Weber HEENT

Skull – 6 bones; protects brain & sensory organs; immobile/fixed

Face –14 bones give shape; immobile except mandible; CN’s V(trigeminal - both) ; VII - (Facial - both) temporal artery behind eyes and ears

• Neck – C1-7 with C7 most prominent; sternocleidomastoid & trapezius muscles; blood vessels
• (jugular veins & carotid arteries)

Larynx – voice box above trachea; thyroid cartilage or “Adam’s apple” protects larynx Hyoid bone = U-shaped bone at base of mandible that anchors tongue & only bone doesn’t articulate with another in body

• Thyroid Gland – largest endocrine
• gland in front of trachea; regulates cell metabolism

Cardiovascular/Lymphatic Structures – supraclavicular drains abd. & thoracic areas

Headaches (migraine, tension, luster, tumors)

Dizziness/Syncope (loss of contiousness) - cardiac, neuro, or inner ear problem

Neck Pain or Stiffness (esp. suddenly with temp & HA = meningitis)

Hoarseness/voice change

Neck Mass (lump or lesion) with decreased range of motion

• Thyroid Disorders (change in skin or hair): Hypo or
• Hyperthyroid

“OLDCARTS” mnemonic - onset, location, duration, characteristics, aggravating/alleviating factors, related s/s, tried treatments & severity 0 to 10 scale

• Past Medical History:
• Surgeries to head, neck, or thyroid
• History of chronic headaches, falls
• Chronic diseases (HT, DM, hypothyroid)
• Radiation to neck
• Medications

• Family History
• Autoimmune disorders (thyroid disease, type I diabetes, rheumatoid arthritis, myasthenia gravis)
• Family member with hypertension or migraine headaches?
• Family history of head or neck cancer

• Use of tobacco & alcohol
• Preventative practices (helmets & seatbelts)
• Recreational activities/contact sports
• Interference with ADL’s
• Risk factors for traumatic brain injury

• Inspect, palpate skull (firm & nontender) -
• Normocephalic
• - appropriately proportioned
• Microcephalic
• - small head
• Macrocephalic - large head

• Inspect facial features, symmetry, & appropriateness of facial expression - Facial features calm plus alert & oriented
• Cranial nerve VII (facial - both) -tongue (salt, sugar, lemon) raise eyebrows, purse lips, stick out tongue, close eyes tightly, show teeth, puff cheeks
• Facial drooping - CVA or Bell’s palsy

Inspect, palpate, & auscultate temporal arteries - temporal artery is elastic and not tender

• Inspect, palpate bony structures of face
• Tenderness = Sinus infection
• Acromegaly -enlarged bony structure due to increased growth hormones

Palpate temporomandibular joint for movement or tenderness/pain - no swelling, tenderness, or crepitation with movement - mouth opens fully (3 to 6 cm) & moves laterally 1-2 cm each direction

• Inspect neck for positioning and range of motion (midline trachea, sternocleidomastoid & trapezius)
• Torticollis = “wry” neck due to muscle spasm/ contraction
• ROM: flex, extend, lateral & rotate

Palpate neck/trachea: midline position not deviated; check neck against resistance - Neck resistance 0-5+ (musculoskeletal) & shrug shoulders against resistance (CN XI, spinal accessory- motor)

Inspect anterior neck for thyroid enlargement below cricoid cartilage

• Palpate thyroid gland (swallow) -
• Posterior approach
• Anterior approach
• Flex neck slightly forward and to the side you are examining
• Push the trachea over to one side then the other

• Thyroid = size of thumb pad, right lobe larger than left; May not be felt
• Ausculate thyroid only if enlarged (bruit/bell)

• Inspect/palpate regional lymph nodes
• Enlarged, tender, and firm but movable suggests infection
• Unilateral, hard, asymmetric, fixed, nontender suggests malignancy
• Lymphadenopathy > 1 cm
• Regional lymphadenopathy

Generalized lymphadenopathy (AIDS)

• Preauricular = in front ear high
• Postauricular = behind ear high
• Occipital = base skull / back neck
• Parotid = anterior ear lobe
• Tonsillar = below ear/jaw level behind
• Submandibular = under jaw
• Sublingual=between jaw & chin
• Submental = under chin
• Cervical = along sternocleidomastoid (anterior & posterior cervical chains in neck)
• Supraclavicular = below clavicle (bad if enlarged as drains from abd. & thorax, esp. left side)

• Check on lymph nodes:
• Size & shape (< 1 cm & pea shaped)
• Delimitation (discrete boundaries v. confluent/merge)
• Mobility (mobile in infection v. fixed in CA)
• Consistency (soft v. CA is hard & firm esp. unilateral)
• Tenderness (tender with infection v. nontender/painless with CA)

