This document provides information on assessing the head and neck. It describes the anatomy of the head and neck, including the bones of the skull, facial bones, muscles and structures of the neck. It outlines the common lymph nodes of the head and neck and provides techniques for assessing them. The document discusses obtaining a health history, including questions about symptoms, and performing a physical exam of the head, neck, thyroid gland and lymph nodes. It provides guidance on normal and abnormal physical exam findings. The goal is to describe and assess the structures of the head and neck through history and physical exam.

1. ASSESSMENT OF HEAD & NECK
Ms. Gulshan Umbreen
Lecturer, SNC
PhD Scholar (Epidemiology & Public Health)

2. Learning Objectives
• Describe Anatomy of Head & Neck
• Describe Physiology of Head, Neck & facial
bones
• Define Common Head & Neck Lymph nodes
• Explain Health history question needed during
physical examination of Head

3. • Describe Specific Assessment made during
Physical Assessment of Head
• Explain Characteristics of Lymph nodes
• Describe Techniques for assessing different
lymph nodes of Neck
• Define different neck & head Abnormalities
• Explain how document subjective & Objective
Data Findings

4. • Head and neck assessment focuses on the
cranium, face, thyroid gland, and lymph
node structures contained within the head
and neck.

5. • THE HEAD
• The framework of the head is the skull, which
can be divided into two subsections: the cranium
and the face
• Cranium
• The cranium houses and protects the brain and
major sensory
• organs. It consists of eight bones:
• • Frontal (1) • Parietal (2) • Temporal (2)
• • Occipital (1) • Ethmoid (1) • Sphenoid (1)

6. • Face
• Facial bones give shape to the face. The face
consists of
• 14 bones:
• • Maxilla (2) • Zygomatic (cheek) (2)
• • Inferior conchae (2) • Nasal (2)
• • Lacrimal (2) • Palatine (2)
• • Vomer (1) • Mandible (jaw) (1)

8. • All of the facial bones are immovable except for the
mandible, which has free movement (up, down, and
sideways) at the temporomandibular joint.
• The face also consists of many muscles that produce
facial movement and expressions.
• The temporal artery, a major artery, is located
between the eye and the top of the ear. Two other
important structures located in the facial region are
the parotid and submandibular salivary glands.

9. • The parotid glands are located on each side of
the face, anterior and inferior to the ears and
behind the mandible.
• The submandibular glands are located inferior
to the mandible, underneath the base of the
tongue.

10. THE NECK
• The structure of the neck is composed of
muscles, ligaments, and the cervical vertebrae
Contained within the neck are the hyoid bone,
several major blood vessels, the larynx, trachea,
and the thyroid gland, which is in the anterior
triangle of the neck.

11. Muscles and Cervical Vertebrae
• The sternomastoid (sternocleidomastoid) and
trapezius muscles are two of the paired muscles
that allow movement and provide support to the
head and neck.
• The sternomastoid muscle rotates and flexes
the head, whereas the trapezius muscle extends
the head and moves the shoulders.

13. Blood Vessels
• The internal jugular veins and carotid
arteries are located bilaterally, parallel and
anterior to the sternomastoid muscles.
• The external jugular vein lies diagonally
over the surface of these muscles
• Need to know the location of the carotid
arteries when assessing the neck to avoid
bilateral compression of the vessels, which
can reduce the blood supply to the brain.

15. Thyroid Gland
• The thyroid gland is the largest endocrine gland
in the body. It produces thyroid hormones that
increase the metabolic rate of most body cells.
• The thyroid gland is surrounded by several
structures that are important to palpate for
accurate location of the thyroid gland.
• The trachea, through which air enters the lungs,
is composed of C-shaped hyaline cartilage rings.
The first upper tracheal ring, called the cricoid
cartilage, has a small notch in it.

16. • The thyroid cartilage (Adam’s apple) is
larger and located just above the cricoid
cartilage.
• The hyoid bone, which is attached to the
tongue, lies above the thyroid cartilage and
under the mandible

18. LYMPH NODES OF THE HEAD AND
NECK
• Lymph nodes filter lymph, a clear substance
composed mostly of excess tissue fluid, after the
lymphatic vessels collect it but before it returns to
the vascular system.
• This filtering action removes bacteria and tumor
cells from lymph.
• In addition, lymphocytes and antibodies are
produced in the lymph nodes as a defense against
invasion by foreign substances.

