3. REMEMBER. . .
. . . a thorough
assessment begins
with the
HISTORY!
4. HISTORY of PRESENT ILLNESS
(HPI or Symptom Analysis)
Location and Radiation
Timing: Onset, Frequency & Duration
Quality and/or Characteristics
Quantity and/or Severity
Setting and/or Situation
Aggravating Factors
Alleviating Factors
Associated Factors/Manifestations
Underlying Concern and/or Perception
5. EQUIPMENT NEEDED
Latex Gloves
Light Source
Cotton
Cup with water (optional)
Measuring tape (possible)
6. GENERAL CONSIDERATIONS
The head and neck exam is not fixed in
sequence.
Different parts of the exam may be included
and/or excluded depending on the history and
the purpose of the exam.
8. Health History
Determine presence/absence of age- and
gender-specific diseases of the head and neck
Common chief complaints
Neck pain or stiff neck
Hoarseness; nasal discharge or obstruction
Neck mass
Headache or facial pain
Head injury ; otalgia; dysphagia; ear discharge
9. General Approach to Head
and Neck Assessment
Greet patient, explain assessment
techniques
Environment
Quiet
Warm
Private
Adequate lighting
Upright sitting position
Compare right and left sides
Systematic approach
10. Where the Head Ends and Neck
Begins
Plane between the external
occipital protuberance and
inferior surface of the
mandible
Neck
Anterior triangle is bordered
by Mandible (above), Cervical
midline(laterally) and
Sternomastoid (anteriorly
11. Where the Head Ends and Neck
Begins
Neck
– Posterior triangle is
bordered by Clavicle
(below), trapezius
(posteriorly) and
Sternomastoid
(anteriorly)
12. Special Bony Areas
External Occipial
Protuberance (notch
in occipital area
Mastoid Process
(behind Ear)
Zygomatic Arch
(Cheekbone)
Orbit (eye socket)
Maxilla (upper jaw)
Mandible (lower Jaw)
13. Assessment of the Face
Inspection
Shape Normal findings
Symmetry – Symmetrical features
INSPECT – Palpebral fissures
Size, shape, and symmetry. equal
Note placement of features , – Nasolabial folds
expression, movements and present bilaterally
Skin characteristics. – Shape can be oval,
PALPATE round, or slightly
Facial bones square
15. Assessment of the Face
Abnormal findings
Deformed or absent structures
Asymmetry
More or less pronounced facial features
Diseases which may alter facial features: Bell’s palsy,
Down syndrome, Graves’ disease, Myxedema,
Cachexia, Cushing’s syndrome
17. Mandible
Palpate and auscultate the TMJ when the
client opens and closes the mouth
Normal findings
No discomfort, joint articulates smoothly without
clicking or crepitus
Abnormal findings
Pain, tenderness, crepitus, clicking, or snapping
sound
18. TEMPORMANDIBULAR
JOINT (TMJ)
Located anterior to tragus,
bilaterally
Assess Abnormals
Palpate with Tenderness,
movement crepitus, clicking
Auscultate: Bell Bruit
Pain with trismus
73. LOCATION of LYMPH NODES of the
NECK
Overlying the sternocleidomastoid
Anterior Cervical Chain
muscle
In the posterior triangle along the
Posterior Cervical Chain
trapezius muscle
Deep under the sternocleidomastoid
Internal Jugular Chain
muscle. Not normally palpated.
Just above & behind the clavicle at the
Supraclavicular
sternocleidomastoid muscle
78. DOCUMENTATION
Face:
Symmetric, no drooping, no weakness, no
involuntary movements. Temporal
artery pulses palpable, no bruits. TMJ
articulates smoothly without clicking,
crepitus or pain.