Head and neck


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Head and neck

  2. 2. BONES OF FACE AND CRANIUM• SKULL – Rigid bony box – Protects brain and special sense organs – Includes bones of the cranium and the face
  3. 3. CRANIAL BONES( (Cranium = Bone Case• FRONTAL-Forms the forehead and roofs of orbit• PARIETAL-Two form the sides and roof of cranial cavity• TEMPORAL- Two form the inferior lateral aspects of cranium; has mastoid process posterior to external auditory canal• OCCIPITAL- Forms the posterior part and most of base
  4. 4. SUTURES SUTURES- Meshed immovable joints where the adjacent cranial bones unite CORONAL- Crowns the head from ear to ear* at the junction of frontal and parietal bones SAGITAL- Separates lengthwise between the* parietal bonesLAMBDOID- Separates parietal bones crosswise* from the occipital bone
  5. 5. FACIAL BONES• 14 Facial Bones articulate at sutures except for the mandible – NASAL-forms part of bridge of nose – PAIRED MAXILLAE- Unite to form upper jaw bone – ZYGOMATIC- Commonly called cheekbones – MANDIBLE- Lower jawbone; largest, strongest facial bone; only skull bone that moves – LACRIMAL- Smallest bones in face; lateral to
  6. 6. FONTANELS((fontenelle= little fountain• At birth, membrane-covered soft spots between cranial bones• These soft spots will eventually ossify-replaced by bone• Allow for growth of the brain during the first year• Posterior or occipital will ossify by 2 months• Anterior or frontal will ossify by 18-24 months
  7. 7. FACIAL MUSCLES• Facial expressions are formed by the facial muscles• Mediated by cranial nerve VII, the facial nerve• Facial muscle is symmetrical bilaterally, except for an occasional quirk or wry expression
  8. 8. Figure 13-2 pg 273
  9. 9. SYMMETRICAL FACIALSTRUCTURES• PALPEBRAL FISSURES- Opening between eyelids• NASOLABIAL FOLDS- Creases from nose to corner of mouth
  10. 10. Salivary glands and neck vessels Salivary Glands and Neck Vessels • Figure13-3 p 273
  11. 11. SALIVARY GLANDS• Two pairs of salivary glands are accessible to examination on the face – PAROTID-In the cheeks over the mandible located near the ears; largest and not normally palpable – SUBMANDIBULAR- Beneath the base of the tongue – SUBLINGUAL- Lie in the floor of the mouth
  12. 12. NECK VESSELS• TEMPORAL ARTERY-Lies superior to the temporalis muscle, and its pulsation is palpable anterior to the ear• CAROTID ARTERY-Right and left arise from the aorta and are the principal blood supply to the head and neck; each of these two arteries divide to form the external and internal carotid arteries• JUGULAR VEIN- External -Lies superficial to the sternocleidomastoid muscle as it passes down the neck to join the subclavian vein; receives blood from the exterior of the cranium and the deep parts of the face ; INTERNAL - Directly continuous with the transverse sinus, accompanying the internal carotid as it passes down the neck; Receives blood from the brain and superficial parts of the face and neck
  13. 13. Salivary Glands and Neck Vessels • . 3
  14. 14. LANDMARKS• Vertebra Prominens-C7 vertebra; has a long spinous process that can be felt when the neck is flexed• Temporal Artery-Pulsation is palpable anterior to ear
  15. 15. MUSCLES OF THE NECK Muscles of the Neck • Figure 13-4. p 274.
