Head, Face, and Neck, Including Regional Lymphatics Chapter 13

Structure and Function Subjective Data—Health History Questions Objective Data—Physical Exam Abnormal Findings

Structure and Function Head Cranial bones Sutures Facial bones Facial muscles Salivary glands

Structure and Function (cont.) Neck Neck muscles Anterior and posterior triangles Thyroid gland

Structure and Function (cont.) Lymphatics Preauricular Posterior auricular (mastoid) Occipital Submental Submandibular

Structure and Function (cont.) Lymphatics (cont.) Jugulodigastric (tonsilar) Superficial cervical Deep cervical Posterior cervical Supraclavicular (may be assessed with breast exam)

Structure and Function (cont.) Developmental care Infants and children Fontanels Head growth Lymphatic system Pregnant female- thyroid enlargement Aging adult-more prominent nose, orbits

Subjective Data— Health History Questions Headache Head injury Dizziness Neck pain or limitation of motion Lumps or swelling History of head or neck surgery

Subjective Data— Health History Questions (cont.) Additional history for infants and children Maternal alcohol or drug use Type of delivery Growth pattern Additional history for aging adult Dizziness Neck pain

Objective Data— Physical Exam Head–Inspect and palpate the Skull Size and shape (normocephalic) Temporal area-TMJ Head–Inspect the face Facial structures- symmetry

Objective Data—Physical Exam (cont.) Neck–Inspect and palpate Symmetry Trachea position Range of motion Lymph nodes Muscle strength SCM, Trapezius

Objective Data—Physical Exam (cont.) Neck–Inspect and palpate (cont.) Thyroid gland Posterior approach Anterior approach Auscultate

Objective Data—Physical Exam (cont.) Developmental care Infants and children Skull- head circumference Special procedures Pregnant female Aging adult

Abnormal Findings Abnormalities in Head Size and Contour Hydrocephalus Paget’s disease of bone (osteitis deformans) Acromegaly

Abnormal Findings (cont.) Swellings of the Head and Neck Torticollis (wryneck) Thyroid—multiple nodules Thyroid—single nodule Pilar cyst (wen) Parotid gland enlargement

Abnormal Findings (cont.) Pediatric Facial Abnormalities Fetal alcohol syndrome Congenital hypothyroidism Down syndrome Atopic (allergic) facies Allergic salute and crease © Pat Thomas, 2006.

Abnormal Facial Appearances With Chronic Illnesses Parkinson’s syndrome Cushing’s syndrome Graves’ disease Hyperthyroidism Myxedema (hypothyroidism) Bell’s palsy Brain attack or cerebrovascular accident Cachectic appearance Scleroderma