L EARNING O BJECTIVES At the end of this lecture each student e should be able to : 1- list structures of head & neck 2- Identify the health history for head & neck. 3- Explain examination techniques for head & neck.

structures Of Head and Neck:  Skull encloses brain  Face: eyes, ears, nose, mouth  Neck: spine, esophagus, trachea, thyroid, arteries, veins, lymph nodes

Health History Of Head And Neck Present health status: changes, chronic disease, medications (what/when), last eye exam; glasses or contacts? Past medical history: surgery, headaches (type), problems now? Family history: thyroid disease, DM, rheumatoid arthritis, high blood pressure, migraines?

Health History: Head and Neck Problem-Based History Headache:- How long or often; gradual or sudden onset? Where occur; single area or generalized pain; when? Patterns, describe pain, intensity, other symptoms (always/sometimes )

Headache :- When occur; lasts how long; pattern? Pain characteristics, intensity, aggravated by movement? Other symptoms How treated (what, effective, when) ?

H EALTH H ISTORY : H EAD AND N ECK P ROBLEM -B ASED H ISTORY Dizziness Describe sensation; first begin, how often, how long What do when occurs, makes worse or better, how treated

Neck pain or stiffness First noticed, constant or come and go, how long, cause? What part of neck painful, radiate, numbness or tingling, intensity? Limited neck motion, movement affects pain, keep from sleeping or working? What makes worse or better, how treated? Other symptoms: been ill, fever, rash, headache?

Hoarseness or voice change Affected by weather, associated with cold or sore throat? What makes better; treating effective?

N ORMAL POSITION OF THE THYROID

Examination techniques of head & neck.  Inspect the skull for size, shape, and symmetry.  Palpate the skull for nodules or masses and depressions.  Use a gentle rotating motion with the fingertips. Begin at the front and palpate down the midline, then palpate each side of the head.

Examination techniques of head & neck.  Inspect the facial features.  Inspect the eyes for edema and hollowness. Note symmetry of facial movements.  Ask the client to elevate the eyebrows, frown, or lower the eyebrows, close the eyes tightly, puff the cheeks, and smile and show teeth.

Examination Overview: Nose and Paranasal Sinuses Inspect and palpate nose: appearance, symmetry, discharge, tenderness Assess nose for patency Inspect internal nasal cavity (mucosa,, septum) Palpate frontal and maxillary sinuses (tenderness)

Mouth and Oropharynx Inspect lips: color, symmetry, moisture, texture Inspect and palpate teeth: condition, color, surface characteristics, stability, alignment Inspect and palpate inner lips and gingiva: integrity, tenderness, color, moisture Inspect buccal mucosa, anterior and posterior pillars: color surface characteristics

Mouth and Oropharynx con’t Inspect tongue: movement, color, surface characteristics Palpate tongue: texture Inspect lateral surfaces of tongue: color, surface characteristics

Mouth and Oropharynx con’t Inspect palate and uvula: texture, color, surface characteristics Inspect soft palate: movement Inspect posterior wall of pharynx and tonsils: color, surface characteristics

G INGIVITIS

P ALPATION OF THE THYROID Best palpated with examiner behind Have patient swallow Palpate both lobes

L YMPH N ODES Anterior cervical chain Located along the sternocleidomastoid muscle

E NLARGED LEFT LOBE THYROID

D IFFERENTIATE BETWEEN H YPOTHYROID AND H YPERTHYROID THROUGH S IGNS & SYMPTOMS Hypothyroid 1. Cold intolerance 2. Slow pulse 3. Thin, dry hair & dry, puffy skin 4. Fatigue 5. Thick tongue 6. Delayed relaxation of Achilles reflex Hyperthyroid 1. Heat intolerance 2. Rapid pulse 3. Flushed, sweating 4. Anxious 5. Fine tremors 6. Exaggerated reflexes