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Chapter 14 Notes Head, Neck ⭐..

Head & Face

  • Head:
    • Normocephalic = normal head size/shape.
    • Inspect symmetry of the face.
  • Disorders:
    • Stroke or Bell’s Palsy → face asymmetry (unequal movement).
    • Preauricular & postauricular nodes → may be enlarged with thyroid problems.
  • Children’s Bones: not fused → swelling may lead to hydrocephalus.
  • Adult Skull: rigid, cannot expand → brain & blood vessel compression if swelling.
  • Facial Expressions: controlled by muscles & nerves. 14 facial bones.

Cranial Nerve VII (Facial – Motor)

  • Exam: check mobility & symmetry.
    • Frown
    • Raise eyebrows
    • Show teeth
    • Puff cheeks
    • Smile
  • Look for symmetry (eyebrows, jaw alignment).
  • Related structures:
    • Salivary glands (sublingual)
    • Temporal artery

Bones, Muscles & Cranial Nerves

  • Each skull bone covers a specific brain area → injury = local brain effect.
  • Cranial Nerve XI (Accessory): innervates neck muscles.
    • Shrug shoulders against resistance.
    • Turn head side-to-side with hand pressure.
  • Cranial bones: Frontal, Parietal, Occipital, Temporal
  • Sutures—adjacent cranial bones mesh at sutures
    • Coronal
    • Sagittal
    • Lambdoid
  • Cranial Nerve XI (Muscles) Spinal Accessory Nerve
    • Trapezius: Moves shoulders (shrugging). Extends the head backward. Rotates/turns the head.
    • Sternomastoid (Sternocleidomastoid). Rotates the head (turns it to the opposite side). Flexes the neck forward.

Endocrine System (Thyroid)

  • Normally not palpable. Formed by two lobes connected by a thin isthmus.
  • Auscultate thyroid for bruit, if enlarged.

(Palpable Landmarks)

  1. Thyroid Cartilage
    • Has a palpable notch on its upper edge (the laryngeal prominence, or “Adam’s apple” - in males only-).
  2. Cricoid Cartilage (upper tracheal ring)
    • Located just below the thyroid cartilage. Used for procedures (e.g., cricothyrotomy).
  3. Isthmus of the Thyroid Gland
    • The center of thyroid, connects the right and left lobes of the thyroid gland.
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  • If enlarged, assess by:
    • Observation while swallowing.
    • Palpation (front & back).
    • Trachea should remain midline.
  • Professor’s Note: Do not palpate thyroid if disorder suspected (may trigger thyroid storm).

Lymphatic System

  • Function: drainage system. Detects and eliminates foreign substances from body. Is a Defense System. Drains from top to bottom.
  • Professor’s Note: Memorize the lymph nodes from slides.
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  • Exam:
    • Shrug shoulders → check supraclavicular nodes.
    • Palpate sequence of 10 cranial nodes.
    • Ear infection → anterior or posterior auricular nodes.
  • Other notes:
    • Pregnancy → thyroid enlargement.
    • Older adults → sagging facial skin (less elasticity).
      • Dentures → restore normal facial shape.
      • They loose fat so Facial bones and orbits appear more prominent.
      • Neck curvature (Kyphosis)
      • Some tremor of head may be normal.
      • Temporal arteries may look twisted.

Cultural Considerations

  • Headaches/migraines → more common in females, more common on Caucasian and Hispanic population. Just think on Karen.
    • Leading cause of acute pain and lost productivity (Like I’m stress my head aches LOL)
    • Chronic migraine: More than 15 days per month

Subjective Data

  • Older adults → dizziness.
  • Head injury in adults: rigid skull increases risk of compression.

Inspection & Palpation

  • Check facial structure, involuntary movement, temporal arteries (may twist with age).
  • Head should be Normocephalic (round and symmetric)
  • TMJ → clicking sound possible.
  • Palpate thyroid for enlargement.
  • Auscultate thyroid: inhale → exhale → hold breath.

Class Recap Face 😐

  • Cranial nerves V (Trigeminal) → sensory + motor.
  • Cranial nerve VII (Facial) → motor (smile, frown, raise eyebrows, close eyes).

Abnormalities:

(Hyperthyroidism) Graces Disease.

Presentation:

  • Goiter
  • Eyelid retraction
  • Exophthalmos

Hypothyroidism: Presentation:

  • Puffy edematous face
  • Periorbital edema
  • Coarse facial features
    • puffiness, thickened skin, and dull appearance
  • Coarse hair and eyebrows
    • → hair becomes dry, brittle, thick, and rough instead of smooth and shiny.
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Acromegaly

  • Cause: Too much growth hormone in adults.
  • Face: Big and heavy looking → large head, big jaw, big nose, thick eyebrows, coarse (rough) features.

Cushing Syndrome

  • Cause: Too much cortisol.
  • Face: “Moon face” → round, puffy cheeks, red (flushed) face, and sometimes extra facial hair (hirsutism).

Bell Palsy

  • Cause: Lower motor neuron (LMN) lesion of facial nerve (CN VII).
  • Face: One side of face droops (can’t close eye, smile, or raise eyebrow on that side).

Stroke (Brain Attack)

  • Cause: Upper motor neuron (UMN) lesion (brain injury).
  • Face: Lower half of face droops on the opposite side of the lesion, but the forehead is spared (they can still raise eyebrows).