1. By O.Krekhovska-Lepyavko, MD, Institute of Nursing, TSMU
Head and Neck
By O.Krekhovska-Lepyavko, MD,
Institute of Nursing, TSMU

2. Anatomy review

3. Anatomy
skull

4. Anatomy – Salivary Glands

5. Anterior and Posterior Triangles

6. Anatomy

7. Lymphatics

8. Anatomy - Lymphatics

9. History
Headaches?
“Any unusually frequent or unusually severe headaches?”
A severe headache for a person who’s never had headaches should warrant further attention
When - onset, duration
Where
Tension headaches – tend to be occipital or frontal
Migraine headaches – supraorbital, retro orbital, or frontotemporal
Cluster headaches – pain around the eye, temple, forehead, and cheek. Pain unilateral.
Character
Throbbing (pounding, shooting) – migraine
Aching (constant pressure, dull) – tension headache
Intensity - mild, moderate, or severe
Precipitating factors
Associated factors
Vision changes, N&V, pain with bright light, neck stiffness, fever,
Alleviating factors
Other illnesses
Medications

10. History Head injury? Dizziness? Neck pain? Lumps or swelling? When
History of head injuries or other medical conditions?
Location
LOC – Loss of Consciousness?
Dizziness?
Lightheadedness or spinning?
Vertigo is true rotational spinning due to neurologic dysfunction (vestibular apparatus)
Objective – perception that room spins
Subjective – perception that person is spinning
Neck pain?
When, where, precipitating and alleviating factors
Acute onset of stiffness along with headache and fever occurs with meningeal inflammation
Limitations to ROM?
Lumps or swelling?
Tenderness?
Acute infection
Lumps
If over 40, suspect malignancy until proven otherwise
Smoker? How long? Packs per day? Chew tobacco?
Increased risk of tumors

11. Assessment - Head Size and shape Temporal artery
Normocephalic
Hydrocephalus
enlargement of head, increased circumference
Paget’s disease
Enlargement and softening of bone
Acromegaly
abnormal enlargement of skull and facial bones
Temporal artery
Palpate above zygomatic bone, between eye and top of ear
Temporomandibular joint
Anterior of ear, between mandible and temporal bone
Palpate joint as person opens mouth.
Normally smooth movement
Abnormal – crepitations, limited ROM, tenderness
acromegaly
TMJ

12. Assessment - Face Symmetry of eyebrows, mouth Changes in skin
Tics or twitches
Tightened facial muscles - pain

13. Stroke vs Bell’s Palsy Bell’s Palsy CN VII paralysis Unilateral
Thought to happen due to herpes simplex virus
Person cannot wrinkle forehead, raise eyebrow, close eye, or show teeth on affected side

14. Stroke
Acute neurological deficit due to obstruction of cerebral vessel, as in atherosclerosis, or rupture in a cerebral vessel
Paralysis of lower facial muscles, but upper half of face not affected.
Still able to wrinkle forehead and close eyes

15. Fetal Alcohol Syndrome

16. Down Syndrome Trisomy 21 Characteristics Upslanting eyes
Flat nasal bridge and nose
Protruding tongue
Short broad neck with webbing
Small hands

17. Assessment - Neck Symmetry – head and neck muscles ROM Muscle strength
Ask person to touch chin to chest, turn head to right and left, try to touch each ear to shoulder, extend head backwards
Note limitation of movement
Muscle strength
Test strength by resisting movement
CN XI – Accessory n. – Trapezius m.
Thyroid gland
Enlargement of lower neck may be bilateral or a unilateral lump
Diffuse enlargement or nodular lump

18. Palpating the Thyroid Gland
Posterior approach
Anterior approach
Place fingers inferior and lateral of thyroid cartilage and ask the person to swallow
Usually, you cannot palpate the normal adult thyroid
Enlarged lobes are also tender to palpation

19. Hypothyroidism
Mild deficiency called “hypothyroidism.” Severe deficiency called “myxedema.” In infancy called “cretinism.”
S/S:
Face is pale, puffy, and expressionless
Skin is cold and dry
Hair is brittle, hair loss
Lowered heart rate and temp
Lethargy, fatigue, intolerance to gold
Impaired mentality
Goiter!
Cause
Hashimoto’s disease
Autoimmune disease where antithyroid antibodies block thyroid hormone production
Iodine deficiency in diet
Surgical removal of thyroid

20. Hyperthyroidism Grave’s disease
Exophthalmos
Grave’s disease
Most common. More common in women.
S/S
Rapid heartbeat, dysrhythmias, angina
Rapid thought flow and rapid speech, nervousness, and insomnia
Increased BMR, appetite
Goiter + Exophthalmos
Cause
Thyroid Stimulating Immunoglobulins (TSIs) mimic the effects of TSH on thyroid function
Toxic nodular goiter (Plummer’s disease)
Result of thyroid adenoma
Exophthalmos is missing

21. Lymph Nodes Lymph nodes
Beginning with the preauricular lymph nodes, palpate the 10 groups of lymph nodes in a routine order
Lymphadenopathy - enlargement of lymph nodes due to infection, allergy, or neoplasm

22. Trachea Normally, the trachea is midline
Palpate for any tracheal shift by placing index finger in the sternal notch
Trachea pushed to unaffected side in aortic aneurism, a tumor, pneumothorax
Trachea pushed to affected side with large atelectasis, pleural adhesions, fibrosis
Tracheal tug is a rhythmic downward pull that is synchronous with systole and that occurs with aortic arch aneurysms

23. Developmental Considerations - Infants
Skull
Should be round and symmetrical
Caput succedaneum – elongation of skull at birth – resolves
Cephalohematoma – hemorrhage due to trauma at birth – resolves in few weeks (Fig 13-17)
Fontanels – anterior and posterior. Normally close by 2 years
Depressed – dehydration
Bulging – increased ICP
Transillumination done if abnormal head size or intracranial lesion is suspected
Hydranencephaly – thinning or absence or cerebral cortex
transillumination
cephalohematoma