-
seven fused skull bones
- frontal
- parietal
- temporal
- occipital
-
-
8 face bones
frontal, zygomatic, nasal, ethmoid, lacrimal, sphenoid, maxillary, mandible
-
major landmarks (2)
- palpebral fissures
- nasolabial folds
-
cranial nerves 5 and 7
innervate face
-
3 paired salivary glands
- parotid gland
- submandibular gland
- sublingual gland
-
neck structure formed by: (4)
- cervical vertebrae
- ligaments
- sternocleidomastoid muscles
- trapezius muscles
-
Lymph nodes (8)
- preauricular
- posterior auricular
- occipital
- tonsilar
- submandibular
- submental
- superficial, posterior, deep cervical
- supraclavicular
-
Inspection (head and face)
- head position and shape
- skull size and shape
- scalp
- hair pattern
- facial features
- facial asymmetry
- tics
- spasms
-
Palpation (head and face)
- skull symmetry/smoothness
- scalp movement
- hair texture
- temporal arteries
- facial bones
- TMJ
- salivary glands
-
percussion and auscultation (head and face)
- (not routine)
- sinuses can be percussed: frontal, maxillary, and ethmoid sinuses
- can listen for temporal artery bruits
-
Inspection (neck)
- muscle symmetry
- alignment of the trachea
- triangles landmarks
- fullness at base of neck
- masses
- webbing
- excess skin folds
- unusual shortness - Turners syndrome
- asymmetry
- carotid artery prominence
- jugular vein distension
- ROM (flexion, extension, lateral)
-
Palpation and Auscultation (neck)
- tracheal alignment
- smoothness/tenderness
- tracheal tugging
- lymph nodes
auscultate carotids
-
Neck-throid gland (inspect, palpate, and auscultate)
- Inspect: symmetry and swallowing symmetry
- Palpation: size, shape, configuration, consistency, tenderness, nodules
- Auscultate: enlarged gland (vascular sounds (bruit)
-
Nose and nasopharynx: how formed
- nose warms and moisturizes air
- detects odors (CN 1)
- cartilage forms external nose and nares
- frontal/maxillary bones form nasal bridge
- the floor formed by hard and soft palate
- turbinates form the lateral wall
- nasolacrimal duct and paranasal sinuses drain into inferior and medial meatus respectively
-
examination of the nose
- Inspect: color, size, position, shape
- nares for discharge
- occlude each nare for patency
- speculum exam of turbinates: boggy, injected, purulent
- palpate for tenderness (nasal bridge)
- olfactory CN1 (use 2 distinct senses)
-
mouth and oropharynx
- vocalization, digestion, food passage, tast
- tounge: dorsal surface supports filiform papillae
- salivary glands
- 32 adult teeth anchored in alveolar ridge
- tonsillar pillars separate mouth from oropharynx
-
Inspection (mouth)
- lips
- buccal mucosa, teeth, gums
- oral cavity, tongue, mouth, and floor
- hard and soft palate, uvula
- oropharynx, tonsils
- gag reflex
-
Palpate (mouth)
- with glove!
- gums, tongue, floor
- submandibular (wharton's ducts)
- parotid (stenson's ducts)
- sublingual glands
-
Related History
- Onset
- Location
- Duration
- Character
- Associated symptoms
- Related factors
- Treatment factors
- --medications
-
common symptoms
- headache
- change in vision/double vision
- hearing loss, earache, tinnitus
- vertigo
- nosebleed
- sore throat
- swollen glands
- goiter
-
related history: PMH
- head trauma
- recent lumbar puncture
- randon/radium tx of the neck or head
- seizures
- headaches
- thryoid dysfunction/surgery
-
Related family history
- headaches
- thyroid dysfunction
- sore throats
- sinus problems
-
Social History
- employment risks
- stress
- injury risks
- recent weight gain/loss
- food intolerances
- use of ETOH/drugs/tobacco
- sexual practices
-
Review of Systems:
Head, Neck, Nose, Mouth/Throat
- Head: cephalgia, head injury, migraines
- Neck: history of injury, masses, pain or stiffness
- Nose: chronic sinusitis, decreased smell, excessive rhinorrhea, unexplained epistaxis, nasal fractures
- Mouth/Throat: tenderness or lesions in oral cavity, frequent sore throats, dysphagia or persistent hoarseness
|
|
