H&N
Examination
Dr. Khaled Said
Examination of Head and Neck should include
Examination of:
• Scalp& skull
• Hair
• Face and skin
• Temporal artery
• TMJ
• Ear
• Nose
• Eyes
• Lips
Examination of Head and Neck should include
Examination of:
• Intraoral examination
• Oropharynx
• Salivary Glands
• The neck
Equipment Needed
• Examination Gloves (latex/synthetic)
• Bright light (Head light / mirror)
• An Otoscope
• Nasal Speculum
• Tongue Blades
• Cotton Tipped Applicators
• Guaze
• Lacrimal Probe Dilator
• Fiberoptic endoscope
Head
Examination of the hair, scalp, skull , face and skin
Palpation of temporal artery
Palpation and range of motion of TMJ
Hair
• Growth patterns, texture (may change in
thyroid disease), lice
Scalp& skull
• Deformity from trauma
• Tenderness: tension headaches
• Swelling
• Ulcer
• Scar
Face and skin
• Symmetry
• Involuntary movements
• Skin lesion or discoloration
Symmetry
• Landmarks of face:
• Palpebral fissures, Nasolabial folds
Palpation of temporal artery
• Immediately in front of the tragus of the ear and up
along the temple.
• Thickening, tenderness, or absent pulse in temporal
arteritis
Palpation and range of motion of
TMJ
• Place index finger tips over the TMJ lightly and ask the
patient to open and close several times
• Note restriction of opening, deviation, clicking or crepitus
Examination of Ear
External ear
• Perichondritis
External ear
• Preauricular skin tags
• Tophi
• Cauliflower
Middle ear
• Using Otoscope
Hearing Evaluation
Examination of Nose
External nose
• Inspection
• Possible findings
• Deformity - trauma
• Discharge- infection, trauma, foreign body
• Flaring - respiratory distress
Examination of Nose
Nasal cavity
Use nasal speculum
Bluish, swollen mucosa - allergies
Generalized redness- infection
Lips
• Angular cheilitis
• Angioedema
• Herpes labialis
Lips
• Pale- anemia
• Blue- cyanosis
• Red- CO poisoning
Intraoral examination Checklist
Intraoral examination Checklist
Intraoral examination Checklist
Intraoral examination Checklist
Intraoral examination Checklist
7- Floor of the mouth
Intraoral examination Checklist
8-tongue
• Geographic tongue
• Black hairy tongue
• Cancer tongue
Examination of Oropharynx
Technique
• “Say ‘ah’”
• Tongue blade, if needed, i s more palatable if moist
Findings
• Bifid uvula- may indicate cleft palate
• Asymmetric movement of soft palate- lesion of CN IX
or X
• Erythema, exudate- tonsillitis
• Asymmetric tonsillar swelling- peritonsillar abscess
• Post- nasal drip
Bifid uvula
Tonsillitis
Peritonsillar abscess
Parotid and other Salivary Glands
Examination of Salivary Glands
Examination of Salivary Glands
The commonest surgical conditions affecting the salivary glands
are:
• Infection and calculus formation in the submandibular gland,
• Tumours of the parotid gland.
Parotid Gland
Parotid Gland
Parotid Gland
Parotid Gland
Parotid Gland
SUBMANDIBULAR GLAND
SUBMANDIBULAR GLAND
• It is important to ascertain the relations of the lump to the
floor of the mouth and the tongue by bimanual palpation.
Feel the lump between the index finger of one hand inside
the mouth (suitably gloved), and the fingers of the other hand
on the outer surface of the lump.
Examination of the neck
Cervical mass is the presenting symptom in 12 to 15%
of patients with head & neck cancer.
• Metastatic disease to the cervical lymph nodes is the
most common type of cancer with
– 85% arising from an upper aerodigestive tract primary
– 10% from infraclavicular tumors
– 5% are unknown primaries.
Examination of the neck
• Range of motion of the cervical spine
• Inspection of Skin
• Examination of trachea
• Examination of lymph nodes
• Examination of thyroid
Examination of the neck
Triangles of the neck
1- Anterior: Bordered by mandibles
and sternocleidomastoids (SCM)
2- Posterior: Bordered by
trapezius, SCM, and clavicle
Examination of the neck
Examination of Cervical LN:
1-Anterior Cervical (both superficial and deep): Nodes that lie
both on top of and beneath the sternocleidomastoid muscles
(SCM) on either side of the neck, from the angle of the jaw to
the top of the clavicle.
Examination of the neck
Examination of Cervical LN:
1-Anterior Cervical (both superficial and deep): identified by
asking the patient to turn his head into your hand while you
provide resistance.
Examination of the neck
Posterior Cervical: Extend in a line posterior to the SCMs but in
front of the trapezius, from the level of the mastoid bone to the
clavicle.
Examination of the neck
Ant Cervical LN: Throat, tonsils, post pharynx, thyroid
Post Cervical LN: Back of skull
Tonsillar LN: Tonsils, posterior pharynx
Sub-MandibularL N: Floor of mouth
Sub-Mental LN: Teeth
Supra-Clavicular LN: Thorax
Pre-Auricular LN: Ear
Examination of the neck
• Level I: Contains the nodes
of the submental
and submandibular
triangles, defined
inferiorly by the
diagastric muscles.
• Level II: Contains the
upper jugular nodes
from the base of skull
to hyoid bone.
Examination of the neck
• Level III: Contains the
middle jugular nodes
from the hyoid
bone to the inferior
edge of the
cricoid cartilage.
• Level IV: Contains
the low jugular nodes
from the cricoid cartilage
to the clavicle.
Examination of the neck
• Level V: Contains the
nodes of the posterior
triangle that is bounded
anteriorly by the
SCM and posteriorly
by the trapezius.
• Level VI: Contains the nodes
of the anterior
central compartment from the
hyoid bone to the manubrium
with lateral boundaries being
the carotid arteries
Examination of the neck
• Level VII: Contains the
superior mediastinal
nodes from the level of the
superior edge of
the manubrium to the
innominate vein.
Examination of the neck
Thyroid Examination:
Examination of the neck
Thyroid Examination : Inspection
Site
Number
Shape
Size
Surface
Skin overlying
Pulsation
Site related test: Movement with deglutition
Examination of the neck
Thyroid Examination: Palpation
• Temperature
• Tenderness
• Confirm
• Shape
• Size
• Surface: smooth/irregular/lobular/nodular
• Consistency
• Lower border
•
Examination of the neck
Thyroid Examination:
Palpate as patient swallows (drinking water helps)
Thank you
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