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EXAMINATION OF THE HEAD AND NECK

I. Anatomy & Physiology

II. Health History

    A. History of Head Trauma
    B. Headaches
    C. Swelling of face, jaws, and mastoid process
    D. Sinus infections
    E. Nasal discharge (post nasal drip)
    F. Prolonged nosebleeds
    G. Medication use
    H. Mouth lesions
    I. Difficulty swallowing/chewing
    J. Voice hoarseness
    K. Allergies
    L. Neck injury/neck surgery
    M. Use of tobacco
    N. Bruxism
    O. Mouth care

III. Examination of the Head and Face

    A. Head
      1. Inspect
        a. Erect and midline
        b. Hair distribution
        c. Symmetry and contour
      2. Palpate
        a. Palpate scalp and hair texture
    B. Face
      1. Inspection
        a. Spontaneous facial expression b. Color (pallor & cyanosis)
        c. Facial lesions, rash, swelling, and redness
        d. Abnormal movement
      2. Palpation
        a. Palpate face for skin tone, muscle tone, and contours
        b. Temporal artery pulses
        c. Palpate the temporomandibular joints
      3. Auscultate
        a. Temporal arteries

    C. Nose
      1. Inspect
        a. Symmetry and contour
        b. Deformity, swelling, discoloration
        c. Flaring of nares
        d. Direct inspection with nasal speculum and penlight
      2. Palpate
        a. Tenderness b. Nasal patency

    D. Sinuses

      1. Inspect frontal and maxillary sinuses for inflammation and edema
      2. Palpate for tenderness
      3. Percuss for tenderness
      4. Transillumination

    E. Mouth and Oropharynx

      1. Inspect
        a. Unusual breath odors
        b. Oral mucosa
        c. Gingival surfaces
        d. Condition of teeth
        e. Tongue
          - pink, rough, midline depression
          - Hypoglossal nerve function (CN 12)
          - Examine underside
          - Lingual frenulum
        f. Hard and soft pallets
        g. Tonsils

      Graded 0 to +4
      0 tonsils behind the pillars
      +1 tonsils are peaking from pillars
      +2 tonsils are between pillars and uvula
      +3 tonsils are touching uvula
      +4 tonsils are extending to midline

      2. Palpate

        a. Palpate upper and lower lips and tongue to evaluate muscle tone and surface structure

      3. Examine oropharynx with tongue depressor and penlight (glossopharyngeal vagus nerves)

    F. Neck
      1. Inspect
        a. Symmetry
        b. Masses
        c. Scars
        d. Ability to swallow (larynx, trachea, and thyroid will all rise)
      2. Lymph Nodes
        a. Inspect and palpate, noting size, shape, delimitation, mobility, consistency, and tenderness
      3. Trachea- inspect and palpate
      4. Thyroid gland- inspect, palpate, and auscultate
      5. Carotid arteries- inspect, palpate, and auscultate
      6. Jugular venous distention

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