Head ad an and d Ne Neck Chapter 10 1
The Head and Neck Ch 10 INHIRAH QADRI
Head • Cranial bones • Sutures • Facial bones Structure and Function 3
• Facial expressions are formed by the facial muscles Head • Mediated by cranial nerve • Facial muscles VII, the facial nerve • Facial muscle should be symmetrical bilaterally. 4
Salivary Glands PAROTID-In the cheeks over the mandible located near the ears; largest and not normally palpable SUBMANDIBULAR- Beneath the base of the tongue 5 SUBLINGUAL- Lie in the floor of the mouth
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
Tonsillar 9
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 of the sternomastoid muscle.
LANDMARKS • 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 14
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 15
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 # Hair: quantity, distribution, texture, pattern of loss. Inspect and palpate the skull # Scalp: lumps, lesions. # Skull: size, deformities, Size depressions, lumps, Normal :Normocephalic; round symmetrical skull appropriately tenderness. related to body size and in the midline. Abnormal: Involuntary movement Acromegally → larger thicker facial and head bones, Normal : head should held Microcephalic → small head, still and upright. Macrocephalic → large head Abnormal: tremors , head 17 tilted to one side
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
Physical Exam: The Head Temporal Area: Normal: Elastic not tender. Abnormal: hard, thick and tender Look for enlarge ; salivary 20
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 21
sical Ex Exam: m: Th The Head Physical 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. 22
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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 or 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 27
Pa Palp lpate ate cerv rvic ical al nodes des 28
Pa Palp lpate ate su supr praclav aclavicul icular ar node de 29
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 . 31 Slide 13-31
Palpate Thyroid; Posterior approach Normal finding: Nonvisible Nonpalpable No bruits 32 .
Physical Exam : Thyroid gland Auscultate for the presence of a bruit: soft, pulsate, whooshing, blowing sound Slide 13- 33
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