Head and Neck

Auscultation, infant, head and neck

Same as adult

Myxedema

Skin and tissue disorder 2/2 prolonged hypothyroidism Hyaluronic acid and chondroitin sulfate accumulate d/t decreased metabolic rate, causes mucinous edema w/ coarse thick skin, puffy eyes, pretibial myxedema Constipation, deafness, cognitive slowing

Microcephaly, infant

Smaller than normal head d/t improper brain development, 2-3 SD below mean Infection, anatomic problems Associated w/ intellectual disability, failure of normal development

Social history considerations, head and neck

Sports/weight training, stress, employment, living conditions/risk for injury

HA differential

Migraine, medication rebound, cluster, hypertensive, muscular tension, temporal arteritis, space-occupying lesion

Infant development, head & neck

7 cranial bones separated by sagittal, coronal, lambdoidal sutures + anterior and posterior fontanels Ossification of sutures at 6 Posterior fontanel closes by 2 months, anterior by 2 year

Hashimoto Thyroiditis

AI antibodies against TPO, thyroglobulin, TSH receptor that decrease production of thyroid hormone More common in children and women 30-50, enlarged, nontender, smooth thyroid

Grave's disease

AI antibodies stimulate TSH receptor, common in 3rd and 4th decades, general sx of hyperthyroidism Also: exophthalmos, diffuse thyroid enlargement, pretibial myxedema

Torticollis

Birth trauma or IU malposition: one SCM shortened relative to the other, head twisted toward affected SCM, chin elevated and turned to opposite side Firm, fibrous mass along affected muscle Acquired: tumor, trauma, CN palsy, muscle spasm, meds

Auscultation, adult, head and neck

Bruit if large vascular malformations on face Vascular anomoly of brain suspected: bell over temporal region, eyes, below occiput for bruit Enlarged thryoid: continuous bruit Systolic bruit of carotid artery

Neck formed by

Cervical vertebrae, ligaments, SCM, trapezius

Branchial cleft cyst

Fuctuant mass, lateral to midline d/t incomplete involution of the branchial cleft Epithelium lined cyst w/ or w/o sinus tract to overlying skin, normally painless unless infected

Family history considerations, head and neck

HA, thyroid disorder, autoimmune

Inspection, infant, head and neck

Head circumference, bulges (caput vs cephalohematoma), head shape, control, position, movement Nuchal folds, webbing, masses, edema of neck Transillumination for suspected fluid accumulation/decreased brain tissue

HPI considerations, head and neck

Head injury: LOC, vision or breathing change, pain HA: aura, precipitating, N/V Stiff neck: injury, electronics use, illness, ROM and movement Thyroid problem: hot/cold, swallowing pain, change in hair or nails, exopthalmos, palpitations, change to menses or bowel habits, herbal supplements

Palpation, infant, head and neck

Identify suture lines and fontaneles, SCM, clavidcles, trachea

Temporal artery

Major accessible artery of the face, passing anterior to the ear, over temporal muscle, and onto forehead

Adolescent development, head & neck

Males: nose and thyroid enlarge, facial hair develops

Anterior triangle of the neck

Medial SCM Mandible Midline

Craniosynostosis, infant

Misshapen head d/t premature closure of cranial sutures, look for signs of increased intracranial pressure if multiple sutures close Skull growth restricted perpendicular to fused suture

Encephalocele, infant

NTD w/ protrusions of brain and membranes through skull openings May have genetic component Dx w/ IU US or at birth, may co-occur with hydrocephalus, other brain malformations

Palpation, adult, head and neck

Scalp symmetry and smoothness, ridges from suture closure may be felt normally Palpate temporal arteries, TMJ space, salivary glands (open mouth)

Percussion, adult, head and neck

Only if eliciting Chvostek sign + indicates HYPO calcemia, may lead to hypocalcemic tetany

Thyroglossal duct cyst

Palpable cystic mass in neck, midline, arising from foramen cecum where anterior 2/3 and posterior 1/3 of the tongue meet May be tender, red, result in difficulty with swallowing or breathing Moves w/ tongue protrusion, swallowing

External landmarks of the face

Palpebral fissures Nasolabial fold

Salivary gland tumor

Parotid usually, slow growing, painless lump, facial weakness, fixation, sensory loss, ulceration, difficulty w/ motor control Benign: pleomorphic adenoma Malignant: less likely to be smooth and regular

Glands of the face

Parotid, submandibular, sublingual: paired, produce saliva Parotid anterior to ear Submandibular medial to mandible Sublingual anterior floor of mouth

Adult head and neck inspection

Symmetry, shape, movement Marked asymmetry: neuro deficit Involuntary movement + pulse: aortic insufficiency Moon-shaped facies, exophthalmos, myxedema facies, malar rash, course features, dilated scalp veins, bossing, flat filtrum, widespread eyes

Older adult development, head & neck

T4 production and degradation decrease, thyroid becomes more fibrotic

Pregnancy changes, head & neck

Thyroid changes, should not be appreciable on exam unless iodine deficient

Neck contains

Trachea, esophagus Internal and external jugular veins Common, internal, and external carotid arteries Thyroid

Posterior triangle of the neck

Trapezius SCM Clavicle

PMH considerations, head and neck

Trauma, recent LP, hx of migraine, motion sickness as a child, radiation treatment, surgery for goiter/tumor, autoimmune dz, seizure disorder, anxiety