HA - HEAD AND NECK

• Skull


  • Round and normal size or head circumference
  • Normocephalic
  • In proportion with gross body structure
  • Frontal, parietal and occipital prominences
  • Smooth skull contour
  • Head should be held still and upright
• Deviations from normal skull

  • Disproportionate
  • Asymmetric parietal and temporal prominences; with more prominent nose and forehead; longer mandible
  • Increased head circumference
  • Square-shaped head (e.g. Mowat-Wilson Syndrome, Smith-Magenis Syndrome)
  • Bulging / depressed bone (Plagiocephaly)
  • Abnormal increase in head size in young child: may indicate hydrocephalus
  • Inconsistently large head size in adolescent or adult: may indicate acromegaly (enlarged features)
  • Acorn-shaped skull bones (seen on Paget's disease)
  • Jerking movement
  • Involuntary nodding
  • Head tilted to one side
• Palpation of head


  • Smooth, uniform consistency; absence of nodules or masses
  • Sebaceous cysts
  • Local deformities from trauma
  • Masses
  • Nodules
• Facial movements


  • Symmetric facial movements
  • Raise or lower both eyebrows
  • Blink both eyes
  • Close both eyes tightly
  • Smile and show the teeth
  • Frown
  • Puff the cheeks
• Deviations in facial movements

  • Asymmetric facial movements (parotid gland enlargement – seen on Parotitis)
  • Drooping of lower eyelid and mouth (facial paralysis – seen on Bell's Palsy; drooping, weakness – seen on CVA/stroke)
  • Involuntary facial movement
• Facial features


  • Symmetric facial features
  • Eyebrow hair equally distributed
  • Palpebral fissures equal in size
• Deviations in facial features

  • Asymmetric features
  • Increased facial hair; thinning of eyebrows; exophthalmos; moon face (moon-shaped face – seen on Cushing's syndrome; mask-like face – seen on Parkinson's disease)
• Eyes


  • No edema
  • Eyes not sunken
  • Wrinkles due to aging
• Deviations in eyes


  • Periorbital edema
  • Sunken eyes, cheeks, and temples (indicative of dehydration, starvation, and illness)
  • Sunken face (Cachexia)
• Temporal artery


  • Elastic
  • Non-tender
• Deviations in temporal artery

  • Tenderness
• Temporomandibular joint range of motion (TMJ ROM)


  • No edema
  • Eyes not sunken
• Deviations in TMJ ROM

  • Abnormal
  • Swelling
  • Tenderness
  • Crepitation
• Neck


  • Erect, midline, no lumps, bulges, or masses
  • Thyroid not visible
  • No masses, swelling, or hypertrophy in mid to lower half of anterior neck
  • Cartilages move symmetrically

  
• Deviations in neck


  • Enlargements
  • Lymphadenopathy, lymphoma, or other malignancy
  • Torticollis
  • Enlarged, visible thyroid
  • Goiter or malignant mass
  • Moves asymmetrically
• Cervical vertebrae (neck)


  • C7 visible
  • Palpable
  • Dowager's hump due to aging
• Deviations in cervical vertebrae

  • Prominence
  • Swelling
• Neck range of motion

  • Movement is smooth and controlled
• Deviations in neck range of motion

  • Spasms
  • Rigidity or limited range of motion
  • Brudzinski sign
  • Kernig sign
• Palpation of neck


  • Supple, nontender, no masses
• Deviations in palpation of neck

  • Masses: Lymphadenopathy, malignancies, thyroid masses
• Trachea


  • Midline
• Deviations in trachea


  • Pulled to one side
• Palpating the thyroid gland (anterior approach)

  1. Slide fingers to the right, gently displace trachea to right, and palpate gland as patient swallows

  2. Slide fingers to the left, gently displace trachea to left, and palpate gland as patient swallows
• Palpating the thyroid gland (posterior approach)

  1. Have patient tilt head to right, and then gently displace trachea to right, slide fingers to right, and palpate right thyroid lobe as patient swallows

  2. Have patient tilt head to left, displace trachea to left, and palpate the left lobe
• Auscultation of the thyroid


  • No bruits
• Deviations in auscultation of the thyroid

  • Bruit
• Lymph nodes


  • No enlargement
  • No tenderness
• Deviations in lymph nodes

  • Enlargement
  • Tenderness
• Normal lymph node characteristics

  • Normally not palpable especially the deep and clavicular nodes
  • If palpable, small (1 cm), mobile, soft, nontender, and usually superficial
• Deviations in palpable lymph nodes

  • Malignancy, inflammatory, or infectious process of glands or area they drain
• Lymph node locations


  • Occipital
  • Post-auricular
  • Pre-auricular
  • Tonsillar
  • Submandibular
  • Submental
  • Superficial cervical
  • Posterior cervical
  • Deep cervical
  • Supraclavicular
  • Infraclavicular
• Palpating the thyroid


  • Generally nonpalpable
  • If palpable, consistency is firm, smooth, and meaty, with no nodularity, enlargement, or tenderness
• Deviations in palpating the thyroid

  • Enlarged thyroid
  • Nodular thyroid tissue
  • Tender thyroid
• Auscultation of the thyroid


  • No sounds detected
• Deviations in auscultation of the thyroid

  • Increased vascularity of hyperthyroidism
• Sinus headache


  Deep, constant, throbbing pain; pressure-like pain in one specific area of face or head (e.g., behind eyes); face tender to touch
• Cluster headache


  Stabbing pain; may be accompanied by tearing, eyelid drooping, reddened eye, or runny nose
• Tension headache


  Dull, tight, diffuse
• Migraine headache


  Accompanied by nausea, vomiting, and sensitivity to noise or light