Head ad an and d Ne Neck Chapter 10 1 The Head and Neck Ch 10 - - PowerPoint PPT Presentation

Head ad an and d Ne Neck

Chapter 10

1

The Head and Neck Ch 10

INHIRAH QADRI

Structure and Function

Head

• Cranial bones
• Sutures
• Facial bones

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Head

• Facial muscles

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• Facial expressions are formed

by the facial muscles

• Mediated by cranial nerve

VII, the facial nerve

• Facial muscle should be

symmetrical bilaterally.

Salivary Glands

PAROTID-In the cheeks

• ver the mandible

located near the ears; largest and not normally palpable SUBMANDIBULAR- Beneath the base of the tongue SUBLINGUAL- Lie in the floor of the mouth

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Two triangles which are considered landmark of

the neck are:

• Anterior triangle: mandible and Sternomastoid

muscle, and the midline of the neck.

• Posterior triangle: Trapezius muscle,

Sternomastoid muscle, and the clavicle.

The Neck

• Composes of:

muscles, ligaments, thyroid, vessels, lymph nodes, and cervical vertebrae.

Muscles:

• Sternomastoid muscle
• Trapezius muscles

Functions: 1- Support head and neck. 2- Sternomastoid muscle rotates and flexes head. 3- Trapezius muscle extends the head and moves the shoulders.

Structure and Function: the Neck

• Thyroid gland
• Trachea

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Tonsillar

The Neck: Lymph nodes

Preauricular; in front of the ear Posterior auricular; superficial to the mastoid process. Occipital; at the base of the skull. Tonsillar; under the angle of the mandible. Submandibular; midway between the angle and the tip of the mandible Submental; in the midline a few centimeters behind the tip of the mandible 10

The Neck: Lymph nodes

 Superficial cervical; superficial to the sternomastoid  Posterior cervical'; along the anterior edge of the trapezius.  Deep cervical chain; deep to the sternomastoid and often inaccessible to examination.  Supraclavicular; deep in the angle formed by the clavicle and the sternomastoid 11

• Ch.Ch. :

1- Size mostly less than 1cm long. 2- Buried deep in the connective tissue. 3- non palpable in normal situation. 4- Appear in clusters ( 2-100 nodes).

• With infection node become large and painful.
• With lymphoma large but not painful

NECK VESSELS 1- Internal jugular veins and carotid arteries are located bilaterally, parallel and anterior to the sternomastoid muscle. 2- External jugular vein lies over the surface

• f the sternomastoid

muscle.

• 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

LANDMARKS

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Subjective Data OLD CART

• Headache
• Head injury
• Dizziness
• Neck pain or limitation of motion
• Lumps or swelling
• History of head or neck surgery
• Enlarged thyroid gland/ thyroid function

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Altered thyroid function * Increase thyroid hormone: weight loss + increase appetite, thinning hair, palpitation, heat intolerance, frequent bowel movement, *Decrease thyroid hormone: swelling of face, hands and legs+ periorbital puffiness, loss of hair, thickening skin and nail, dry/ coarse/ cool skin, constipation, fatigue, weight gain + anorexia, bradycardia.

Physical Exam: The Head

Inspect and palpate the skull Size

Normal :Normocephalic; round symmetrical skull appropriately related to body size and in the midline. Abnormal:

• Acromegally → larger thicker

facial and head bones,

• Microcephalic → small head,
• Macrocephalic → large head

Involuntary movement

Normal : head should held still and upright. Abnormal: tremors , head tilted to one side 17 # Hair: quantity, distribution, texture, pattern of loss. # Scalp: lumps, lesions. # Skull: size, deformities, depressions, lumps, tenderness.

Physical Exam: The Head Inspect the face ( CN Vll )

Motor Assessment

• Assess client’s facial expression.
• Ask client frown, smile, show teeth, raise eyebrows, close

eyes tightly puff cheeks and press the puffed cheeks.

• Assess the client’s facial features (eyebrows, palpebral

fissures, nasal folds, and sides of mouth) with movement.

• No involuntary movements or swelling

Sensory assessment

• Assess the client's taste (CN Vll and CN lX)

Slide 13- 19

Temporal Area:

Normal: Elastic not tender. Abnormal: hard, thick and tender

Look for enlarge ; salivary

Physical Exam: The Head

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Physical Exam: The Head

Trigeminal (CN V). Motor Assess

• Inspect just anterior to the ears.
• Palpate the temporalis and masseter muscles,

While the client to clenching the teeth.

• Palpate the temporomandibular joint (TMJ) then

ask the client to perform movements

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Physical sical Ex

Exam: m: Th The Head

Assess the Range of Motion (ROM):

• Asking the client to open mouth maximally about 3-6 cm then

close.

• Partially open mouth then protrusion and retraction.
• Partially open mouth then and lateral, or side-to-side, motion.
• Ask the client's to repeat ROM for muscle strength.

Se Sensory y as assess

• Use a fine wisp of cotton.
• Test forehead, maxillary, and mandible for each side.
• Ask the client to response whenever you touch the skin.
• Test corneal reflex.

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Physical Exam: the Neck Inspect and palpate the neck

• Range of motion (ROM); CN Xl
• no limitation of movement
• no pain
• Strong muscles
• Inspect and palpate carotid artery: pulsating

Slide 13- 24

Physical Exam: the Neck

Inspect and palpate the neck

Symmetry

head position is centered in midline erect and still head Symmetric accessory neck muscles

Skin condition Glands thyroid Lymph nodes.

Slide 13- 25

The Neck: Lymph nodes

• If palpable: describe size, shape,

tenderness and consistency.

• lf its discrete or matted, mobile
• r fix, Small or large, soft or

hard, and, non-tender or tender.

Slide 13- 26

Pa Palp lpate ate De Deep p Cerv rvical ical Cha hain in

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Pa Palp lpate ate cerv rvic ical al nodes des

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Pa Palp lpate ate su supr praclav aclavicul icular ar node de

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Physical Exam : Trachea

• In midline,
• No tracheal shift
• Symmetric in both

sides .

Slide 13- 30

In Insp spect; ect; Thy hyroid roid Gla land nd

• In visible
• Symmetric .

Slide 13-31

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.

Palpate Thyroid; Posterior approach

Normal finding: Nonvisible Nonpalpable No bruits

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Physical Exam : Thyroid gland

Auscultate for the presence of a bruit: soft, pulsate, whooshing, blowing sound

Slide 13- 33