Head and Neck

Tape measure

image Cup of water

image Stethoscope

image Transilluminator


Ask patient to sit.

Observe head position
  EXPECTED:Upright, midline, still.
  UNEXPECTED:Tilted, horizontal jerking or bobbing, tics, nodding,.
Inspect facial features

image 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.

image 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.
Inspect skull and scalp

image Size/shape/symmetry

image Scalp condition

image Systematically part hair from frontal to occipital region.

image Hair pattern

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


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

EXPECTED:Bitemporal recession or balding over crown in men.

UNEXPECTED:Random areas of alopecia or alopecia totalis.
Palpate head and scalp

image 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.
Palpate hair
imageTexture/color distribution EXPECTED:Smooth, symmetrically distributed.
UNEXPECTED:Splitting or cracked ends. Coarse, dry, or brittle. Fine and silky.
Palpate temporal arteries
Note course of arteries. UNEXPECTED:Thickening, hardness, or tenderness.
Auscultate temporal arteries and over skull and eyes
  EXPECTED:No bruits.
Inspect salivary glands

image Symmetry/size

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

UNEXPECTED:Asymmetry or enlargement. Tenderness. Discrete nodule.
Inspect neck

image 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

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Mar 25, 2017 | Posted by in PHYSIOLOGY | Comments Off on Head and Neck

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