Head and Neck

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

2. Anatomy review

3. Anatomy

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? • 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 • 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 • 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. 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 Hypothyroidism

20. Hyperthyroidism 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