BIOE221. Session 03. Head and Neck Assessment. Bioscience Department. Endeavour College of Natural Health endeavour.edu.au

Transcription

1 BIOE221 Session 03 Head and Neck Assessment Bioscience Department

2 Session Objectives Understand the importance and rationale for the examinations of the mouth and throat Understand the importance and rationale for the examinations the ears Understand the importance and rationale for the examinations of the lymph nodes of the neck Understand the importance and rationale for the examinations the thyroid Understand the importance and rationale for the examination of the eye mucous membranes

3 Anatomy of Neck Neck Conduit for passage of many structures Blood vessels/ muscles/ nerves/ lymphatics Viscera of respiratory & digestive systems Major muscles Sternocleidomastoid muscle Trapezius both innervated by the CN11 (spinal accessory nerve) Thyroid gland Straddles the trachea in the middle of the neck Inferior to the thyroid cartilage Has two lobes attached by the isthmus lying over the second and third tracheal rings Highly vascular

4 Anatomy of Head Salivary Glands Parotid in cheeks over the mandible, anterior to & below the ear largest but not normally palpable Submandibular beneath mandible at the angle of the jaw Sublingual floor of the mouth

5 Structures of the Neck (Jarvis, 2016, p.252)

6 Structure related to the face The paranasal sinuses air-filled pockets within the cranium used for communication and production of mucous they are narrow and easily occluded which may cause inflammation and sinusitis Frontal sinuses in the frontal bone above and medial to the orbits Maxillary sinuses in the maxilla (cheekbone) along the sides of the walls of the nasal cavity Ethmoid sinuses smaller and deeper / between the two orbits Sphenoid smaller and deeper/ within the sphenoid bone

7 (Tortora & Derrickson, 2014, p.211) 7

8 General Head Examination A general examination of the head should consider the following:- Frontal view Symmetry of the boney and muscular structures Skin condition and colour The general appearance and expression of the person Side view Shape of head and cervical region Shape of anterior neck particular to the thyroid

9 Oral Cavity (Tortora & Derrickson, 2009, p. 929)

10 Lips Teeth Gums Examination of the Mouth & Throat Structure Signs Relevance Symmetry Colour Moisture Cracks or Lesions Alignment Discolouration Cracks or cavities Inflammation Atrophy, hyperplasia Easy bleeding Facial muscles and nerves Pale, inflammation, cyanotic Dryness or exudates Trauma, infection or nutritional deficiencies. Malocclusion or TMJ disorder Smoking, drug use, fluorosis, tartar Grinding, tooth decay Gingivitis, infection, smoking, alcohol Chronicity of inflammation Gingivitis, anticoagulant therapy

11 Examination of the Mouth & Throat Structure Signs Relevance Tongue Buccal Oropharynx Colour & size Surface condition Coating Moisture Colour Lesions Pillars, tonsils, uvula & posterior oropharynx for redness, pus, or enlargement Redness, pale, nutritional deficiencies, hypothyroidism Dehydration, burns Infection, gastric reflux, candida Dehydration, effects of medication Anaemia, jaundice, inflammation Trauma, biting, ill-fitting dentures Redness, inflammation, exudate suggests acute infection. No or little inflammation with enlargement of tonsil crypts suggests chronic history of infection

12 Examination of the Throat (OroPharynx) Grading Tonsil Enlargement 1+ Visible 2+ Half way to uvula 3+ Touching uvula 4+ (L) touches (R) tonsil Be aware that grade 3 & 4 tonsil enlargement may cause airway obstruction or be associated with sleep apnoea. Be especially cautious in babies and young children. (Jarvis, 2016, p.367)

13 Anatomy of the Ear (Tortora & Derrickson, 2009)

14 Middle Ear (Tortora & Derrickson, 2009)

15 Structure of the Ear External auditory canal approx cm long in the adult terminates at the tympanic membrane lined with sebaceous glands that secrete cerumen (wax that lubricates and protects the ear) helps keep foreign bodies out by catching them in the sticky wax chewing and talking moves the wax out to the meatus Outer 1/3 is cartilage Inner 2/3 consists of bone covered by thin sensitive skin

16 Structure of the Ear Tympanic membrane (eardrum) Separates the external and middle ear and is tilted obliquely to the ear canal The drum is oval, slightly concave, translucent membrane with a pearly grey colour, its centre is attached to the malleus which provides tension to the tympanic membrane. Lymphatic drainage of the external ear flows to the parotid, occipital and superficial cervical nodes

17 Examination of the Ear Structure Signs Relevance Helix, pinna, lobe External auditory meatus Tympanic membrane Redness, inflammation Microtia or macrotia Skin condition Tophi, cysts, lesions Redness, inflammation, exudate Foreign object Redness, inflammation, exudate Yellow, fluid, bubbles Infection Malformation, swelling Eczema, infection Uric acid, infection, melanoma Otitis externa or media Refer for removal Acute otitis media Supurative otitis media Serous otitis media

18 Using the Otoscope When using the otoscope to perform an examination of the ear, it is essential that you: First perform a thorough inspection of the outer structures of the ear Next palpate the outer structures of the ear including the mastoid bone and surrounding lymph nodes For adults and older children lift the pinna up and back For young children and infants gentle pull the lobe straight down Through the scope observe for the manubrium, umbro, cone of light, and hairlessness as indications that you are looking at the tympanic membrane.

