Assessment of the Head,

Face, and Neck

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PRETEST
1. Joins mandible and temporal bone,
allowing movement of the mandible.

2. Small hairs that filter air.

3. Controls sense of smell. Stimulated by

olfactory receptor cells located in upper
nasal cavities.

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PRETEST
4. Needed for chewing; also have esthetic
value.

5. Help to anchor teeth, part of oral

mucosa, cover alveolar bone.

6. Muscle controlled by CN XII; needed for

chewing, swallowing, and speech.

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PRETEST
7. It is the most posterior portion of
the pharynx.

8. Forms the floor of the nasal cavity.

9. Posterior to hard palate, elevates during

swallowing to prevent food and saliva
from entering the nasopharynx.

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PRETEST
10. Fleshy conelike structure in the center
of the soft palate that prevents food from
entering nasal passages.

11. Secrete saliva, which contains amylase to

convert starch to maltose.

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PRETEST
12. Salivary glands anterior to the ear.
Secretions help lubricate food to facilitate
chewing and swallowing.

13. Drains the parotid gland, enters the oral

cavity through the buccal mucosa,
opposite the second upper molar.

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PRETEST
14. Located at the posterior corner of the
mandible.

15. Drains submandibular and sublingual

salivary glands, enters the oral cavity
under the tongue on the floor of the
mouth.

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PRETEST
16. Controls metabolism and helps regulate
calcium.
17-18. The thyroid is the largest endocrine
organ and produces ____ and ____
which are largely involved in the body’s
metabolism as well as cardiovascular,
gastrointestinal, and neuromuscular
functions.

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PRETEST
19. Located on the posterior side of the
thyroid; increase blood calcium levels.

20. Part of the lymphatic system. Drain the

structures of the head and neck.

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ANSWERS
1. Joins mandible and temporal bone, allowing
movement of the mandible.
-TEMPOROMANDIBULAR JOINT

2. Small hairs that filter air.

-CILIA
3. Controls sense of smell. Stimulated by
olfactory receptor cells located in upper
nasal cavities.
-OLFACTORY NERVE ( CN 1)
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ANSWERS
4. Needed for chewing; also have esthetic
value.
- TEETH

5. Help to anchor teeth, part of oral mucosa,

cover alveolar bone.
- GINGIVA/ GUMS
6. Muscle controlled by CN XII; needed for
chewing, swallowing, and speech.
- TONGUE
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ANSWERS
7. It is the most posterior portion of
the pharynx.
- LARYNGOPHARYNX
8. Forms the floor of the nasal cavity.
- HARD PALATE
9. Posterior to hard palate, elevates during
swallowing to prevent food and saliva
from entering the nasopharynx.
- SOFT PALATE

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ANSWERS
10. Fleshy conelike structure in the center
of the soft palate that prevents food from
entering nasal passages.
- UVULA
11. Secrete saliva, which contains amylase to
convert starch to maltose.
- SALIVARY GLANDS

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ANSWERS
12. Salivary glands anterior to the ear.
Secretions help lubricate food to facilitate
chewing and swallowing.
- PAROTID GLANDS

13. Drains the parotid gland, enters the oral

cavity through the buccal mucosa,
opposite the second upper molar.
- STENSEN’S DUCT
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ANSWERS
14. Located at the posterior corner of the
mandible.
- SUBMANDIBULAR GLANDS

15. Drains submandibular and sublingual

salivary glands, enters the oral cavity
under the tongue on the floor of the
mouth.
- WHARTON’S DUCTS
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ANSWERS
16. Controls metabolism and helps regulate
calcium.
- THYROID

17-18. The thyroid is the largest endocrine

organ and produces ____ and ____ which
are largely involved in the body’s metabolism
as well as cardiovascular, gastrointestinal, and
neuromuscular functions.
- T3(THYROXINE)
- T4 ( TRIIODOTHYRONINE)

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ANSWERS
19. Located on the posterior side of the
thyroid; increase blood calcium levels.
- PARATHYROID GLAND
20. Part of the lymphatic system. Drain the
structures of the head and neck.
- CERVICAL LYMPH NODES

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Skull: Cranial Skull
It consists of eight bones:
Frontal “1”
Parietal “2”
Temporal “2”
Occipital “1”
Ethmoid “1”
Sphenoid “1”

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DEVELOPMENTAL, CULTURAL,
AND ETHNIC
VARIATIONS

Infants and Children

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Head
 At birth, the head is molded into a less than
round shape during vaginal delivery, yet it
assumes a symmetrical for several days.
 The fontanels remain open, but close over
the first year of life.
 The head circumference if large head can
indicate hydrocephaly, whereas a small head
can indicate a developmental delay.
 In comparison to the head of an adult, the
head of an infant or toddler is large in
proportion to its body.

