1 HEAD AND NECK Health Assessment MARITES TALANIA, RN LECTURER

2 Lectures objectives Identify the anatomic structures of the head and neck. Identify the lymph nodes of the head and neck. Describe the system-specific health history for the head and neck.

3 Lectures objectives Demonstrate the physical assessment of the head and neck. Describe normal findings in the physical assessment of the head and neck. List common abnormalities found in physical assessment of the head and neck.

4 Overview The integration of body systems and regions begins with the head and neck. The head provides a means of identifying individuals through the uniqueness of hair, eyes, and facial characteristics. With assessment of the head and neck, clues to the client’s nutritional status, airway clearance, tissue perfusion, metabolism, level of activity, sleep, rest, stress, and self-care abilities will be identified.

5 Anatomy and Physiology The skull is made up of the bones of the cranium and the face. The cranium includes frontal, parietal, temporal, and occipital bones. The muscles of the face play a role in expression of emotions and assist in neck movement. Movement of the facial muscles is controlled by cranial nerves V and VII. The carotid arteries provide the blood supply to the head; the temporal artery supplies blood to much of the face. The neck is supported and made mobile by vertebral processes and the sternocleidomastoid and trapezius muscles. The hyoid bone, superior to the larynx, is the only bone in the body that does not directly articulate with another bone. It serves as a movable base for the tongue, and an attachment for muscles of the neck. The thyroid gland is in the middle of the neck anterior to the trachea. The isthmus is the center, and the two lobes lie on either side of the trachea. The nine sets of lymph nodes drain the head and neck.

6 Structure and Function

Head and neck assessment focuses on the: -cranium -face -thyroid gland -lymph nodes 7

HEAD The framework of the head is the skull,which can be divided into two subsections, the CRANIUM and the FACE. CRANIUM=it houses and protects the brain and major sensory organs. It consists of 8 bones 8

Frontal (1) Parietal ( 2) Temporal ( 2) Occipital (1) Ethmoid ( 1) Sphenoid (1) 9

In the adult client, the cranial bones are joined together by immovable sutures: Sagittal Coronal Squamosal Lamboid 11

FACE Facial bones give shape to the face. It consists of 14 bones. All of the facial bones are immovable except for the mandible, which has free movement at the temporomandibular joint(TMJ) 12

14 facial bones 1. Lacrimal (2) 2. Inferior nasal concha (2) 3. Maxilla (2) 4. Mandible (1) 5. Palatine (2)- comprises your hard palate 6. Zygomatic (2)- cheek bone 7. Vomer 8. Nasal (2)

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THE NECK The structure of the neck is composed of 1. Muscles 2. Ligaments 3. Cervical vertebrae- Contained within the neck are the 1. Hyoid bone 2. Several major blood vessels 3. The larynx 4. Trachea 5. Thyroid gland

Muscles and cervical vertebrae Stermomastoid (sternocleidomastoid) Trapezius muscles - are two of the paired muscles that allow movement and provide support to the head and neck. 22

Cranial nerve 11 – responsible for muscle movement that permits shrugging of the shoulders C1 thru C7 are located in the posterior neck and support the cranium 23

Thyroid gland It is the largest endocrine gland in the body. Secretes T3 and T4, which regulate the rate of cellular metabolism. Structures: Trachea- thru which the air enters the lungs - composed of C-shaped hyaline cartilage rings Cricoid cartilage- 1 st upper tracheal ring which has a small notch 24

Thyroid cartilage ( Adam’s apple) is larger and located just above the cricoid cartilage Hyoid bone-which is attached to the tongue, lies above the thyroid cartilage and under the mandible 25

Lymph nodes of the head and neck -filter lymph, (a clear substance composed mostly of excess tissue fluid) after the lymphatic vessels collect it but before it returns to the vascular system -produce lymphocytes and antibodies as a defense against invasion by foreign substances -<1cm long and are buried deep in the connective tissue,round in shape,smooth in consistency 26

Preauricular nodes ( front of the ears) Postauricular nodes ( behind the ears) Occipital nodes ( posterior base of the skull) Tonsillar nodes ( angle of the mandible, on the anterior edge of the sternocleidomastoid) Submandibular nodes ( medical border of the mandible Submental nodes ( a few centimeters behind the tip of the mandible) Superficial cervical nodes ( superficial to the sternocleidomastoid muscle) Deep cervical chain nodes ( deep within and around the sternocleidomastoid muscle) Superclavicular nodes ( hook fingers over clavicles and feel deeply between the clavicles and the sternocleidomastoid muscles)

