onset- when did this kind of headache start?
Location- where do you feel it?
Is pain localized on one side or all over?
Character: throbbing(shooting) or aching
(dull)?
Is it mild, moderate, or sever?
Duration- what time of day do the headaches
occur: morning, evening?
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1. Headache: cont

How long do they last?

Precipitating factors- what brings it on?
Associated factors- as nausea or
vomiting?
Do you have any other illness?
Do you take any medications?

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Types of headaches

Headaches

Migraine
Cluster
Tension

2 . Head injury:

onset-when? describe exactly what

happened?
Setting- any hazardous conditions
as(wearing helmet)?
Any hx of illness as DM?
Duration- how long were you unconscious?
Associated symptoms- as vision change?

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3. Dizziness:

onset- abrupt or gradual? Associated factors?

As nausea or vomiting or tinnitus

4. Neck Pain:

onset- how did the pain start? injury

accidentetc
location- does the pain radiate? to shoulder,
arms?
Associated symptoms- limitations to range of
motion
Precipitating factors-what movements cause
pain?
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6. Lumps or swelling:

7.

how long have you had it? has it changed in

size?
Any difficulty swallowing?
Do you smoke?
Ever had a thyroid problem?

history of head or neck surgery:

for what condition? when did the surgery
occur?
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Specific Questions

Illness, infection, or injury

Symptoms
Pain
Behaviors
Infants and children
Environment

THANK YOU

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**Objective Data:
The Head:

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LEARNING OBJECTIVE THREE

Assessment of the Head and Neck

Techniques

Inspection
Palpation
Auscultation

LEARNING OBJECTIVE
THREE

Areas of the Head

Palpation of the head and scalp

Observation of the skin and tissue integrity
Palpation of the temporal artery

Areas of the Head

1. Inspection and palpate of the

head and scalp
2. Inspection and palpate of the
face
3. Observation of movements of the
head, face, and eyes

* INSPECT & PALPATE SKULL

1- size & shape: Normocephalic,

round symmetric skull, related to body

size. for shape palpate scalp, no
tenderness(symmetric & smooth).
2- temporal area: palpate temporal
artery, palpate joint tempomandibular
joint- as the person opens mouth, no
limitation or tenderness.
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Figure 12.10

Palpating the temporal artery.

Abnormalities of the Skull and Face

Hydrocephalus

Acromegaly

Down syndrome

**INSPECT THE FACE:

facial structures: facial expression

appropriate to behavior CN VII , symmetric

same for eye brows, nasolabial folds &
sides of the mouth. note any involuntary
movements.

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Abnormal Facial Features

TICS- Abnormal facial movements

Exophthalmos- bulging eyeballs

Acromegaly- Gradual enlargement of

the bones of the face and jaws

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Abnormalities of the Skull and Face

Paralysis following brain attack

Abnormalities of the Face

Bells palsy

The Neck:

** INSPECT & PALPATE THE

NECK:

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NECK:

Symmetry: head held erect & still

ROM: ask the person to touch the chin to chest,
turn head to rt & lt, try to touch each ear to the
shoulder- test muscle strength ( cranial nerve
XI) by trying to resist the persons movements
with your hands as the person shrugs shoulders
& turns the head to each side.- note
enlargement of salivary glands & lymph nodesnote pulsations(carotid artery)

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Trachea: midline, palpate for shift,

place your index on trachea in the

sternal notch& slip it off to each side.
Should be symmetric on both sides.

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Palpate Trachea

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Thyroid gland:

inspect neck as person takes a sip & swallow

, thyroid moves up with a swallow
a. posterior approach: move behind the
person ask him to sit up straight & then to
bend head slightly forward & to right, use
fingers of your lt hand to push trachea
slightly to rt. Curve your rt fingers between
trachea & sternomastoid , ask him to take a
sip of water ,thyroid moves up, reverse the
procedure for lt side, check for enlargement,
symmetry.
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Thyroid gland

Posterior approach

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Palpate Thyroid; Posterior appraoch

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Thyroid gland:

b. anterior approach: stand facing person.

ask him to tip head forward & to rt, use your

rt thumb to displace trachea slightly to the
persons right. Hook your lt thumb & fingers
around the sternomastoid. Feel for lobe
enlargement as he swallows.
c. auscultate thyroid: if it enlarged auscultate
for bruit( a soft pulsatile blowing sound heard
with bell).
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Thyroid gland

Anterior approach

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Palpate Thyroid: Anterior

appraoch

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NECK: cont

Lymph nodes: using gentle circular motion of

your finger pads, palpate lymph nodes, palpate

10 groups in a routine order in both hands. if
any nodes are palpable note location, size,
shape, mobility, tenderness, cervical nodes
palpable in health persons decreased with age,
normal nodes feel movable, soft & no tender.

