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Head and Neck Examination (Subgroup 2: lymph nodes (submandibular…
Head and Neck Examination
Subgroup 1: overall appraisal of head and neck
begins while greeting and seating patient
assessment of facial form and symmetry; inspection of skin
explain examination to patient
visually inspect head and scalp for abnormalities; inspect ears
position patient in upright position
normal findings
even distribution of hair on scalp; intact skin, uniform in color; face and neck appear symmetrical
notable findings
lesions or color changes of skin; uneven pattern of hair loss; masses in neck; wounds, bruises, scars; swelling of face or neck; asymmetry of face or neck
examination techniques
inspection
visual examination of general appearance, skin, or part of body
palpation
examination using fingertips to move or compress a structure against underlying tissue
Subgroup 2: lymph nodes
occipital
located: base of skull
your position: stand behind patient
patient position: head forward slightly
Palpation: begin at midline of neck; circular motions with fingertips to compress tissues against base of underlying bone
posterior auricular
located: behind the ear
Your position: stand behind patient
patient position: head in upright position
palpation: displace right ear forward; steady, gentle circular motions with fingertips to compress tissues against the bone of patient's skull
preauricular
located: front of ears
your position: stand behind patient
patient's position: head upright
palpation: steady, gentle circular motions with fingertips against underlying bone. Note tender or enlarged nodes
submental
location: under jaw on either side of midline of the mandible
your position: stand behind or to the side of patient
patient's position: head upright
palpation: use thumb and index finger to compress area behind and beneath the midline area of mandible. Note: tender or enlarged nodes
submandibular
location: under jaw, along side of mandible
your position: stand behind patient
facilitate palpation: Begin with right side. Use your left hand as stabilizing hand to move tissue under chin toward right side of neck. Moving the tissue toward the right side assists the examiner in rolling the tissue over the right side of the mandible.
patient's position: head upright
Right hand is used for palpation:cup your fingers under the chin; roll the tissue up and over the inferior border of mandible.Keeping fingertips in place, allow the tissue to slowly slide down over the mandible, back into normal position. As tissue moves over the mandible, enlarged nodes detected. Similarly examine nodes on left side
cervical anterior chain
location: above SCM
your position: stand behind patient
patient's position: chin down slightly; turn head left
palpation: medial to SCM; with right hand, grasp SCM between fingetips and thumb; rotate fingertips back and forth over muscle, covering entire length from behind ear to clavicle
cervical posterior chain
location:beneath and posterior to SCM
your position: stand behind patient
patient's position: chin down slightly; turn head left
palpate: nodes on right side of neck; position fingertips of index and middle fingers under SCM, applying gentle compression against underlying tissues along entire length of SCM from behind ear to clavicle; repeat CAC and CPC for left side of neck
supraclavicular
location: in the angle formed by SCM and clavicle
your position: stand to side of patient
patient's position: face forward with chin slightly down
palpation: index and middle finger above clavicle on right side of neck and apply circular compression; repeat for left side
normal findings
lymph nodes are usually not detectible; no tenderness
notable findings
infected lymph nodes
firm; tender; enlarged and warm; bilateral (both sides of head); freely movable from underlying structures; feel like swollen grape; Following infection: lymph nodes may be permanently enlarged which will be less than 1 cm, with rubbery consistency
malignancies
firm; not tender; matted (stuck together); fixed (stuck to underlying tissues); unilateral (only enlarged on one side)
Subgroup 3: salivary and thyroid glands
parotid
location: between ear and jaw
your position: stand behind or slightly to side of patient
patient's position: head upright
palpation: place palms of hands in front of ears with fingers extending full length of cheek; use circular compression
submandibular
location: below jaw toward back of mouth; antegonial notch of mandible
your position: stand behind patient
patient's position: head upright
palpation: place fingers under chin to locate gland; ask patient to press tongue against roof of mouth; bilaterally compress glands upward against tense muscles
thyroid
location: middle of lower neck; below larynx, over trachea, just above clavicles
your position: stand behind patient and position hands with thumbs on the nape of the neck
patient's position: ask patient to flex the neck forward and tilt head slightly to the right
palpation: use left hand as stabilizing hand to displace trachea slightly to the right; use right hand for palpation: position fingers between the Adam's apple and SCM; ask patient to take sip of water and swallow. gland will slide beneath fingers; normal gland will be undetectable or barely detectable
normal findings
usually not detectible; no tenderness
notable findings
salivary glands
swollen or enlarged; firm, hard consistency; tender to palation
thyroid gland
palpable gland; deviates from midline of neck; asymmetrical lobes; enlarged lobes, irregular borders; nodules present; hard, firm consistency; fixed to underlying structures
Subgroup 4: Temporomandibular Joint (TMJ)
location: place index fingers in front of tragus of ear; ask patient to open and close mouth; fingertips should drop into joint spaces
your position: stand behind patient
patient's position: head upright
palpation: place fingers on joint; ask patient to open and close several times; note any deviations during opening
palpation of lateral excursions: with hands over joint, ask patient to open slightly and move lower jaw laterally to the right. Repeat to left. Ask patient to protrude lower jaw forward; listen for abnormal sounds such as popping or clicking
normal findings
smooth motions as jaw is moved; symmetrical movement
notable findings
abnormal sounds (popping, clicking); grating sensations as jaw opens and closes; asymmetrical movements; limited range of movement; tenderness or pain reported by patient