HEAD AND NECK

• Assessment of the head

  • Inspect skull size, shape and configuration
  • Palpate head for consistency (nodules or masses & depression)
  • Inspect symmetry of facial movements
  • Inspect facial features
  • Inspect eyes for edema and hollowness
  • Palpate for temporomandibular joint range of motion (TMJ ROM)
• Normal skull


  • 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

  • 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
• Normal palpation of head


  • Smooth, uniform consistency; absence of nodules or masses
• Deviations from normal palpation of head

  • Sebaceous cysts
  • Local deformities from trauma
  • Masses
  • Nodules
• Normal 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 from normal facial movements

  • Asymmetric facial movements
  • Drooping of lower eyelid and mouth
  • Involuntary facial movement
• 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; exopthalmos; moon face
• Normal eyes


  • No edema
  • Eyes not sunken
• Deviations from normal eyes

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


  • No edema
  • Eyes not sunken
• Deviations from normal TMJ ROM

  • Abnormal
  • Swelling
  • Tenderness
  • Crepitation
• Assessment of the neck

  • Inspection of the Neck
  • Palpation of the Neck
  • Cervical Nodes
  • Palpating the Thyroid
  • Auscultation of the Thyroid
• Normal neck inspection


  • 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 inspection

  • Enlargements
  • Lymphadenopathy, lymphoma, or other malignancy
  • Torticollis
  • Enlarged, visible thyroid
  • Goiter or malignant mass
• Normal neck palpation


  • Supple, nontender, no masses
• Deviations from normal neck palpation

  • Masses: Lymphadenopathy, malignancies, thyroid masses
• Cervical lymph nodes


  • Occipital nodes
  • Post-auricular nodes
  • Pre-auricular nodes
  • Tonsillar nodes
  • Submandibular nodes
  • Submental nodes
  • Superficial cervical nodes
  • Posterior cervical nodes
  • Deep cervical nodes
  • Supraclavicular nodes
  • Infraclavicular nodes
• Normal lymph nodes


  • Lymph nodes normally not palpable especially the deep and clavicular nodes
  • If a node is palpable, normal characteristics include small, 1 cm, mobile, soft, nontender, and usually superficial
• Deviations from normal lymph nodes

  • Palpable nodes (1 cm or greater): Malignancy, inflammatory, or infectious process of glands or area they drain
• Palpating the thyroid


  • Anterior approach
  • Posterior approach
• Normal thyroid palpation


  • Generally nonpalpable. If some tissue is palpable, consistency is firm, smooth, and meaty, with no nodularity, enlargement, or tenderness
• Deviations from normal thyroid palpation

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

  Listen over the thyroid gland with the bell portion of the stethoscope for bruits
• Normal thyroid auscultation


  • No sounds detected
• Deviations from normal thyroid auscultation


  • Increased vascularity of hyperthyroidism