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Nose and Sinuses
 Only the ethmoid and maxillary sinuses
are fully developed at birth.
 Others develop over the first 7 years.
 Children have a tendency to place small
objects in their noses.
 Unilateral purulent drainage often results.

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Teeth
 The number of teeth varies, depending on
a child’s age.
 Infants get their first incisors at
approximately 6 months of age.
 At age 6 or 7 years, they gradually begin
to lose the 20 deciduous teeth, which are
replaced with 32 permanent ones.

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Throat and Neck

 The tonsils, which are small in infancy, may

become larger during childhood. They often
become smaller again by approximately age
12.
 The neck muscles of an infant are weak, and
the infant must develop control of them to
control the head.
 The thyroid of infants and children is not
palpable.
 It is not unusual for young children to have
palpable, small cervical nodes.

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Pregnant Women

Neck
 Pregnant women may have palpable thyroids
because the gland is stimulated by estrogen
and develops increased vascular supply.
Face
 (chloasma or the mask of pregnancy) may
occur.
Mouth
 Hypertrophy of the gums may occur during
pregnancy.

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Older Adults

Teeth
 Older people lose some of their teeth.
 They often have dental prostheses. Dentition
plays a significant role in the nutrition of
elderly people.
Mouth and Nose
 Older people tend to have decreased
production of saliva.
 With age, the senses of olfaction and taste
may be diminished, which can affect
nutritional status.

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SYMPTOM ANALYSIS

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 Symptom Analysis
Head Pain
Head pain can be associated with a variety of problems,
including migraines, tension, systemic infections, and
trauma.
Jaw Tightness and Pain
The cause may be TMJ syndrome, trauma or
infection/inflammation in the structures near the jaw
An important consideration for jaw discomfort is
whether it might be caused by cardiovascular disease.
Always ask patients if they have a personal or family
history of heart disease.
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Symptom Analysis
Neck Pain and Stiffness
Can stem from musculoskeletal problems
as well as from infections.
Neck Mass
It might be a goiter of the thyroid gland or
enlarged lymph nodes.
Enlarged nodes may signal either an
infectious or a malignant disorder

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 Symptom Analysis
Nasal Congestion
Is usually caused by an upper respiratory
infection or allergy.
Nosebleed
Epistaxis, or nosebleed, is usually self-limited
and has relatively benign causes.
It can be caused by coagulopathies or other
hematologic disturbances, malignancies,
hypertension, or trauma.
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Symptom Analysis
Mouth Lesions
Can be caused by a malignancy, trauma,
nutritional deficit, or poorly fitted dentures
or orthodontic appliances.
Mouth and Dental Pain
Can be caused by ischemic heart disease,
musculoskeletal disorders, or dental
problems.

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 Symptom Analysis
Sore Throat
The most common cause is a bacterial or
viral illness. However, throat discomfort can
be associated with throat masses, including
thyroid hypertrophy or malignancies, foreign
objects in the throat, and other causes.

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 Symptom Analysis
Hoarseness
May be caused by overuse of the voice, for
example, prolonged periods of shouting or
loud speech.
It can also be an indication of gastroesophageal
reflux, malignancies, neuromuscular
disorders, or other health problems.

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Assessing the Head and Face

 Inspection:
 Have patients remove hats, wigs, or hair.
 Put on gloves in case there are open
lesions under the hair.
 Begin with inspection.
 Identify the prominences of the brows,
cheeks, mastoids, and occiput.

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Assessing the Head and Face

 Palpation
 There should be no tenderness and,
except in infants, no soft areas in the
head.
 Palpate the TMJ, ask the patient to open
and close his or her mouth and deviate
his or her jaw from side to
side.
Determine sensation, motion, and strength
of the face.
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 Assessing the Sinuses
 Assessment of the sinuses includes
inspection (with transillumination), palpation,
and percussion.

 Only the frontal and maxillary sinuses are

readily accessible for assessment.

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Paranasal Sinuses

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Assessing the Sinuses
 Inspection
 A transilluminator should be used; however,
either a penlight or an otoscope with a
speculum attached are good alternatives.
Transillumination requires a darkened room.
To transilluminate the frontal
 sinuses, hold the light source so that the
light is directed
 upward from just below the brows.A glow
of light may be

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 Assessing the Sinuses
Palpation
Palpate the sinuses for tenderness.To palpate the
frontal sinuses,press upward just below the
medial third of each eyebrow.
To palpate the maxillary sinuses, apply pressure
to the lower portion of the cheeks, below the
eyes.
Percussion
If tenderness is elicited with palpation, omit
percussion over that area.