19. • The size and shape of lymph nodes vary but
most are less than 1 cm long and are buried deep
in the connective tissue, which makes them non-
palpable in normal situations.
• They usually appear in clusters that vary in size
from 2 to 100 individual nodes.

20. Common Head and Neck Lymph Nodes
• The most common head and neck lymph nodes are
referred to as
• follows:
• • Preauricular
• • Postauricular
• • Tonsillar
• • Occipital
• • Submandibular
• • Submental
• • Superficial cervical
• • Posterior cervical
• • Deep cervical
• • Supraclavicular

22. HISTORY OF PRESENT HEALTH
CONCERN
• Pain
• Do you experience neck pain?
• Do you experience headaches? Describe.
• Do you have any facial pain? Describe.
• Do you have any difficulty moving your head or
neck?

23. Other Symptoms
• Have you noticed any lumps or lesions on your head or
neck that do not heal or disappear? Describe their
appearance and location.
• 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 changes in your energy level, sleep
habits, or emotional stability?
• Have you experienced any palpitations, blurred vision
or changes in bowel habits?

24. COLDSPA Example
Mnemonic
Character
Question Client
Describe the sign or
symptom
Response Example
“I have trouble turning my head to the
right.”
Onset When did it begin? “Two days ago when I woke up in the
morning,
and it is getting worse.”
Location Where is it? Does it
radiate? Location Does it occur “In the back of
my neck and it radiates to my
anywhere else? right shoulder with
movement.”

25. Duration Duration How long
does it last? Does it
recur?
Duration How long does it last? Does it
recur? “It is OK if I just sit still, but it
hurts more
if I turn.”
Severity Severity How bad is
it? How much does it
bother you?
“It is difficult to drive because I I can’t
see over my shoulder to change lanes.”
Pattern
Associate
d factors/
How it
affects the
client
Pattern What makes it
better or worse?
How does it affect
you?
“Ibuprofen and a heating pad or warm
shower
helps a little.”
“I can’t do my work on the computer
being irritated with it.”

26. PAST HEALTH HISTORY
• Describe any previous head or neck problems
(trauma, injury, falls) you have had. How were
they treated (surgery, medication, physical
therapy)? What were the results?
• Have you ever undergone radiation therapy for a
problem in your neck region?

27. FAMILY HISTORY
• Is there a history of head or neck cancer in your
family?
• Is there a history of migraine headaches in your
family?

28. LIFESTYLE AND HEALTH PRACTICES
• Do you smoke or chew tobacco? If yes, how
much?
• Do you wear a helmet when riding a horse,
bicycle, motorcycle, or other open sports vehicle
(e.g., four-wheeler, go-cart)?
• Do you wear a hard hat for hazardous
occupations?
• What is your typical posture when relaxing, during
sleep, and when working?

29. • In what kinds of recreational activity do you
participate? Describe the activity.
• Have any problems with your head or neck
interfered with your relationships with others or
the role you occupy at home or at work?

30. Preparing the Client
• Prepare the client for the head and neck
examination by instructing him or her to remove
any wig, hat, hair ornaments, pins, rubber bands,
jewelry, and head or neck scarves.
• Take care to consider cultural norms for touch
when assessing the head. Some cultures (e.g.,
Southeast Asian) prohibit touching the head or
touching the feet before touching the head

31. • Ask the client to sit in an upright position with
the back and shoulders held back and straight.
• Explain the importance of remaining still during
most of the inspection and palpation of the head
and neck.
• However, explain she will be requested to move
and bend the neck for examination of muscles and
for palpation of the thyroid gland.

32. • Be aware that some clients may be anxious as
you palpate the neck for lymph nodes, especially
if they have a history of cancer that caused
lymph node enlargement.
• Tell the client what you are doing and share your
assessment findings.
• Another important thing to keep in mind as you
examine the head and neck is that normal facial
structures and features tend to vary widely
among individuals and cultures.

