HEAD AND NECK

ASSESSMENT
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A. Structure & function

HEAD
Cranium

Cranium houses & protects the brain and

major sensory organs
Consist

of 8 bones:

frontal

temporal

parietal

occipital
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13
12

1
2

11

3
4

10
9
8
5
6

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Face
Facial

bones (14 bones)

All

facial bones are immovable

except the mandible which has a
free movement at the
temporomandibular joint.

Consists

of many muscles that

produce facial movement &
expression

Temporal
Parotid

artery

glands

Submandibular

salivary
glands
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NECK
Compose

of muscles,
ligaments and the cervical
vetebrae.

Contained

within the neck

are:

Hyoid bone

Several major blood

vessels

The larynx

Trachea
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Muscles

and Cervical
Vertebrae
Sternocleidomastoid

rotates and flexes the

head

Trapezius

extends the
head and moves the
shoulders

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Two

major muscles also

forms triangles that
provide important
landmarks for assessment;

Anterior triangle under

the mandible

Posterior triangle
between the trapezius
and sternomastoid
muscles.

C1

- C7 located in the
posterior neck and
support the cranium

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Blood vessels
Internal
Carotid

jugular veins
arteries

External

jugular veins

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Thyroid gland
Largest

endocrine gland

Produces

Landmark

thyroid hormones

structure for

accurate palpation:
Trachea
Cricoid

cartilage

Thyroid

cartilage (Adams apple)

larger, located just above the

cricoid cartilage.
Hyoid

bone
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Lymph nodes of the head & neck

10
1

9
8

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Collecting
subjective data
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Health history
Use

COLDSPA

Pain

Do you experience neck pain?

Do you experience headache? Describe.

Do you have any facial pain? Describe.

Do you have difficulty moving your head or

neck?

Other

symptoms

Have you noticed any lumps or lesions on your

head or neck that do not heal or disappear?
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Have

you experienced any dizziness,

lightheadedness, spinning sensation, or
loss of consciousness? Describe.

Have

you noticed a change in the

texture of your skin, hair or nails.

Have

you noticed a change in your

energy level, sleep habits or emotional
stability?

Have

you experienced any palpitations,

blurred vision or changes in bowel
habits?
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Past health history

Described

any previous head or

neck problems you have had?
treatment?, Results?

Have

you ever undergone radiation

therapy for problem in your neck
region?

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Family history
History

of head and neck cancer in

your family?

History

of migraine headaches in
your family?

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Collecting
objective data
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Physical examination
Head

and Face

Inspection
1.

Inspect the head. For size, shape &

configuration.

Normal: Symmetrical, round & erect

and in midline. No lesions visible.

Abn : Skull & facial bones are larger &

thicker
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2.

Inspect for involuntary

movement.

Normal : Head is still and

upright

Abn : Tremors, involuntary

nodding, head tilted to one
side

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3.

Inspect the face. For symmetry,

features, movement, expression & skin
conditions

Normal : Symmetric with a round and

oval, elongated or square appearance. No
abnormal movements.

Abn : Asymmetry in front of the earlobes

(parotid enlargement), Unusual or
asymmetric orofacial movements,
drooping on one side of the face, Masklike face, Sunken face with depressed
eyes and hallow cheeks, swollen face
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Palpation
1.

Palpate the head. Palpate for

consistency.

Normal : Hard and smooth without

lesions

Abn : Lesions or lumps on the head

2.

Palpate temporal artery

Normal : Elastic and non-tender

Abn : Hard, thick, and tender with

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3.

Palpate the Temporomandibular

joint (TMJ)

Normal : (-) swelling, tenderness, or

crepitation, mouth opens & closes
fully, lower jaw moves laterally

Abn : Limited ROM, swelling,

tenderness, or crepitation

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NECK
Inspection
Inspect

the neck.

Normal

: symmetric with head centered and

without bulging masses.

Abn

: Swelling, enlarged masses, or nodules

Inspect

movement of neck structures

Normal

: thyroid & cricoid cartilage, and

thyroid gland move upward symmetrically.

Abn

: Asymmetric and generalized

enlargement
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Inspect

the cervical vertebrae.

Normal : C7 or vertebrae prominence is

visible and palpable.

Abn

: Prominence or swelling other than C7.

Inspect ROM.

Normal

: smooth and controlled with 45

degree flexion, 55 degree extension, 40
degree lateral abduction, 70 degree
rotation.

Abn

: Stiffness, rigidity. Limited ROM

(inflammation, spasms, arthritis)
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Neck Palpation
Palpate
Normal
Abn

the trachea
: midline

: Pulled to one side

Palpate

the thyroid gland.

Normal

: if palpable, smooth, firm,

nontender, nodule free. Right lobe 25%
larger than left lobe

Abn

: enlargement, (+) nodules

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Lymph nodes of the head and

neck

Palpate the:

1.

Preauricular nodes

2.

Postauricular nodes

3.

Occipital nodes

4.

Palpate the tosillar

nodes

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5.

Palpate the
submandibular

6.

Palpate the
submental

7.

Palpate the
superficial cervical
nodes
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8.

Palpate the
posterior cervical
nodes

9.

Palpate the deep

cervical chain nodes

10. Palpate

the
supraclavicular
nodes

11. Infraclavicular

nodes
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Differentiating Lymph Nodes

CHARACTERISTICS

NORMAL

INFECTION

MALIGNANCY

Size

1 cm

Enlarged

Enlarged

Shape

Round

Round

Irregular

Consistency

Soft to rubbery

Boggy

Hard

Delimitation

Well defined

Well defined

Irregular borders

Mobility

Mobile

Mobile

Immobile

Tenderness

Nontender

Tender

Nontender

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Normal

: (-) swelling, tenderness,

hardness, enlargement

Abn

: (+) swelling, tenderness, hardness,

enlargement, immobility.

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Neck Auscultation
Auscultate

the thyroid only if

you find an enlarged thyroid
gland.
Normal

: No sound

Abn

: a soft, blowing, swishing

sound (bruit) auscultated over
thyroid lobes is often heard in
hyperthyroidism.
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