19 Normal Tympanic Membrane (Jarvis, 2016, p. 334)

20 Dry Wax on Tympanic Membrane (Jarvis, 2012)

21 Acute Otitis Media (Jarvis, 2012)

22 Serous Otitis Media (Jarvis, 2012)

23 Suppurative Otitis Media (Jarvis, 2012)

24 Grommet in Tympanic Membrane Ref Jarvis 2012 (Jarvis, 2012)

25 Causes of Hearing Loss (Jarvis, 2016, p. 344)

26 Lymphatic System (Tortora & Derrickson, 2012)

27 Lymphatic System (Tortora & Derrickson, 2012)

28 Lymphatic Flow & Drainage During circulation of the blood, more fluid leaves the capillaries than the veins can absorb Lymphatics form as a completely separate vessel system which retrieves excess fluid from the interstitium and returns it to the bloodstream Without lymphatic drainage, fluid would build up in the interstitial spaces and produce oedema Lymph flow is slow compared with blood flow Aided by Contracting skeletal muscles Abdo-thoracic pressure changes related to breathing Contraction of vessel walls themselves

29 Lymphatic System Lymph nodes are small, oval clusters of lymphatic tissue that occur at set intervals along the lymph vessels like beads on a string Filter the lymph & engulf pathogens, preventing potentially harmful substances from entering the circulation They react to inflammation and Neoplasms in the body by increasing in size, texture and tenderness. Lymph nodes are located all through the body but are only accessible to examination in four areas Head & neck (greatest supply) Epitrochlear (lower arms) Axillae (Breast and upper arms) Inguinal region (Lower limbs and abdo-pelvic region)

30 Lymph flow of the Neck (Jarvis, 2012)

31 Muscles of the Neck (Jarvis, 2012)

32 Lymph Nodes of Head & Neck Preauricular in front of the ear Posterior auricular (mastoid) superficial to the mastoid process Occipital at the base of the skull Submental midline, behind the tip of the mandible Submandibular halfway between the angle and the tip of the mandible Jugulodigastric under the angle of the mandible Superficial cervical overlying the sternocleidomastoid muscle Deep cervical deep under the sternocleidomastoid muscle Posterior cervical in the posterior triangle along the edge of the trapezius muscle Supraclavicular just above & behind the clavicle, at the sternocleidomastoid muscle

33 Palpating Lymph Nodes When palpating lymph nodes use a slow, circular motion using the pads of your fingers. Follow a logical order to ensure that you don t miss nodes o Location o Temperature o Number o Size o Shape o Surface o Consistency o Mobility o Tenderness 33

34 Palpating the lymph Nodes (Jarvis, 2012)

35 Lymph nodes of the Neck Order of Lymph Nodes Palpation (Jarvis, 2008)

36 Lymph Node Examination Normal Feel movable, discrete, soft & non-tender Cervical nodes are often palpable in healthy persons, although palpability decreases with age Abnormalities Lymphadenopathy Enlargement of lymph nodes (>1cm) Due to infection/ allergy/ neoplasm

37 Lymph Node Exam - Abnormalities Common clues to abnormal findings (don t always apply) Acute infection nodes are bilateral, enlarged, warm, tender, firm but freely movable Chronic inflammation e.g. TB - the nodes are clumped Cancerous nodes hard, fixed, unilateral and non tender Nodes with HIV infection enlarged, firm, non tender, mobile occipital node enlargement is common with HIV infection A single, enlarged, non tender, hard, left supraclavicular node (Virchow s node) may indicate neoplasm in thorax or abdomen Painless, rubbery, discrete nodes that gradually appear occur with Hodgkin s lymphoma

38 Location of the Thyroid (Jarvis, 2016, p. 254)

39 Thyroid Examination Thyroid gland can be difficult to palpate therefore optimize your examination by patient and room preparation. Be sure to inspect from the side using a lamp or torch to highlight any thyroid enlargement. Supply the person with a glass of water First inspect the neck as the person takes a sip and swallows Thyroid tissue moves up with swallow (If no water / drink available just ask the client to swallow)

40 Thyroid Examination When palpating the thyroid use a posterior approach. A normal functioning thyroid is usually unremarkable on palpation. An enlarged thyroid is commonly easily palpable. Take particular note of: Nodules Multiple nodules will usually indicate inflammation or multinodular goitre Single nodules are usually benign, but pose a greater risk of being cancer

41 Palpating the Thyroid (Jarvis, 2008)

42 Thyroid Examination Auscultate the thyroid gland If the thyroid is enlarged, auscultate over each lobe for the presence of a BRUIT (brew-ee) this is a soft, pulsatile, whooshing, blowing sound heard best with the bell of the stethoscope A bruit is not normally present Abnormal A bruit occurs with accelerated or turbulent blood flow, indicating hyperplasia of the thyroid e.g. hyperthyroidism

43 Thyroid Presentations (Jarvis, 2016, p. 275)

44 Thyroid Presentations (Jarvis, 2016, p. 277)

45 Eye Mucous Membranes Inspect the outer structures of the eye looking for any injuries, inflammations, cysts, swelling, excess watering or exudate. Inspect the sclera, which should be predominantly white with only a few fine blood vessels obvious. Excessive redness, enlarged blood vessels or discolouration may indicate local or systemic disease. Gently fold back the lower eyelid to inspect the conjunctiva for redness, inflammation, paleness, discolouration, pustules, exudate or foreign matter. (Jarvis, 2016, p.281) 45

46 Resources Jarvis, C. (2016) Physical Examination and Health Assessment (7 th ed.). Missouri: Saunders. Tortora, G.J. & Derrickson, B. (2014). Principles of Anatomy and Physiology (14th ed.). Hoboken, NJ: John Wiley.

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