33. Physical Assessment
Assessment Normal Findings Abnormal Findings
Inspect the
head.
Inspect for
size,
shape, and
configuration.
Head size and shape vary,
especially
in accord with ethnicity.
Usually the head is
symmetric, round, erect,
and in midline. No lesions
are visible.
The skull and facial bones are
larger and thicker in
acromegaly, which
occurs when there is an
increased production of growth
hormone
Inspect for
involuntary
movement.
Head should be held still
and upright.
Tremors associated with
neurologic disorders
may cause a horizontal jerking
movement. An involuntary
nodding movement may be
seen in patients with aortic
insufficiency.

34. Palpate the head.
Palpate for
consistency.
The head is
normally hard and
smooth
without lesions.
Lesions or lumps on the
head may
indicate recent trauma or
cancer.
Inspect the face.
Inspect for
symmetry,
features, movement,
expression, and
skin condition.
The face is
symmetric with a
round, oval,
elongated, or square
appearance.
No abnormal
movements noted.
Asymmetry in front of the
earlobes occurs with
parotid gland enlargement
from an abscess or tumor.
Unusual or asymmetric
orofacial movements
may be from an neurologic
problem,
In older clients, facial wrinkles are prominent because subcutaneous fat
decreases with age. In addition, the lower face may shrink and the mouth
may be drawn inward as a result of resorption of mandibular bone, also
an age-related process.

35. Palpate the temporal
artery, which is
located between the
top of the ear and
the eye
The temporal artery is
elastic and not
tender.
The strength of the
pulsation of the temporal
artery may be decreased
in the older client.
The temporal artery is
hard, thick, and
tender with
inflammation as seen
with temporal arteritis
(inflammation of the
temporal arteries that
may lead to blindness).
Palpate the
temporomandibular
joint.
To assess the
temporomandibular
joint (TMJ), place
your index finger over
the front of each ear as
you ask the client to
open her mouth
Normally there is no
swelling, tenderness, or
crepitation with
movement.
Mouth opens and closes
fully (3 to 6 cm between
upper and lower teeth).
Lower jaw moves
laterally 1 to 2 cm in each
direction.
Limited range of
motion, swelling,
tenderness,
or crepitation may
indicate TMJ
syndrome.

36. One-sided facial paralysis Palpating the temporal artery. Palpating the TMJ.

37. THE NECK
Inspect the neck.
Observe the client’s
slightly extended neck
for position, symmetry,
and lumps or masses.
Shine a light from the
side of the neck across
to highlight any
swelling.
Neck is symmetric with
head centered
and without bulging
masses.
Swelling, enlarged
masses, or nodules
may indicate an
enlarged thyroid gland
inflammation of
lymph
nodes, or a tumor.
Inspect movement of
the neck structures.
Ask the client to
swallow a small sip of
water. Observe the
movement of
the thyroid cartilage,
thyroid gland
The thyroid cartilage,
cricoid cartilage,
and thyroid gland move
upward symmetrically
as the client swallows.
Asymmetric
movement or
generalized
enlargement of the
thyroid gland is
considered
abnormal.

38. Inspect the cervical
vertebrae.
Ask the client to flex
the neck (chin to chest,
ear to shoulder, twist
left to right and right to
left, and backward and
forward).
C7 (vertebrae
prominence) is usually
visible and palpable.
Prominence or
swellings other than
the C7 vertebrae may
be abnormal.
Inspect range of
motion.
Ask the client
to turn the head to the
right and to the left
(chin to shoulder),
touch each ear to the
shoulder, touch chin to
chest, and lift the
chin to the ceiling.
Normally neck
movement should be
smooth and controlled
with 45-degree
flexion, 55-degree
extension, 40-degree
lateral abduction, and
70-degree rotation.
Muscle spasms,
inflammation, or
cervical
arthritis may cause
stiffness, rigidity,
and limited mobility of
the neck, which
may affect daily
functioning.