  16. 16. NECK MUSCLES• STERNOMASTOID- Arises from the sternum and the medial part of the clavicle and extends diagonally across the neck to the mastoid process behind the ear; Accomplishes head rotation and flexion• TRAPEZIUS- Two muscles that form a trapezoid shape on the upper back arising from the occipital bone and extends fanning out to the clavicle and scapula; moves the shoulders and extends and turns the head
  17. 17. TRIANGLES• The sternomastoid muscle divides each side of the neck into two triangles: – Anterior triangle -Formed by medial borders of sternocleidomastoid muscle and mandible; Inside has hyoid, cricoids cartilage, trachea, thyroid, anterior cervical lymph nodes – Posterior triangle - Formed by trapezius, sternocleidomastoid muscles and clavicle; contains posterior cervical lymph nodes
  18. 18. THYROID GLAND• Important endocrine gland with a rich blood supply• Straddles the trachea in the middle of neck• Synthesizes and secretes thyroxine (T4) and triiodothyronine (T3), hormones that stimulate the rate of cellular metabolism• Has 2 lobes, conical in shape connected in the middle by a thin isthmus lying over the 2nd and 3rd tracheal rings• Sometimes a 3rd lobe (pyramidal) is present and is cone shaped
  19. 19. Neck• CRICOID- Above the thyroid isthmus within about 1cm is the cricoid cartilage or upper tracheal ring• THYROID CARTILAGE- Above the cricoid with a small palpable notch in its upper edge-the Adam’s Apple-forms anterior wall of larynx• HYOID- Highest is the hyoid bone, palpated at the level of the floor of the mouth
  20. 20. Location of Thyroid Gland • Figure 13-5 p. 274.
  21. 21. LYMPH NODESMajor part of immune system detecting and eliminating foreign substances from the bodyOval structures located along the length of lymphatic vesselsScattered throughout the bodyPacked with lymphocytesLymph (clear, watery fluid) flows in one direction thru nodeFilters lymph of foreign substances as passes back into bloodstreamForeign substances are trapped by reticular fibers and destroyed by phagocytosis and lymphocytes
  22. 22. Location of Lymph Nodes • Figure 13-6 p. 275.
  23. 23. DRAINAGE PATTERNS OFLYMPH NODES Figure 13-7. p. 276
  24. 24. Order of Palpation of Lymph Nodes •
  25. 25. Accessible Lymph Nodes to Locate• Submental• Sub mandibular• Supraclavicular• Superficial Anterior Cervical• Preauricular and Postauricular• Occipital• Superficial Posterior Cervical
  26. 26. Subjective Data• Headache-unusually frequent or severe, onset-gradual or sudden, locaton, character, course or duration, precipitating factors, associated factors, aggravating/alleviating factors, meds?, other illnesses?, pattern, effort to treat; migraines, tension, cluster• HEAD Injury-Loss of consciousness or change in level of consciousness
  27. 27. SUBJECTIVE DATA• Dizziness -lightheaded feeling vs. vertigo which is rotational spinning• Neck Pain -Limitations to range of motion• Lumps or Swelling-tenderness indicates infection while persistent lump arouses malignancy suspicion• Hx of head or neck surgery
  28. 28. Objective Data• Normocephalic-round symmetrical skull• Microcephalic-abnormally small head• Macrocephalic-abnormally large head• Hydrocephalic-obstruction of drainage of cerebrospinal fluid in the head resulting in enlargement
  29. 29. Abnormal Facial Features• TICS- Abnormal facial movements• Exophthalmos- bulging eyeballs• Acromegaly- Gradual enlargement of the bones of the face and jaws
  30. 30. INFANT HEAD FINDINGS• MOLDING- Bones overlap due to passing through the birth canal• CEPHALHEMATOMA- collection of blood under the scalp due to trauma• DEPRESSED FONTANELS- Due to dehydration• BULGING FONTANELS- May indicate increase in intracranial pressure
  31. 31. Palpating Lymph Nodes• USE A FIRM DELIBERATE YET GENTLE TOUCH• INFECTION - May be indicated when nodes are palpable bilaterally, feel large, warm, tender, firm but freely movable• MALIGNANCY - May be indicated when nodes are unilateral, hard, discrete, asymmetric, fixed, and nontender• Abnormal Nodes- Explore the area proximal (upstream) to the location of the abnormal node
  32. 32. Palpate Deep Cervical Chain
  33. 33. Palpate supraclavicular node
  34. 34. Palpate cervical nodes
  35. 35. Palpate Trachea
  36. 36. Palpate Thyroid; Posterior appraoch .
  37. 37. Palpate Thyroid: Anterior appraoch
  38. 38. HEAD & NECK• Skull palpation• Face/jaw• Head Position• Neck ROM and strength• Trachea• Cricoid cartilage• Thyroid cartilage• Thyroid