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Palpating Lymph Nodes

USE A FIRM DELIBERATE YET GENTLE TOUCH

INFECTION- May be indicated when nodes are
palpable bilaterally, feel large, warm, tender, firm
but freely movable
MALIGNANCY- May be indicated when nodes are
unilateral, hard, discrete, asymmetric, fixed, and
no tender
Abnormal Nodes- Explore the area proximal
(upstream) to the location of the abnormal node

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Palpate Deep Cervical Chain

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Palpate supraclavicular node

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Palpate cervical nodes

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THANK YOU

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Clinical Case Study 1

Focused Assessment

Mr. Omar A. is a 57-years old ,insurance

executive who is in his fourth
postoperative day after a transurethral
resection of the prostate gland. He also
has chronic hypertension, managed by
oral hydrochlorothiazide, exercise, and
a low-salt diet.

Subjective data:

Complaining of dizziness, a lightheaded

feeling that occurred on standing and cleared
on sitting. No previous episodes of dizziness.
Denies palpitations, nausea, or vomiting.
States urine pink tinged as it was yesterday
with no red blood. No pain medication today.
On second day of same antihypertensive
medication he took before surgery.

Objective data:

BP 142/88 RA sitting, 94/58 RA standing. Pulse 94

sitting and standing, regular rhythm, no skipped
beats. Temp 37o C.
Color tannish-pink, no pallor, skin warm and dry.
Neuro: Alert and oriented to person, place, and time.
Speech clear and fluent. Moving all extremities, no
weakness. No nystagmus, no ataxia, past pointing
normal. Rombergs sign negative (normal).
Intake/output in balance. Urine faint pink tinged, no
clots.
Lab: Hct 45, serum chemistries normal.

Assessment

Orthostatic hypotension
Risk for injury R/T orthostatic
hypotension

Clinical Case Study 2

Focused Assessment:
Mara is a 19-year-old single white
female college student with a history of
good health and no chronic illnesses;
she enters the outpatient clinic today
stating. I think Ive had a stroke.

Subjective data:

One day PTA: first noticed at dinner at

college cafeteria when joking with friends,
started to stick out tongue and roll tongue
and could not do it, right side of tongue was
not working. Mara left room to look in mirror
and became scared; when smiled, noticed
right side was not working. Tried to pucker
lips, could not. Could not whistle, could not
raise eyebrow

I looked like a Vulcan. No other movement

disorder below neck. Mild pain behind right
ear with buzzing in ear. Able to sleep last
night, but roommate said Maras right eyelid
did not close completely during sleep.
Today: still no movement on complete right
side of face. Feeding self-conscious in class
and during conversations with friends. Now
has taste aversion, fluids with high water
content taste especially bitter. No hearing
loss.

Objective data:

T 37o C, P 64, R 14, B/P 108/78

Forehead appears smooth and immobile on
right, unable to wrinkle right side. Unable to
close right eye, Bells phenomenon present
when attempts to close (right eyeball rolls
upward), right plapebral fissure appears
wider. No corneal reflex on right. Unable to
whistle or puff right cheek. Absent nasolabial
fold on right. Mouth sroops on right, sags

Objective data

on right when tries to smile. Slight drooling.

Left side of face responds appropriately to all
these movements. Superficial sensation
intact.
Rest of musculoskeletal system intact; able to
hold balance while standing, able to walk
heel-to-toe, do knee bend on each knee. Arm
strength and range of motion intact.

Assessment

Right-sided facial paralysis, consistent with

Bells palsy
Disturbed body image R/T effects of loss of
facial function
Risk for deficient fluid volume R/T taste
aversion and dietary alteration
Risk for sensory deficit, visual Impairment,
R/T effects of neurological impairment