Overview
This lecture covers the assessment of the head and neck, including inspection techniques, anatomical structures, relevant cranial nerves, and common clinical findings.
Head & Skull Assessment
- Inspect the skull for size (normocephalic), shape (rounded), and symmetry from side to side.
- Look for abnormal masses, nodules, or lesions on the skull and face.
- Refer to textbook page 531 and figure 30-11 for anatomy and assessment procedures.
Face and Cranial Nerve VII (Facial Nerve)
- Assess facial nerve function (CN VII) by having the patient wrinkle forehead, tightly close eyelids, and smile.
- Compare both sides of the face for equal strength and symmetrical nasolabial folds.
- Bell’s palsy causes facial asymmetry, drooping, and smooth nasolabial fold.
- Test sensory function by applying taste stimuli (salt, sugar, lemon juice) to the tongue.
Nose and Sinuses Assessment
- Inspect nose for position, symmetry, and flaring (respiratory distress sign).
- Examine the nasal cavity for redness, swelling, and tenderness.
- Test Cranial Nerve I (Olfactory Nerve) by having the patient identify common scents.
- Palpate frontal and maxillary sinuses for tenderness or peri-orbital edema.
Mouth and Oropharynx Assessment
- Lips and buccal mucosa should be uniform, pink, moist, and smooth.
- Adults have 32 teeth which should be white, with pink, firm gums.
- Inspect the tongue for moisture and midline position (assesses Cranial Nerve XII, Hypoglossal).
- Inspect floor of mouth and under tongue for lesions (common site for oral cancer).
- Note changes such as angioedema (acute, painless swelling), oral bleeding, and gum changes.
- Palate and uvula should be pink; ask patient to say "ah" to observe palate rise.
- Inspect tonsils for color, size (grade 1 is normal), and absence of discharge.
Neck, Lymph Nodes, and Thyroid Assessment
- Inspect and palpate neck muscles, lymph nodes, carotid arteries, jugular veins, thyroid gland, and trachea.
- Assess sternocleidomastoid and trapezius muscles, using range of motion and resistance (tests Cranial Nerve XI).
- Elderly may have decreased neck mobility and pain.
- Palpate lymph nodes for size, shape, mobility, and tenderness; enlarged, firm, or warm nodes may suggest infection or malignancy.
- Normal lymph nodes are not easily palpable; use fingertips and compare both sides.
- Inspect lower neck for symmetry and obvious masses over thyroid gland and above suprasternal notch.
Key Terms & Definitions
- Normocephalic — normal head size and shape.
- Bell’s palsy — facial nerve disorder causing asymmetry and facial droop.
- Cranial Nerve I (Olfactory) — nerve responsible for sense of smell.
- Cranial Nerve VII (Facial) — controls facial expressions and taste on anterior tongue.
- Cranial Nerve XI (Accessory) — moves neck muscles.
- Cranial Nerve XII (Hypoglossal) — controls tongue movement.
- Angioedema — sudden, painless skin or mucosal swelling.
- Peri-orbital edema — swelling around the eyes, often from infection.
- Tonsil Grade 1 — tonsils contained behind pillars, normal size.
Action Items / Next Steps
- Review textbook pages 531 (skull/face), 544-545 (nose/sinuses), and 546-549 (mouth/oropharynx).
- Practice head and neck assessment procedures in lab.
- Prepare any questions you have for next class session.