Shape

Observe eyelids, eyebrows, palpebral fissures, nasolabial folds, mouth at rest, during movement, with expression.

EXPECTED:Variations according to race, sex, age, body build.

UNEXPECTED:Change in shape. Unusual features: Edema, puffiness, coarsened features, prominent eyes, hirsutism, lack of expression, excessive perspiration, pallor, or pigmentation variations.

Symmetry

Note if asymmetry affects all features of one side or a portion of face.

EXPECTED:Slight asymmetry.

UNEXPECTED:Facial nerve weakness or paralysis, or problem with peripheral trigeminal nerve.

Size/shape/symmetry

Scalp condition

Systematically part hair from frontal to occipital region.

Hair pattern

Pay special attention to areas behind ears, at hairline, at crown.

EXPECTED:Symmetric.

UNEXPECTED:Lesions, scabs, tenderness, parasites, nits, scaliness.

EXPECTED:Bitemporal recession or balding over crown in men.

UNEXPECTED:Random areas of alopecia or alopecia totalis.

Symmetry

Palpate in gentle, rotary motion from front to back.

EXPECTED:Symmetric and smooth with bones indistinguishable. Ridge of sagittal fissure occasionally palpable.

UNEXPECTED:Indentations or depressions.

Symmetry/size

Palpate if asymmetry noted. Have patient open mouth and press on salivary duct to attempt to express material.

Symmetry

Inspect in usual position, in slight hyperextension, and during swallowing. Look for landmarks of anterior and posterior triangles.

EXPECTED:Bilateral symmetry of sternocleidomastoid and trapezius muscles.

UNEXPECTED:Asymmetry, torticollis webbing, excessive posterior skinfolds, unusually short neck, distention of jugular vein; prominence of carotid arteries, or edema