HEAD AND NECK ASSESSMENT

• TRUE OR FALSE?

  TRUE: Take care to consider cultural norms for touch when assessing the head.
• TRUE OR FALSE?

  TRUE: Another important thing to keep in mind as you examine the head and neck is that normal facial structures and features tend to very widely among individuals and cultures.
• TRUE OR FALSE?

  TRUE: Head circumference may vary according to the age of patient.
• A normal head size is referred to as normocephalic.
• Names of areas of the head are derived from names of the underlying bones: frontal, parietal, occipital, mastoid process, mandible, maxilla, and zygomatic
• Kidney or cardiac disease can cause edema of the eyelids.
• Hyperthyroidism can cause exophthalmos.
• exophthalmos, a protrusion of the eyeballs with elevation of the upper eyelids, resulting in a startled or staring expression.
• Hypothyroidism, or myxedema, can cause a dry, puffy face with dry skin and coarse features and thinning of scalp hair and eyebrows.
• Moon Face - Increased adrenal hormone production or administration of steroids can cause a round face with reddened cheeks
• Prolonged illness, starvation, and dehydration can result in sunken eyes, cheeks, and temples.
• Lack of symmetry, increased skull size with more prominent nose and forehead; longer mandible (may indicate excessive growth hormone or increase bone thickness). 
• Palpate the skull for nodules or masses and depression using a gentle rotating motion with the fingertips. Begin at the front and palpate down the midline, then palpate each side of the head.
• Moon face: usually present in Cushing’s syndrome—serious condition of an excess of the steroid hormone cortisol in the blood level caused by a pituitary tumor secreting adrenocorticotropic trauma hormone (ACTH).
• Eye Abnormalities: Periorbital edema; sunken eyes
• Note symmetry of facial movements by asking the client to elevate the eyebrow, frown, or lower the eyebrows, close the eyes tightly, puff the cheeks, and smile and show teeth.
• Newborns delivered vaginally can have elongated, molded heads, which take on more rounded shapes after a week or two. Infants born by cesarean section tend to have smooth rounded heads.
• The posterior fontanel (soft spot) is about 1 cm (0.4 in) in size and usually closes by 8 weeks. The anterior fontanel is large, about 2 to 3 cm (0.8 to 1.2 in.) in size. It closes by 18 months.
• Newborn can lift their heads slightly and turn them from side to side. Voluntary head control is well established by 4 to 8 months.
• I (Olfactory)

  Sensory

  Carries smell impulses from nasal mucous membrane to brain.
• II (Optic)

  Sensory

  Contracts visual impulses from eye to brain.
• III (Oculomotor)

  Motor

  Contracts eye muscles to control eye movements (interior lateral, medial, and superior), constricts pupils, and elevates eyelids.
•  IV (Trochlear)

  Motor

  Contracts one eye muscle to control inferomedial eye movement.
• V (Trigeminal)

  Sensory motor

  Carries sensory impulses of pain, touch, and temperature from the face to the brain. Influences clenching and lateral jaw movements (biting, chewing).
• VII (Facial)

  Sensory motor

  S – Contains sensory fibers to tases on anterior two-thirds of tongue and stimulates secretion from salivary glands (submaxillary and sublingual) and tears from lacrimal glands.

  
  

  M – Supplies the facial muscles and affects facial expressions (smiling, frowning, closing eyes).
• VIII (Acoustic, Vestibulocochlear)

  Sensory

  Contains sensory fibers for hearing and balance.
• IX (Glossopharyngeal)

  Sensory motor

  S – Contains sensory fibers for taste on posterior third of tongue and sensory fibers of the pharynx that result in the gag reflex when stimulated.

   

  M – Provides secretory fibers to the parotid salivary glands; promotes swallowing
• X (Vagus)

  Sensory motor

  Carries sensations from the throat larynx, heart, lungs, bronchi, gastrointestinal tract, and abdominal viscera. Promotes swallowing, talking, and production of digestive juices.
• XI (Spinal accessory)

  Motor

  Innervates neck muscles (sternocleidomastoid and trapezius) that promotes movement of the shoulders and head rotation. Also promotes some movement of the larynx.
• XII (Hypoglossal)

  Motor

  Innervates tongue muscles that promote the movement of food and talking.
• Occipital

  LOCATION: At the posterior base of the skull.
• Occipital

  AREA DRAINED: The occipital region of the scalp and the deep structures of the back of the neck.
• Postauricular (mastoid)

  LOCATION: Behind the auricle of the ear or in front of the mastoid process.
• Postauricular (mastoid)

   AREA DRAINED: The parietal region of the head and the part of the ear.

   
• Preauricular

  LOCATION: In front of the tragus of the ear.
• Preauricular

  AREA DRAINED: The forehead and upper face.
• Submandibular (submaxillary)

  LOCATION: Along the medial border of the mandible, half-way between the angle of the jaw and the chin.
• Submandibular (submaxillary)

  AREA DRAINED: The chin, upper lip, cheek, nose, teeth, eyelids, part of the tongue and the floor of the mouth.
• Submental

  LOCATION: Behind the tip of the mandible in the midline, under the chin.
• Submental

  AREA DRAINED: The anterior third of the tongue, gums, and floor of the mouth.