Head neck face assessment

• The cranium houses and protects the brain and major sensory organs
• The cranium consists of eight bones:

  • Frontal: forms the anterior portion of the cranial cavity and contributes to the facial skeleton
  • Parietal: forms part of the side and top of the head
  • Temporal: protects the temporal lobe of the brain and surrounds the ear canal
  • Occipital: located at the back and base of the skull
  • Ethmoid: located in the center of the skull between the eyes
  • Sphenoid: located at the central skull base and is the most complex bone in the human body
• The face consists of 14 bones, including:

  • Maxilla: holds tooth roots and forms most of the nasal aperture and floor
  • Zygomatic (cheek): defines the anterior and lateral portions of the face
  • Inferior conchae: helps filter and humidify the air we breathe
  • Nasal: forms the bridge of the upper one third of the nose
  • Lacrimal: provides structure for the orbital cavity and supports the eye
  • Palatine: located above the uvula in the throat
  • Vomer: divides the nasal cavity
  • Mandible (jaw): largest bone in the human skull, holds lower teeth in place
• The temporomandibular joint connects the jaw to the temporal bones of the skull, allowing movement for talking, chewing, and yawning
• The neck is composed of muscles, ligaments, and cervical vertebrae
• The sternomastoid muscle rotates and flexes the head, while the trapezius muscle extends the head and moves the shoulders
• The eleventh cranial nerve (accessory nerve) is responsible for muscle movement that permits shrugging of the shoulders and turning the head against resistance
• The thyroid gland is the largest endocrine gland in the body, located in the anterior neck below the larynx
• Lymph nodes filter lymph, remove bacteria and tumor cells, and produce lymphocytes and antibodies for defense
• Common head and neck lymph nodes include:

  • Preauricular: located just in front of the ears
  • Postauricular: located just beneath the ear
  • Tonsillar: located below the angle of the mandible
• Lymph node locations in the head and neck:

  • Preauricular: in front of the ear
  • Tonsillar: located just below the angle of the mandible, drainage to the tonsilar and posterior pharyngeal regions
  • Occipital: found on the back of the head near the base of the skull, drainage to the occipital region of the scalp
  • Submandibular: along the underside of the jaw on either side, drainage to the structures in the floor of the mouth
  • Submental: just below the chin, drainage to the teeth and intra-oral cavity
  • Superficial cervical: location not specified
• • Deep cervical: located on both sides of the neck from the angle of the jaw to the top of the clavicle
  • Posterior cervical: located from the level of the mastoid bone to the clavicle, drainage to the skin on the back of the head
  • Supraclavicular: in the hollow above the clavicle, drainage to part of the thoracic cavity and abdomen
• Assessment of the head:

  • Evaluate the overlying protective structures (cranium and facial bones)
  • Assess special senses (vision, hearing, smell, taste) and neurologic system
  • Detect abnormalities in head and facial shape, asymmetry, structural changes, or tenderness
• Assessment of the neck:

  • Inspect for position, symmetry, and lumps or masses
  • Observe movement of neck structures during swallowing
  • Assess range of motion by turning head, touching ear to shoulder, chin to chest, and lifting chin to the ceiling
• Cultural considerations during assessment:

  • Explain procedures to the client, especially regarding touching the head
  • Ensure client cooperation and prevent anxiety by explaining actions and sharing assessment findings
• Equipment needed for assessment:

  • Small cup of water
  • Stethoscope
  • Gloves
• Normal findings during head and face inspection and palpation:

  • Head size and shape vary, usually symmetric, round, erect, and in midline
  • No lesions visible
  • Face symmetric with no abnormal movements
  • Nasolabial folds and palpebral fissures ideal for checking facial symmetry
  • Temporal artery elastic and not tender
• Abnormal findings during head and face inspection and palpation:

  • Abnormally small head (microcephaly)
  • Larger and thicker skull and facial bones in acromegaly
  • Acorn-shaped, enlarged skull bones in Paget’s disease
  • Lesions or lumps on head may indicate trauma or cancer
  • Involuntary movements may indicate neurologic disorders
• Abnormal findings during neck inspection and palpation:

  • Swelling, enlarged masses, or nodules may indicate thyroid gland enlargement, lymph node inflammation, or tumor
  • Asymmetric movement or generalized enlargement of the thyroid gland is considered abnormal
  • Trachea may be pulled to one side in cases of tumor, thyroid gland enlargement, aortic aneurysm, pneumothorax, atelectasis, or fibrosis
• Auscultation of the thyroid:

  • Auscultate only if an enlarged thyroid gland is found during inspection or palpation
  • No bruits (abnormal sounds) should be auscultated
  • Soft blowing, swishing sound may be heard in hyperthyroidism due to increased blood flow through thyroid arteries
• Client preparation for head and neck assessment:

  • Ask focused interview questions about symptoms or medical history related to head and neck issues
  • Instruct client to remove any head or neck accessories before examination
• Communication during assessment:

  • Explain procedures to the client to gain cooperation and prevent anxiety
  • Share assessment findings with the client
  • Communication is key during the physical examination
• Assessment procedure steps:

  • Inspect head size, shape, and configuration
  • Palpate head for consistency
  • Inspect face for symmetry, features, movement, expression, and skin condition
  • Palpate temporal artery between the top of the ear and the eye
• Older adult considerations during assessment:

  • Prominent facial wrinkles due to decreased subcutaneous fat with age
  • Asymmetry in front of the earlobes may indicate parotid gland enlargement
  • Unusual or asymmetric orofacial movements may be from organic disease or neurologic problem
• Client positioning during assessment:

  • Sit in an upright position with back and shoulders held back and straight
  • Remain still during most of the inspection and palpation
  • Move and bend the neck as needed for examination of muscles and thyroid gland
• Client considerations during assessment:

  • Some clients may be anxious during neck palpation, especially with a history of cancer
  • Explain procedures to gain client cooperation and prevent anxiety
• Documentation and hygiene during assessment:

  • Perform hand hygiene to prevent spread of microorganisms
  • Document findings as baseline data for nursing diagnosis
• Nursing diagnoses based on assessment:

  • Ineffective Health Maintenance related to refusal to wear protective gear
  • Ineffective Tissue Perfusion: Cerebral related to impaired circulation to the brain
  • Impaired swallowing related to lack of gag reflex, paralysis of facial muscles, decreased cognition
  • Disturbed Body Image related to head injury
  • Activity Intolerance related to fatigue and weakness secondary to hypothyroidism or surgery