Overview
This lecture covers the anatomy, physiology, and assessment techniques of the head and neck, focusing on key structures, lymph node locations, normal and abnormal findings, and pertinent health history questions.
Anatomy and Physiology Review
- The head and neck contain many vital structures including cranial bones, facial muscles, salivary glands, vessels, nerves, the thyroid gland, and lymph nodes.
- Major neck muscles are the sternomastoid and trapezius.
- The thyroid gland straddles the trachea, produces T3 and T4 hormones, and is located beneath the thyroid cartilage.
- The lymphatic system in the head and neck is extensive and critical for immune response.
Lymph Node Locations and Palpation
- Pre-auricular: in front of the ear.
- Posterior auricular: behind the ear over the mastoid process.
- Occipital: base of the skull.
- Submental: midline behind the chin.
- Submandibular: halfway between jaw angle and tip.
- Tonsillar (jugulodigastric): under the jaw angle.
- Superficial cervical: over sternomastoid.
- Deep cervical: beneath sternomastoid.
- Posterior cervical: along the trapezius edge.
- Supraclavicular: above the clavicle.
Assessment History Questions
- Ask about headache onset, location, characteristics, duration, triggers, associated symptoms, and history.
- Inquire about head injuries, dizziness, neck pain, swelling, and impacts on daily activities.
- For females, ask about correlation with the menstrual cycle and coping strategies.
Physical Assessment Techniques
- Inspect and palpate the skull for size, shape, and tenderness.
- Palpate temporal artery for pulsation.
- Assess temporomandibular joint (TMJ) for smooth movement and tenderness.
- Inspect facial symmetry and note abnormal features or involuntary movements.
- Inspect and palpate the neck for symmetry, range of motion, and muscle strength (cranial nerve XI).
- Palpate lymph nodes noting size, consistency, mobility, and tenderness.
- Examine the trachea for midline position.
- Palpate the thyroid gland using anterior or posterior technique; auscultate for bruit if enlarged.
- Note any swelling, lumps, nodules, or abnormal pulsations.
Normal and Abnormal Findings
- Normal: skull symmetric, no tenderness; face symmetric; lymph nodes soft, movable, non-tender, discrete; thyroid not enlarged; trachea midline.
- Abnormal: enlarged, hard, fixed, or tender lymph nodes; thyroid enlargement; facial asymmetry; unusual pulsations.
Key Terms & Definitions
- Sternomastoid — Major neck muscle used as a landmark for lymph node palpation.
- Trapezius — Large neck/back muscle forming the posterior triangle of the neck.
- Thyroid gland — Endocrine gland in the neck producing metabolic hormones.
- Lymph nodes — Small immune organs filtering lymphatic fluid, grouped in cervical regions.
- Temporal artery — Artery over the temporal bone, palpable above the cheekbone.
- TMJ (Temporomandibular joint) — Jaw joint, assessed for movement and tenderness.
- Cranial nerve XI — Accessory nerve controlling sternomastoid and trapezius muscles.
Action Items / Next Steps
- Review anatomical locations of cranial bones, muscles, salivary glands, lymph nodes, and thyroid.
- Practice palpation techniques for lymph nodes, thyroid, and TMJ.
- Study health history questions and expected normal versus abnormal findings.
- Prepare for Exam 2 by following the lecture objectives.