Head and Neck
Including Regional
Lymphatics
N1037
Head and Neck &
Regional Lymphatics
Review and locate – The
Skull (bones of the
cranium and the face)
Note the location of the
CRANIAL BONES
Frontal, Parietal, Occipital
& Temporal
Note the location of the
sutures.
Coronal, Sagittal,
Lambdoid
Unite adjacent cranial
bones
Note facial bones.
Nasal, Lacrimal, Maxilla,
Sphenoid & Zygomatic bones.
Mandible (moves up, down,
sideways)
Head-facial muscles



Facial expressions are formed by
facial muscles
Facial structures should be
symmetric.
Facial muscles are innervated by
cranial nerve VII
Note major Neck
muscles.
Sternocleidomastoids and
trapezii muscles
(each side of neck form
2 triangles- anterior &
posterior cervical )
Thyroid gland and
other landmarks
Thyroid gland - largest endocrine gland
-secretes T3 & T4 to regulate cellular
metabolism
-flattened butterfly shape structure
- 2 lateral lobes connected by isthmus
- isthmus rest on trachea, inferior to
the criocoid cartilage (highest point
Adam’s Apple)
Note location of lymphatics
1. Preauricular,
2. post. auricular,
3. occipital,
4. submental,
5. submandibular,
6. Jugulodigastric or tonsillar,
7. superficial cervical chain,
8. deep cervical chain,
9. post. cervical,
10. supraclavicular.
Lymph Nodes
 Usually
less than 1 cm
 round or ovid in shape
 smooth in consistency
 when
enlarged or tender - assess for
infection or maligancy and the area
the node drains ( see p322 example)
BLOOD SUPPLY
 Major
arteries to head and neck
– common carotids bifurcate into
– internal & external carotids
 Major
veins from head and neck
– internal an external jugular veins
– and subclavian veins
Head and Neck &
Regional Lymphatics
Health History
Subjective Data
Head and Neck & Regional
Lymphatics- Health Hx
facial or neck surgery
• history of headaches or dizziness
• allergies
• Neck pain, limitation of movement
• Lumps or swelling, difficulty
swallowing or chewing, history of
smoking
• head injuries
•
Head: Inspect and
palpate the skull
Objective Data
Head: Inspect and palpate the
skull
Size and Shape
 (I)Normocephalic: round, symmetric
and approximated to body size.
 (P)Shape: symmetric and smooth, no
tenderness reported.
– Use finger pads on scalp & palpate all surfaces
– Assess contour, masses, depressions,tenderness
– Note deformities lumps and tenderness.
Head: Inspect and palpate the
scalp
 (I)
Scalp should be shiny, intact and
without lesions or masses.
– Part hair repeatedly and inspect scalp
 (P)
palpate with finger pads on the
scalp for lesions or masses
Head: Inspection of the face



(I) Symmetry of facial features:
– Observe facial expression, shape and
symmetry of nose, eyes, eyebrows, mouth,
ears
(I) Shape and features of face
– Note shape of face
– Note swelling (edema) , abnormal features,
disproportionate structures (stroke, Bell’s Palsy
= cranial nerve 7 damage -facial nerve), and
involuntary movement (the presence of tics normally none occur)
(I) Facial expression: emotions
– Note appropriateness to verbal and nonverbal
Head: Palpate and
Auscultation of Mandible
Temporal Area
 (P)Temporal artery: above the cheek bone, between
the eye and the top of ear.
– Palpate with finger pads for pulse
 (P)Temporomandibular joint: articulates smoothly
with no limitation, no crepitus, no clicking
– use index and middle finger to palpate anterior to
tragus of ear on both sides
– ask pt to open & close mouth
– observe smoothness of movement, any discomfort
– clicking/crepitus could indicate arthritis or
dislocation
The Neck- Inspect and
palpate
Objective Data
The Neck- Inspect and palpate
What position do you ask the client to
assume while you inspect the neck?

Head erect and still, sitting up
straight, head at your eye level
The Neck- Inspect and palpate
Symmetry
 Head position: centered, midline, erect, still
 Symmetry of the Sternocleidomastoid & trapezii
muscles
 ROM of neck (flexion, lateral rotation, lateral
bending, extension, test muscle strength:Touch chin
to chest, ear to shoulder




Turn head left to right
Extend head backwards
Motions should be smooth and controlled.
resists movement of shoulder shrug and head turn side to
side

limited ROM with meningitis, muscle spasm, osteoarthritis
The Neck- Inspect and palpate

(P) Muscles - should be symmetrical &
without palpable masses or spasms
– palpate Sternocleidomastoid and trapezii muscles
for tenderness, masses, spasms
– spasms due to infections, trauma, chronic
inflammation, neoplasm
The Neck- Inspect and palpate
Lymph Nodes

(P) Lymph nodes - should not be palpable, but
small discrete , movable nodes are often
present
 Begin with preauricular lymph nodes and proceed
in a systematic fashion (1 to 10)
 Use gentle pressure
 Deep cervical chain: tip head toward side
 Supraclavicular Node: hunch shoulders & elbows
forward
tender nodes = inflamed due to infection
firm, non movable nodes may be = malignancy
The Neck- Inspect and palpate
Trachea
Midline normal (note deviations)
 Palpate for tracheal shift: space
should be symmetric on both sides.

The Neck- Inspect, palpate,
auscultate
Thyroid Gland
 inspect for swelling using lamp (ask to
sip and swallow water)
– thyroid tissue moves up with swallowing
 observe for goiter - enlarged thyroid
 palpate
-anterior/posterior approaches
– have pt slightly lower head to relax neck muscles
– palpate isthmus for nodules, masses, tenderness or
enlargement while swallowing
– then displace/stabilize lobe on one side and palpate the
other side while pt swallows
 gland is smooth, soft, & no tenderness/enlrgmt/masses
The Neck- Inspect, palpate,
auscultate
 auscultate
lobes for bruit
– (use bell)
– no bruit should be present
bruits indicate blood supply r/t tumor or toxic
goiter.
Developmental Considerations
Infant/Children
 Skull and fontanels
Pregnant Female
 Cholasma on face = pregnancy mask
Aging Adult
 Temporal arteries twisted and visible
 Rhythmic tremor of head may be present
 Perform ROM slowly to prevent dizziness