39. Palpation
Palpate the trachea. Place
your finger in
the sternal notch. Feel each
side of the notch and
palpate the tracheal rings
(The first upper ring above
the smooth tracheal rings is
the cricoid
cartilage.
Trachea is midline. The trachea may be
pulled to one side in
cases of a tumor,
thyroid gland
enlargement,
aortic aneurysm,
pneumothorax,
atelectasis, or fibrosis.
Palpate the thyroid
gland. Locate key
landmarks with your index
finger and thumb
Landmarks are
positioned midline.
Landmarks deviate
from midline or are
obscured because of
masses or abnormal
growths.

40. • Hyoid bone (arch-shaped bone that does not
articulate directly with any other bone; located
high in anterior neck).
• Thyroid cartilage (under the hyoid bone; the area
that widens at the top of the trachea), also known
as the “Adam’s apple.”
• Cricoid cartilage (smaller upper tracheal ring
under the thyroid cartilage).

41. Palpating the trachea

42. Inspecting the neck. (A) Slightly extended
neck discloses internal structure. (B) Neck
structures move (rise and fall).
Diffuse enlargement of
the Thyroid gland.

43. • To palpate the thyroid, use a posterior approach.
Stand behind the client and ask her or him to
lower the chin to the chest and turn the neck
slightly to the right.
• This will relax the client’s neck muscles. Then
place your thumbs on the nape of the client’s
neck with your other fingers on either side of the
trachea below the cricoid cartilage. Use your left
fingers to push the trachea to the right. Then use
your right fingers to feel deeply in front of the
sternomastoid muscle

44. Normal Findings
• Unless the client is extremely thin with a long
neck, the thyroid gland is usually not palpable.
However, the isthmus may be palpated in
midline. If the thyroid can be palpated, the lobes
are smooth, firm, and nontender.
• Abnormal Findings
• In cases of diffuse enlargement; such as
hyperthyroidism, Graves’ disease, or an endemic
goiter, the thyroid gland may be palpated. An
enlarged, tender gland may result from thyroiditis.
Multiple nodules of the thyroid may be seen in
metabolic processes.

45. Palpating the Thyroid

46. Auscultation
Auscultate the thyroid
only if you find
an enlarged thyroid
gland during
inspection or palpation.
Place the bell of
the stethoscope over the
lateral lobes of the
thyroid gland . Ask the
client to hold his breath
(to obscure any tracheal
breath sounds while you
auscultate).
No bruits are
auscultated.
A soft, blowing,
swishing sound
auscultated
over the thyroid lobes
is often
heard in
hyperthyroidism
because of an
increase in blood flow
through the
thyroid arteries.

47. Auscultating for bruits over the thyroid gland

48. General Guidelines for Palpation
of Lymph Nodes
• Have the client remain seated upright. Then
palpate the lymph nodes with your finger pads in
a slow walking, gentle, circular motion.
• Ask the client to bend the head slightly toward
the side being palpated to relax the muscles in
that area.
• Compare lymph nodes that occur bilaterally. As
you palpate each group of nodes, assess their
size and shape, delimitation (whether they are
discrete or confluent), mobility, consistency, and
tenderness.

49. Characteristics of the Lymph Nodes
• While palpating the lymph nodes, note the
following:
• Size and shape
• Delimitation
• Mobility
• Consistency
• Tenderness and location

50. Size and Shape
• Normally lymph nodes, which are round and
smaller than 1 cm, are not palpable. In older
clients especially, the lymph nodes become
fibrotic, fatty, and smaller because of a loss of
lymphoid elements related to aging. (This may
decrease the older person’s resistance to
infection).

51. • When lymph node enlargement exceeds 1 cm, the
client is said to have lymphadenopathy, which may
be caused by acute or chronic infection, an
autoimmune disorder, or metastatic disease.
• If one or two lymphatic groups enlarge, the client
is said to have regional lymphadenopathy.
• Enlargement of three or more groups is
generalized lymphadenopathy. Generalized
lymphadenopathy that persists for more than 3
months may be a sign of human immunodeficiency
virus (HIV) infection.

52. Delimitation
• Normally lymph node delimitation (the lymph
node’s position or boundary) is discrete. In
chronic infection, however, the lymph nodes
become confluent (they merge). In acute
infection, they remain discrete.

