1. Including Regional Lymphatics N1037
Head and Neck
Including Regional Lymphatics
N1037

2. Head and Neck & Regional Lymphatics
Review and locate – The Skull (bones of the cranium and the face)

3. Note the location of the CRANIAL BONES
Frontal, Parietal, Occipital & Temporal

5. Note the location of the sutures.
Coronal, Sagittal, Lambdoid
Unite adjacent cranial bones

7. Note facial bones.
Nasal, Lacrimal, Maxilla, Sphenoid & Zygomatic bones.
Mandible (moves up, down, sideways)

9. Head-facial muscles Facial expressions are formed by facial muscles
Facial structures should be symmetric.
Facial muscles are innervated by cranial nerve VII

10. Note major Neck muscles.
Sternocleidomastoids and trapezii muscles
(each side of neck form
2 triangles- anterior & posterior cervical )

12. Thyroid gland and other landmarks
Thyroid gland - largest endocrine gland
-secretes T3 & T4 to regulate cellular metabolism
-flattened butterfly shape structure
- 2 lateral lobes connected by isthmus
- isthmus rest on trachea, inferior to
the criocoid cartilage (highest point
Adam’s Apple)

14. Note location of lymphatics
1. Preauricular,
2. post. auricular,
3. occipital,
4. submental,
5. submandibular,
6. Jugulodigastric or tonsillar,
7. superficial cervical chain,
8. deep cervical chain,
9. post. cervical,
10. supraclavicular.

15. Lymph Nodes Usually less than 1 cm round or ovid in shape
smooth in consistency
when enlarged or tender - assess for infection or maligancy and the area the node drains ( see p322 example)

17. BLOOD SUPPLY Major arteries to head and neck
common carotids bifurcate into
internal & external carotids
Major veins from head and neck
internal an external jugular veins
and subclavian veins

18. Head and Neck & Regional Lymphatics
Health History
Subjective Data

19. Head and Neck & Regional Lymphatics- Health Hx
facial or neck surgery
• history of headaches or dizziness
• allergies
Neck pain, limitation of movement
Lumps or swelling, difficulty swallowing or chewing, history of smoking
head injuries

20. Head: Inspect and palpate the skull
Objective Data

21. Head: Inspect and palpate the skull
Size and Shape
(I)Normocephalic: round, symmetric and approximated to body size.
(P)Shape: symmetric and smooth, no tenderness reported.
Use finger pads on scalp & palpate all surfaces
Assess contour, masses, depressions,tenderness
Note deformities lumps and tenderness.

22. Head: Inspect and palpate the scalp
(I) Scalp should be shiny, intact and without lesions or masses.
Part hair repeatedly and inspect scalp
(P) palpate with finger pads on the scalp for lesions or masses

23. Head: Inspection of the face
(I) Symmetry of facial features:
Observe facial expression, shape and symmetry of nose, eyes, eyebrows, mouth, ears
(I) Shape and features of face
Note shape of face
Note swelling (edema) , abnormal features, disproportionate structures (stroke, Bell’s Palsy = cranial nerve 7 damage -facial nerve), and involuntary movement (the presence of tics -normally none occur)
(I) Facial expression: emotions
Note appropriateness to verbal and nonverbal

24. Head: Palpate and Auscultation of Mandible
Temporal Area
(P)Temporal artery: above the cheek bone, between the eye and the top of ear.
Palpate with finger pads for pulse
(P)Temporomandibular joint: articulates smoothly with no limitation, no crepitus, no clicking
use index and middle finger to palpate anterior to tragus of ear on both sides
ask pt to open & close mouth
observe smoothness of movement, any discomfort
clicking/crepitus could indicate arthritis or dislocation

25. The Neck- Inspect and palpate
Objective Data

26. The Neck- Inspect and palpate
What position do you ask the client to assume while you inspect the neck?
Head erect and still, sitting up straight, head at your eye level

27. The Neck- Inspect and palpate
Symmetry
Head position: centered, midline, erect, still
Symmetry of the Sternocleidomastoid & trapezii muscles
ROM of neck (flexion, lateral rotation, lateral bending, extension, test muscle strength:Touch chin to chest, ear to shoulder
Turn head left to right
Extend head backwards
Motions should be smooth and controlled.
resists movement of shoulder shrug and head turn side to side
limited ROM with meningitis, muscle spasm, osteoarthritis

28. The Neck- Inspect and palpate
(P) Muscles - should be symmetrical & without palpable masses or spasms
palpate Sternocleidomastoid and trapezii muscles for tenderness, masses, spasms
spasms due to infections, trauma, chronic inflammation, neoplasm

29. The Neck- Inspect and palpate
Lymph Nodes
(P) Lymph nodes - should not be palpable, but small discrete , movable nodes are often present
Begin with preauricular lymph nodes and proceed in a systematic fashion (1 to 10)
Use gentle pressure
Deep cervical chain: tip head toward side
Supraclavicular Node: hunch shoulders & elbows forward
tender nodes = inflamed due to infection
firm, non movable nodes may be = malignancy

31. The Neck- Inspect and palpate
Trachea
Midline normal (note deviations)
Palpate for tracheal shift: space should be symmetric on both sides.

32. The Neck- Inspect, palpate, auscultate
Thyroid Gland
inspect for swelling using lamp (ask to sip and swallow water)
thyroid tissue moves up with swallowing
observe for goiter - enlarged thyroid
palpate -anterior/posterior approaches
have pt slightly lower head to relax neck muscles
palpate isthmus for nodules, masses, tenderness or enlargement while swallowing
then displace/stabilize lobe on one side and palpate the other side while pt swallows
gland is smooth, soft, & no tenderness/enlrgmt/masses

33. The Neck- Inspect, palpate, auscultate
auscultate lobes for bruit
(use bell)
no bruit should be present
bruits indicate blood supply r/t tumor or toxic goiter.

35. Developmental Considerations
Infant/Children
Skull and fontanels
Pregnant Female
Cholasma on face = pregnancy mask
Aging Adult
Temporal arteries twisted and visible
Rhythmic tremor of head may be present
Perform ROM slowly to prevent dizziness