• Neck pain with decreased ROM due to arthritis
• Facial wrinkles from less SQ fat with prominent nose
• Mouth drawn inward from mandibular reabsorption
• Head position more forward & downward
• Cervical curvature with kyphosis

• Women with “dowager hump” from vertebrae degeneration
• Extrapyramidal invol. head movements
• Thyroid nodular with fibrosis from aging
• Lymph nodes more fibrotic & fatty

Migraine-throbbing unilat., pain begins with aura (smells); photophobia & nausea due to vasospasm; esp. women

• Cluster-unilat. intense pain in eye (burning, stabbing) lasts daily for weeks then remission for months; esp. young
• men & ETOH

Tension-bilat. front or back of head due to stress; viselike tight band around head (dull, aching); esp. women; relief analgesics - aggrivated by activity

Tumor-related-morning HA subsiding in day; N&V; location varies; aggravated by moving

• Risk Factors for Headaches:
• Stress/anxiety
• Visual disturbances
• Medication side effects
• Alcohol (sulfites in wine)
• Smoking
• Lights
• Family history of migraines or headaches
• Trigger foods: chocolate, dairy products, fruits, coffee, nitrates (bacon), Chinese (monosodium glutamate), caffeinated beverages

• Thyroid Disease Risk Factors:
• Autoimmune disease family history
• Family history thyroid cancer
• Gender-females with more nodules (hyper), yet males with more thyroid cancer
• Radiation exposure to head or neck

Increased thyroid hormone due to autoimmune disorder (Graves’ disease)

• SIGNS & SYMPTOMS:
• Enlarged thyroid
• + Bruit from goiter
• Tachycardia
• Weight loss yet increased appetite
• Muscle tremor
• Fine hair & hair loss
• Warm skin with increased perspiration
• Exophthalmos = bulging eyes

Decreased production of hormone due to autoimmune or iodine deficiency

• SIGNS & SYMPTOMS:
• Goiter as compensatory response
• Fatigue/lethargy
• Bradycardia
• Weight gain with decreased appetite
• Slow movements/muscle aches
• Dry, brittle hair with flaky skin
• Cold intolerance

TSH - thyroid stimulating hormore - will be up because the body is trying to compensate

Synthroid early in the morning - normal circadian rhythem - body distributes hormones early morning (6am)

• Benign:
• Adult, More prevalent in females
• Slow growth
• + Family history
• No change in voice
• More than one
• No lymphatic involvement

• Malignant:
• Adult, More prevalent in males
• Rapid growth
• No family history,
• Hoarseness, dysphagia
• One Nodule, may have + lymph node involvement
• Repeated x-ray exams

• Risk for head trauma RT lack of protective gear (helmets & seatbelts)
• Ineffective tissue perfusion to brain
• Impaired swallowing RT decreased gag reflex
• Activity intolerance RT hypothyroidism
• Imbalanced nutrition, less than required RT hyperthyroidism/hypermetabolism

• Imbalanced nutrition, more than required RT hypothyroidism
• Risk for infection RT lymphadenopathy

• Humidifies, filters & warms air
• 3 turbinates provide heat & water exchange
• Lined with cilia (nasal hairs) that trap particles from getting into lungs
• Identifies odors (CN I – Olfactory)
• Gives resonance to voice
• Kiesselbach’s area – nasal septum with blood supply
• Kiesselbach’s area for most nose
• bleeds (front/anterior nasal septum with rich blood supply esp. veins)
• However, posterior bleeds (epistaxis) more
• severe as difficult to pack

• Tongue – dorsal surface with taste buds (sweet, sour, bitter, salty); ventral surface vascular
• Teeth: 20 deciduous (baby teeth)
• 32 permanent teeth
• Salivary glands – 3 pairs:

• Parotid – in front ears above mandible
• Submandibular – under mandible
• Sublingual – floor of mouth
• Oropharynx – structures in back mouth
• Uvula – suspended midline
• Tonsils – lymphoid tissue

• Throat (Pharynx) structures
• Hard anterior palate (roof)
• Soft posterior palate
• Uvula
• Tonsils (protect against infection) – palatine, lingual, pharyngeal (adenoids)

• Bilateral air-filled cavities that make skull lighter
• 4 sets:
• Frontal – above eyebrows
• Maxillary – either side of nose by cheekbones (drain supine—not upright)
• Ethmoid – bridge of nose
• Sphenoid – behind ethmoid to ear

• Nasal Discharge
• Yellow-green = bacterial infection
• Bloody = neoplasm or trauma
• Clear, watery = allergies or CSF
• Foul smelling & unilateral discharge = foreign body
• Sinus congestion – pain in eyes & front teeth
• Epistaxis (bloody nose)
• Mouth pain/lesions – TMJ, gingival disease, herpes, dental problems
• Throat problems -
• Dysphagia (difficulty swallowing)
• Sore throat – nasal congestion, dust & pollen
• Hoarseness