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Assessing the Nose

 Inspect the external structures

 Palpate the external structures
 Inspect the internal structures (nasal
cavity).
 Turbinates: Superior, middle, and inferior
Bony conchae (folds) of the internal nasal
walls that increase the surface area for air
to be filtered, warmed, and humidified
before entering the lungs.
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Assessing the Nose

Inspection
Inspection of the septum, nasal mucosa, and
medial and inferior turbinates.
If you are using an otoscope with a wide-
tipped speculum, stabilize the patient’s
head with one hand and then slowly and
gently insert the speculum into the nares.
Take care not to press on the central
septum because this area is sensitive.
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 Assessing the Nose

Palpation
Palpate the bony ridge and soft tissues of the
external nose.
The cartilaginous, distal two-thirds of the
nose should be mobile without pain.
Gently occlude one nostril at a time and have
the patient inhale through the nose to
determine patency

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Assessing the Mouth and Throat

Inspection
Inspect the lips, gingiva, buccal mucosa,
tongue, and pharynx for color, lesions, and
exudates.
Note the color, number, condition, and
occlusion of the teeth.
Using the tongue blade to displace the
cheeks and lips, first inspect the buccal
mucosa.
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Assessing the Mouth and Throat

The Stensen’s ducts are located on the

buccal mucosa at the point of the second
upper molars.
The Wharton’s ducts, openings for the
submandibular
glands, are located on either side of the
frenulum under the tongue.
Inspect all aspects of the tongue: Note the
color, moisture, and surface texture and
observe for any swelling. Observe the
frenulum and the mobility of the tongue.

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Assessing the Mouth and Throat

Palpation
Palpate the tongue for nodules or areas of
thickening.
 The parotid, submandibular, and sublingual
glands should also be palpated for
enlargement and tenderness.

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Assessing the Neck

 Inspection
 Inspect the cervical lymph nodes and
thyroid gland.
 Remember, lymph nodes drain toward the
center of the body.
 When examining the thyroid gland, focus
your attention on the middle to lower
third of the anterior neck, checking for
enlargements.
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Assessing the Neck

Palpation
The order in which you palpate the cervical
lymph nodes is not important, although it is
best to develop a sequence and be
consistent to ensure that you do not omit a
group.

One common sequence is to start with the

preauricular nodes, followed by the
postauricular nodes, then move to the
tonsillar, submandibular, and submental
nodes along the mandible.
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Assessing the Neck

 Palpate the occipital area, followed by the

superficial and deep cervical, posterior
cervical, and supraclavicular nodes.
 Palpate node groups gently with one or two
fingers, applying alternate pressure.
 Palpate any identified nodes between two
fingers to establish their dimensions, texture,
consistency, and shape.
 Although the lymph nodes are generally not
palpable, it is not unusual to identify them at
1 cm or less in size.

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 Assessing the Neck

 Palpable lymph nodes should be described

according to their location, size, shape,
consistency, mobility, and tenderness.
 Palpable small nodes should be soft, freely
mobile, distinct, round, and nontender.
 The term used to describe enlarged nodes (1
cm in diameter) is lymphadenopathy.
 Lymphadenopathy can be regional (involving one
or two groups) or more generalized (involving
three or more groups).

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H E L P F U L H I NT S

• Lymphatic tissue is largest in childhood

and decreases in size with age.
Normal palpable node are more likely to be
found in children than in adults.
• Patients who present with a sore throat
often complain about “swollen glands.”
They are actually feeling their
submandibular salivary glands.

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 To distinguish between salivary glands and
lymph nodes, remember:
 A normal lymph node is either small (1 cm),
round, soft, movable, and nontender or tender
and enlarged with infection.
 Submandibular glands are larger, soft, glandular,
and not freely movable.
 A palpable normal node is more likely to be a
superficial node than a deep cervical one.
 Deep cervical nodes are normally
nonpalpable
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Neck
 Thyroid Gland:
 Controls metabolism and helps regulate
calcium.
 The thyroid is the largest endocrine organ
and produces (T4) and (T3), which are
largely involved in the body’s metabolism as
well as cardiovascular, gastrointestinal, and
neuromuscular functions.
 The thyroid also produces calcitonin, which
lowers calcium and phosphate blood levels.

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Neck
 Parathyroid Glands: Located on the
posterior side of the thyroid; increase
blood calcium levels.

 Cervical Lymph Nodes: Part of the

lymphatic system. Drain the structures of
the head and neck.

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Thyroid
 To palpate the thyroid, use an anterior or
posterior approach.
 Begin by locating the thyroid gland.
 Although the thyroid is usually nonpalpable,
you may be able to feel the isthmus, which
connects the two lobes and lies below the
cricoid cartilage.
 The lobes are located behind the
sternocleidomastoid muscle.
 The likelihood of palpating the isthmus
increases with very thin or pregnant

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Auscultation

 The final portion of the neck examination,

auscultation of the thyroid gland, is generally
reserved for situations in which the thyroid
is enlarged or a mass is palpated.
 To auscultate the gland, place the bell of
your stethoscope over one lobe, then the
other. Ask the patient to briefly stop
breathing as you auscultate, to optimize your
ability to hear without the distraction of the
tracheal breath sounds.
 There should be no thyroid sounds.
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