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