Head and Face

• scalp - the bones of the skull are covered by muscles and skin
• upper face - forehead and eyes
• middle face - nose, cheeks, and ears
• lower face - lips, chin, and jaw
• mandible -forms the lower jaw and is the only movable bone in the skull
• maxilla - forms the upper jaw and supports the upper teeth
• TMJ - responsible for: opening/closing of jaw; protraction/retraction of the lower jaw; side-to-side movement of the lower jaw
• guarino’s auscultatory-percussion for intracranial masses - diaphragm on left ear, percuss on forehead, listen on right ear, vice versa
• Acromegaly


  • Prominent jaw, enlarged facial features, especially lips, and nose, which project away from the head (gorilla-like face)
  • Enveloping, pillow-like feel to the handshake
• Amyloidosis


  • Periorbital purpura (raccoon eyes) just after a rapid increase in venous pressure from coughing, for example, or classically, after proctoscopy
  • Note: Raccoon eyes can also be a sign of basilar skull fracture
• Cushing's syndrome


  • Moon face where the buccal fat pads obscure the ears from the front view
  • Red cheeks
• Depression


  • Worn, weary look; poor eye contact, smile, if present, is forced
  • Appearance of sadness, loss of pleasure
• Down's syndrome


  • Slanted eyes (almond-shaped) with inner epicanthal folds; low set ears; a short, flat nose, and a thick, protruding tongue
  • Prominent simian crease (single transverse palmar crease); small, open mouth small white spots (Brushfield's spots on the iris)
• Klippel-Feil syndrome


  • Exaggerated forward head position from congenital abnormalities of the cervical vertebrae
  • Short neck; restricted movements of head and neck; low hairline at the back of the head
• Myxedema


  • Coarse facial features; full (round); coarse, dry, brittle hair; periorbital edema with little sacs of fluid; facial puffiness; dull, lethargic expression may be present
  • Slow movements, large tongue, elbows with dirty-appearing hyperkeratosis
• Nephrotic syndrome


  • Periorbital puffiness, dullness, lassitude (weariness)
  • Grayish, sallow pallor if renal failure is present
• Parkinson's disease


  • Bent posture; dull eyes peering from the upper half of the orbit
  • In men, several days of beard growth under the neck because of the inability to see this area in the mirror
• Polycythemia rubra vera


  • Ruddy cyanosis of the nose and clubbing (stunting) of the digits
  • Sensation of fullness in the head; epistaxis (nose bleed)
• Scleroderma (Systemic sclerosis)


  • Raynaud's phenomenon (90%); dysphagia (90%); thickening, tight and inelastic facial skin
  • mouth may not be fully closed; small oral opening
• Seborrhea


  • Prominent sebaceous glands (greasy) and fissures on the scalp, face, and trunk
  • evident in the eyebrows or across the bridge of the nose
• Stroke


  • Weakness on paralysis on one side; loss of voluntary muscle control; difficulty interpreting visual, tactile, and auditory stimuli
• Terminal illness


  • Pallor; dependence; loss of muscle tone; decreased circulation and respirations; sensory impairment
  • Hippocratic facies; sunken appearance of the eyes
• Paget’s disease - pronounced forehead causes a large-shaped head; increased breath sounds over the skull
• Mitral stenosis 


  flushed cheeks; drawn look to the face, making nose seem prominent

  malar rash or cyanosis in sever cases
• Range of TMJ

  • open mouth and close jaw with and without resistance
  • CN V testing
• Smoking - excessive facial wrinkles; hollow cheeks; bright-appearing eyes
• Leprosy - coarsening of facial features with enlargement and infiltration of the nose and earlobes; attenuated skinfolds