Head, Face, and Neck

Add. history for aging adults

-Dizziness -Neck pain

The Aging Adult Development

-Facial bones and orbits appear more prominant -Facial skin sags as a result of : < elasticity < subcutaneous fat < moisture in the skin -Lower face will look smaller if teeth are lost

Thyroid Physical Examination

-Hard to examine -use lamp to view swelling -tilt head back to stretch skin -give glass of water to watch tissue move up and down Posterior approach: standing behind the person Anterior approach: standing facing the person *If lymph node is enlarged, auscultate for a bruit*

Add. history for infants and children

-Maternal alcohol/ drug use -type of delivery -Growth pattern

Pregnant Female Development

-Thyroid gland > slightly during pregnancy -causes hyperplasia of the tissue, and increased vascularity

Pilar Cyst

-also known as Wen -smooth, firm, fluctuant swelling on scalp with sebum and keratin -benign -shiny and taut

Head

-cranial bones: frontral, parietal, occipital, and parental -sutures: immovable parts where cranial bones meet -facial bones: articulate at sutures -facial muscles: mediated by cranial nerve 7 (facial expressions) -salivary glands: parotid (check), and submandibular glands

Neck

-neck muscles: sternomastoid and trapezius they are inverted by cranial nerve 11 (spinal accessory). -anterior triangle: lies in the front, between the sternomastoid and the midline of the body -posterior triangle: behind there sternomastoid muscle, with the trapezius muscle on the outside -thyroid gland: an important endocrine gland with a rich blood supply. Straddles the trachea in the middle of the neck

Aging Adult

-temporal arteries may look twisted and prominent -mild rhythmic tremor of the head is normal MAY HAVE: -Senile Tremors: benign/ include head nodding/ tongue protrusion -increased cervical curve to compensate for kyphosis of the spine -prolapse of submandibular glands (can be mistaken for tumor) Assess: -direct person to perform ROM slowly -may experience dizziness and neck pain

Trachea Physical Examination

-the trachea should be midline -palpate for tracheal shifts -place index finger on trachea in sternal notch and slip to each side -should be symmetric on both sides

Down Syndrome

A chromosomal aberration (trisomy 21) -up slanting eyes -epicanthal folds -flat nasal bridge -neck webbing

Allergic Salute and Crease

A transverse line on the nose from chronic allergies -child uses hand to push up and back their nose when itches -"allergic salute"

Atopic (allergic) facies

Children with chronic allergies such as atopic dermatitis often develop characteristic facial features characteristics: -exhausted face -blue shadows under eyes "allergic shiners" -double/single under eyelid crease (Morgan lines) -central facial pallor -open mouth breathing (allergic gaping)

Parkinson's syndrome

Deficiency of the neurotransmitter dopamine and degeneration of basal ganglia in the brain features: -flat face that is expressionless -elevated eyebrows -staring gaze -drooling

Health History questions

Factors to consider: (onset, location, character, course and duration, precipitating factors, associated factors) 1. Headache 2. Head injury 3. Dizziness 4. Neck pain/ limitation of motion 5. Lumps/ Swelling- infection? tenderness? change in size? diff. swallowing? smoker? thyroid problem? 6. History of head/ neck surgery- Ever had surgery for this?

Infants and Children Development

Fontanels: help separate the bones of neonatal skull w/ sutures, the spaces where the bones intersect. -"soft spots" -allow growth of the brain during the first year Head Growth: During fetal growth head growth predominates -Head size > chest circumference at birth -reaches 90% final size at 6 yrs. old Lymphatic System: Lymphoid tissue is well developed at birth and grows to adult size when the child is 6 yrs. old -the child's lymphatic system grows rapidly until age 10 or 11 yrs.

Lymphatics

Head and neck have up to 60-70 lymph nodes -pre-auricalar: in front of the ear -posterior auricular (mastoid): superficial to the mastoid process -occipital: at the base of the skull (posterior) -Submental: midline, behind the tip of the mandible -Jugulodigastric (tonsillar): under the angle of the mandible -Superficial cervical: overlying the sternocleidomastoid muscle -Deep cervical: deep under the sternomastoid muscle -Posterior cervical: in the posterior triangle, behind the clavicle at the sternomastoid muscle -Supraclavicular: just above and behind the clavicle, at the sternomastoid muscle

Graves disease (hyperthyroidism)

Increased production of thyroid hormones causes an increased metabolic rate -this is manifested by a goiter and exophthalmus (bulging eyeballs) Symptoms: nervousness, fatigue, weight loss, muscle cramps, heat intolerance characteristics: tachycardia shortness of breath excessive sweating infrequent blinking staring appearance

Infants Skull

Measure the head size each size up to 2, and then again at age 6. -avg. newborns head is 34-38cm -2cm longer than chest circumference -frontal bulges in head are from rickets -head may feel asymmetrical from molding of skull - note head posture/head control 2 common variations to make head look asymmetrical: 1. caput succedaneum-birth trauma/edematous 2. cephalhematoma- birth trauma/ hemorrhage/ > risk of jaundice

