Head and Neck

• Equipment

  • Small cup of water
  • Stethoscope
  • Flashlight
  • Gloves
• Preparing the Client

  1. Remove any wig, hat, hair ornaments, pins, rubber bands, jewelry, and head or neck scarves

  2. Sit in an upright position with the back and shoulders held back and straight

  3. Remain still

  4. Need for the client to move and bend
• The procedures should not be painful, so instruct the patient to tell you if any part of the head and neck examination causes discomfort

  
• Inspect skull size, shape and configuration

  • Round and is of normal size or head circumference
  • Normocephalic
  • In proportion w/ gross body structure
  • Frontal, parietal and occipital prominences
  • Smooth skull contour

  
• Deviations from normal skull size, shape and configuration

  • Disproportionate
  • Asymmetric parietal and temporal prominences; with more prominent nose and forehead; longer mandible
  • Increased head circumference
  • Square-head
  • Bulging / depressed bone
  • Abnormal increase in head size in young child: may indicate hydrocephalus
  • Inconsistently large head size in adolescent or adult: may indicate acromegaly

  
• Deviations from normal head

  • Disproportionate
  • Asymmetric parietal and temporal prominences; with more prominent nose and forehead; longer mandible
  • Increased head circumference
  • Square-head
  • Bulging / depressed bone
  • Abnormal increase in head size in young child: may indicate hydrocephalus
  • Inconsistently large head size in adolescent or adult: may indicate acromegaly

  
• Acromegaly


  Enlarged features
• Microcephaly


  Abnormally small head
• Deviations from normal seen in Paget's disease

  • Acorn-shaped skull bones

  
• Deviations from normal head movement

  • Jerking movement
  • Involuntary nodding
  • Head tilted to one side
• Deviations from normal palpation of head


  • Lesions
  • Lumps
• Normal findings on palpation of head


  • Hard and smooth, without lesions
• Deviations from normal facial movements

  • Asymmetric facial movements
  • Drooping of lower eyelid and mouth
  • Involuntary facial movement
• Parotitis


  Parotid gland enlargement
• Bell's Palsy

  Facial paralysis
• Cerebrovascular Accident/Stroke


  Drooping, weakness
• Normal facial features


  • Symmetric facial features
  • Eye brow hair equally distributed
  • Palpebral fissures equal in size
• Deviations from normal facial features

  • Asymmetric features
  • Increased facial hair
  • Thinning of eyebrows
  • Exophthalmos
  • Moon face
• Cushing's Syndrome


  Moon-shaped face
• Parkinson's disease

  Mask-like face
• Normal findings on inspection of eyes

  • No edema
  • Eyes not sunken
• Deviations from normal findings on inspection of eyes

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


  Sunken face
• Normal findings on palpation of temporal artery

  • Elastic and non-tender
• Deviations from normal findings on palpation of temporal artery

  • Tenderness
• Normal findings on palpation of temporomandibular joint


  • No swelling, tenderness or crepitation
• Deviations from normal findings on palpation of temporomandibular joint


  • Swelling, tenderness, crepitation
• Neck should be erect, midline, with no lumps, bulges, or masses. Thyroid not visible. No masses, swelling, or hypertrophy in mid to lower half of anterior neck.
• Deviations from normal neck


  • Enlargements
  • Lymphadenopathy, lymphoma, or other
• Normal findings

  • (-) swelling
  • (-) tenderness
  • (-) crepitation
• Abnormal findings

  • (+) swelling
  • (+) tenderness
  • (+) crepitation
• Inspect

  1. Temporal artery

  2. TMJ
• Inspect NECK

  1. from neutral position

  2. when hyperextended
• Normal findings NECK

  • Neck erect, midline, no lumps, bulges, or masses
  • Thyroid not visible. No masses, swelling, or hypertrophy in mid to lower half of anterior neck
• Deviations from normal NECK

  • Enlargements
  • Lymphadenopathy, lymphoma, or other malignancy
  • Torticollis
  • Enlarged, visible thyroid
  • Goiter or malignant mass
• Inspect NECK

  1. movement of structures

  2. Allow small sip of water

  3. Cartilages move symmetrically

  4. moves asymmetrically
• Normal findings NECK

  • C7 visible, palpable
• Deviations from normal NECK

  • (+) prominence
  • (+) swelling
  • Dowager's hump
• Normal findings NECK

  • Movement is smooth and controlled
• Deviations from normal NECK

  • (+) spasms
  • (+) rigidity or limited range of motion
  • (+) Brudzinski sign
  • (+) Kernig sign
  • limitation