• Past Medical History – oral or nasal surgeries for tonsils, polyps, teeth extractions, broken nose, etc.; history of
• sinus infections; Chronic illnesses (nasal polyps with C.F., mouth lesions with herpes simplex, & dysphagia with CVA)

Family History – allergies or allergic rhinitis; any mouth, throat, nose or sinus cancer

• Life Style & Health Practices:
• Tobacco (smoking & smokeless)
• Alcohol use
• Bruxism/teeth grinding
• Mouthcare – last dental visit; halitosis; brush, floss, brush tongue; lip screen; dentures fit

• Nose (external & internal)
• Lips
• Teeth
• Sinuses
• Mouth & Tongue
• Tonsils & Uvula

Inspect & palpate nose for general appearance, symmetry, tenderness, discharge; rhinophyma

Assess nose for patency & evaluate olfactory nerve (CN I – smells, anosmia (can't small very well)

Inspect internal nasal cavity (mucosa, turbinates & septum) with light source

Inspect & palpate nose for general appearance, symmetry, tenderness, discharge; rhinophyma

Assess nose for patency & evaluate olfactory nerve (CN I – smells, anosmia)

Inspect internal nasal cavity (mucosa, turbinates & septum) with light source

• Palpate frontal & maxillary sinus areas for tenderness
• Transilluminate the sinus areas
• (no illumination = congested or not developed)
• Inspect lips for color, symmetry, moisture & texture
• Inspect & palpate teeth for condition, color, stability & alignment (CN VII, facial for clench teeth & smile)
• Inspect & palpate inner lips & gingiva (gums) for tenderness, color & moisture

• Inspect buccal (cheek) mucosa for color & characteristics (coral to pink color)
• Leukoplakia – white patches due to Candida
• Erythroplakia – red patches on oral mucosa

• Inspect tongue for movement, color & texture (stick out tongue; dorsal rough, ventral smooth)
• Beefy- red = vit. B deficiency
• Yel.-brown hairy = antibiotics, pipe, steroids, excess mouthwash
• Enlarged = mental retardation/Down’s Syndrome or
• hypothyroidism
• Longitudinal fissures = dehydration

Inspect & palpate uvula for texture, color, & surface characteristics (Asians & Amer. Ind.split)

Inspect movement of soft palate “ah” with tongue blade (CN IX glossopharyngeal & CN X vagus)

Inspect posterior wall of pharynx & tonsils for color & surface characteristics (pink, irreg.)

• 0 = no tonsils
• 1+ = visibly swollen
• 2+ = halfway between pillars & uvula
• 3+ = tonsils nearly touch uvula
• 4+ = “kissing” tonsils (touch one another)

• Larger nose due to unabated cartilage formation
• Coarser nasal hair with less filtering more colds
• Decrease smell due to less sensory cells in nose
• Decrease taste buds/perception
• Problems swallowing/dysphagia

• Teeth darken/stain with enamel
• Decrease gingival tissue as less elastic so more bleeding gums
• Xerostomia (dry mouth)
• Varicose veins on ventral surface of tongue

• Slow growing squamous cell cancer
• Signs & Symptoms –
• Nonhealing ulcerated sore on lower lip
• Leukoplakia (white) or erythroplakia (red) patches
• Painless, nonhealing ulcer
• Later a mass, bleeding, loose teeth & dysphagia (difficulty swallowing)

• Tobacco (90% smokers)
• Excess alcohol (75 – 80%)
• Excess sun exposure (lip CA)
• Diet low in vitamins A, C & E
• Poorly fitting dentures
• Gender: males 2X > females
• Race esp. African Americans
• Age > 40 yrs. (peaks ages 64-74 yrs.)
• Previous history of cancer, or immuno-suppression
• Ethnicity

Inflammation of gums usually due to poor dental hygiene

• SIGNS/SYMPTOMS -
• Hyperplasia of gums
• Erythema & bleeding (painless)
• Progresses to Pyorrhea (periodontitis) with loss of supporting bone, inflammation & erosion of gum tissue & loose teeth

Infection of tonsils usually due to beta-hemolytic streptococci

• SIGNS/SYMPTOMS -
• Sore throat
• Odynophagia (pain with swallowing)
• Fever/chills
• Tender cervical lymph nodes
• Enlarged, erythema tonsils with white or yellow exudate

• Readiness for enhanced management of teeth & gums
• Risk for aspiration RT decreased gag reflex
• Risk for infection of gums or tonsillitis
• Disturbed sensory perception RT smell (CN I) & taste (CN VII & IX)
• Pain RT sinusitis
• Impaired Swallowing RT dysphagia
• Impaired oral mucous membranes