Infants neck

Neck will look short and grows in ages 3-4. Support the infants neck by tilting the head back a little Assess for: -ROM -flexion -extension -rotation

Special Procedures in infants

Percussion: can directly percuss with plexor finger on head surface -"cracked pot" sound is normal before closure of fonteals Auscultation: Bruits are common in the skull when younger than 4-5 w/ anemia -systolic, continuous, temporal area

Neck Physical examination

Symmetry: head is centered in the midline, accessory neck muscles should be symmetric -should be held erect and still. Range of motion: Note any limitations of movement during active motion ask the person to: 1. touch chin to chest 2. turn the head to the right and left 3.try to touch the ear to the shoulders 4.extend the head backwards -if neck is supple, motion is smooth and controlled. Lymph nodes: palpate lymph nodes in circular motion -being with pre auricular lymph and palpate 10 lymph nodes in order

Congenital Hypothyroidism

Thyroid deficiencies 1 in 4000 new borns

Myxedema (hypothyroidism)

a deficiency of the thyroid hormone that reduces the metabolic rate and when severe causes non pitting edema -hashimoto thyroiditis Symptoms: fatigue and cold intolerance Characteristics: puffy, edematous face, puffy hands and feet, cool dry skin, coarse facial features

Acromegaly

abnormal growth of hands, feet, and face caused by overproduction of growth hormone. -elongated head -massive face -heavy eye brow ridge

Cachectic Appearance

accompanies chronic wasting diseases such as: cancer, dehydration, and starvation -sunken eyes -hollow cheeks -exhausted, defeated expression

Torticollis

also known as Wryneck -hematoma in one sternomastoid muscle -results in head tilt to one side and limited neck ROM to the opposite -requires treatment -muscle can become fibrotic, permanently shortened, permanent limitation of ROM -asymmetry of head and face -visual problems b/c of non horizontal position of eyes

Pagat's disease of bone

also known as osteitis deformans -enlarged bones -causes excessive breakdown and formation of bone

Stroke "Brain attack"

an upper motor neuron lesion (central) -an acute neurological deficit caused by blood clot of a cerebral vessel -atherosclerosis or rupture in cerebral vessel -if suspect stroke ask if they can smile -note the upper and lower facial muscles -still able to wrinkle forehead and close eyes

Hydrocephalus

caused by an obstruction of drainage of CSF. results: excessive accumulation increased intracranial pressure enlarged of the head -increased pressure causes dilated scalp veins, frontal bossing, down cast eyes -cranial bones thin, sutures separate, percussion yields "cracked pot" sound

Infants face

check for: -symmetry -appearance -presence of swelling symmetry of wrinkling-crying for smiling

Pregnant Female

chloasma- blotchy, hyper pigmented area over cheeks and forehead that fade after delivery -Thyroid may be palpable during pregnancy

Cushing's Syndrome

excessive secretion of adrenocorticothrophin hormone (ACTH), and chronic steroid use characteristics: -plethoric, round, moon like face -red cheeks -hirsutism of upper lip

Scleroderma

hardening or contraction of the skin locally or through out the body

Fetal Alcohol Syndrome

increases with the amount of alcohol a pregnant woman may drink -severe cognitive and psychological impairment and changes in facial and brain structure -include a wide range of neurologic and behavioral deficits Characteristics include: -narrow palpebral fissures -epi-canthal folds -mid-facial hypoplasia

Thyroid-mutiple nodules

indicates inflammation or a multiple nodular goiter rather than a neoplasm. -refer to an ultrasonography

Bell's Palsy

lower motor neuron lesion (peripheral) -rapid onset of cranial nerve VII paralysis of facial muscles -unilateral -reactivation of herpes simplex virus (HSV-1) -COMPLETE paralysis of one half of face -condition is greatly improved with corticosteroids 72 hr. within onset

Parotid Gland Enlargement

rapid inflammation of the parotid that occurs with mumps -occurs with a blockage of duct, abscess, or tumor -swelling anterior to lower ear lobe

Head physical exam

size and shape- "Normocephalic" means a round symmetrical skull, symmetrical and smooth to body size. -Note lumps, depressions, or abnormal protrusions. Temporal area- palpate temporal artery above the zygomatic (cheek) bone, between eyes and top of the ear. -temporomandibular joint as person opens mouth -note crepitation, limited ROM, or tenderness Facial Structures- note the facial expression and its appropriateness to behavior or reported mood. -facial features should always be symmetrical -note any abnormal facial structures or abnormal swelling -note grinding of jaws, tics, fasciculations, or excessive blinking.

Thyroid-single nodules

suspect: most are benign (95%) painless, rapidly growing nodule, especially a single nodule in a young person cancerous nodules are: -hard and fixed to surrounding structure - males <15 or >45 ->4 cm in size -history of radiation exposure