53. Mobility
• Typical lymph nodes are mobile both from side
to side and up and down. In metastatic disease,
the lymph nodes enlarge and become fixed in
place.

54. Consistency
• Somewhat more fibrotic and fatty in older
clients, the normal lymph node is soft, whereas
the abnormal node is hard and firm. Hard, firm,
unilateral nodes are seen with metastatic
cancers.

55. Tenderness and Location
• Tender, enlarged nodes suggest acute infections;
normally lymph nodes are not sore or tender. Of
course, you need to document the location of the
lymph node being assessed.

56. Lymph Nodes of the Head and Neck
Assessment Procedure Normal Findings Abnormal Findings
Palpate the preauricular
nodes (in front of the
ear), postauricular
nodes (behind the ears),
occipital nodes (at the
posterior base of the
skull).
There is no swelling
or enlargement and
no tenderness.
Enlarged nodes are
abnormal.
Palpate the tonsillar
nodes at the angle
of the mandible on the
anterior edge of
the sternomastoid muscle
No swelling, no
tenderness, no
hardness
is present.
Swelling, tenderness,
hardness, immobility
are abnormal.

57. Palpate the submandibular
nodes located on the medial
border of the mandible
No enlargement or
tenderness is
present.
Enlargement and
tenderness are
abnormal.
Palpate the submental
nodes, which are
a few centimeters behind
the tip of the
mandible
No enlargement or
tenderness is
present.
Enlargement and
tenderness are
abnormal.
Palpate the superficial
cervical nodes in
the area superficial to the
sternomastoid
muscle.
No enlargement or
tenderness is
present
Enlargement and
tenderness are
abnormal.

58. Palpating the tonsillar, Submandibular,
Supraclavicular Nodes.

59. Palpate the posterior
cervical nodes in
the area posterior to the
sternomastoid
and anterior to the
trapezius in the posterior
triangle.
No enlargement or
tenderness is present.
Enlargement and
tenderness are
abnormal.
Palpate the deep
cervical chain nodes
deeply within and
around the
sternomastoid
muscle.
No enlargement or
tenderness is present.
Enlargement and
tenderness are
abnormal.

60. Palpate the
supraclavicular nodes
by
hooking your fingers
over the clavicles
and feeling deeply
between the clavicles
and the sternomastoid
muscles
No enlargement or
tenderness is present.
An enlarged, hard,
nontender node,
particularly
on the left side, may
indicate
a metastasis from a
malignancy in the
abdomen or thorax.

61. Head & Neck Common Abnormailities
Acromegaly is characterized by
enlargement of the facial features
(nose, ears) and the hands and feet.
A moon-shaped face with reddened
cheeks and increased facial hair may
indicate Cushing’s syndrome.

62. A tightened-hard face with thinning
facial skin is seen in scleroderma.
Exophthalmos is seen in
hyperthyroidism.

63. VALIDATING AND
DOCUMENTING FINDINGS
• Validate the head and neck assessment data that
you have collected.
• This is necessary to verify that the data are
reliable and accurate. Document the assessment
data following the health care facility or agency
policy.

64. Sample of Subjective Data
• No history of head or neck problems, trauma, or
surgery. No head or facial pain. Has not
experienced episodes of lightheadedness or
dizziness. Does not chew or smoke tobacco.
Works as secretary. Has good work setting and
equipment to promote correct posture. Rides bikes
10 miles four times a week to relieve stress. Wears
a bike helmet. Has no complaints about current
condition of head and neck.

65. Sample of Objective Data
• Head symmetrically round, hard, and smooth
without lesions or bumps. Face oval, smooth, and
symmetric. Temporal artery elastic and nontender.
Temporomandibular joint palpated with full range
of motion without tenderness. Neck symmetric with
centered head position and no bulging masses. C7
is visible and palpable with neck flexed. Has
smooth, controlled, full range of motion of neck.
Thyroid gland nonvisible but palpable when
swallowing.

66. • Trachea in midline. Lymph nodes non- palpable
except for a few deep cervical less than 1 cm
bilaterally.

67. Reference
• Weber, J. R. (2001). Nurses handbook of health
assessment (4th ed). Philadelphia: J. B.
Lippincott.