29 Health History Determine presence/absence of age- and gender-specific diseases of the head and neck Common chief complaints Neck pain or stiff neck Hoarseness Neck mass Headache Head injury

30 Evaluating Chief Complaint Determine the following characteristics Quality Associated manifestations Aggravating factors Alleviating factors Setting Timing

31 Past Health History Medical conditions Surgeries Medications Injuries or accidents

32 Family Health History Determine if family history of Thyroid disease Headache

33 General Approach to Head and Neck Assessment Greet patient, explain assessment techniques Environment Quiet Warm Private Adequate lighting Upright sitting position Compare right and left sides Systematic approach EQUIPMENT Tape measure ◆ Stethoscope ◆ Cup of water (for evaluation of thyroid gland)

34 Assessment of the Head Inspection Shape Symmetry Palpation Contour Masses Depression Tenderness

35 Inspection and Palpation of the Scalp Inspect Lesions or masses Normal findings Scalp is shiny, intact, without lesions or masses Abnormal findings Bleeding, lesions, masses, hematomas

36 Assessment of the Face Inspection Shape Symmetry Normal findings Symmetrical features Palpebral fissures equal Shape can be oval, round, or slightly square

37 Assessment of the Face Abnormal findings Deformed or absent structures Asymmetry More or less pronounced facial features Diseases which may alter facial features: Bell’s palsy, A temporary disorder affecting cranial nerve VII and producing a unilateral facial paralysis

38 ACROMEGALY - An enlargement of the skull and cranial bones due to increased growth hormone HYDROCEPHALUS - The enlargement of the head caused by inadequate drainage of cerebrospinal fluid, resulting in abnormal growth of the skull

39 Hydrocephalus, with characteristic enlarged head, bulging fontanel, dilated scalp veins,

40 Early acromegaly. Note the coarsening of features with broadening of the nasal alae and prominence of the zygomatic arches

41 Left facial palsy. Facies include asymmetry of one side of the face, eyelid not closing completely, drooping lower eyelid and corner of mouth, and loss of nasolabial fold.

42 Cushing syndrome. Facies include a rounded or “moon-shaped” face with thin, erythematous skin. Hirsutism may also be present, especially if the condition is caused by an adrenal cancer

43 Down syndrome. Note depressed nasal bridge, epicanthic folds, mongoloid slant of eyes, low-set ears, and large tongue

44 Hyperthyroid facies. Note fine, moist skin with fine hair, prominent eyes and lid retraction, and staring or startled expression

45 Mandible Palpate and auscultate the temporo- mandibular joint when the client opens and closes the mouth Normal findings No discomfort, joint articulates smoothly without clicking or crepitus Abnormal findings Pain, tenderness, crepitus

46 Neck Inspection Palpation Normal findings Full ROM, pain free, symmetrical muscles, no masses Abnormal findings Limited ROM, pain, asymmetrical muscles, masses

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49 Thyroid Gland Inspection Palpation Auscultation Normal findings Symmetrical movement with swallowing Adam’s apple more pronounced in males No masses, tenderness, or enlargement Absent bruit Abnormal findings Mass Enlarged gland Goiter Asymmetrical enlargement Presence of a nodule or bruit

50 HYPERTHYROIDISM The excessive production of thyroid hormones, resulting in enlargement of the gland, exophthalmos (bulging eyes), fine hair, weight loss, diarrhea, and other alterations. HYPERTHYROIDISM HYPOTHYROIDISM Metabolic disorder causing enlarged thyroid due to iodine deficiency. HYPOTHYROIDISM

51 Lymph Nodes Inspection Palpation Location Preauricular Postauricular Occipital Submental Submandibular Anterior and posterior cervical chains Tonsilar Supraclavicular

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53 Lymph Nodes Normal findings Unable to palpate or see nodes Abnormal findings Enlarged nodes Able to palpate or see nodes Tenderness Firm, hard nodes

54 Position of the thumbs to evaluate the midline position of the trachea

THANK YOU!! 55