HEAD AND NECK

2
• Nose
• Oral Cavity
• Neck

Montserrat Ezquerra,MD
m.ezquerra@edu.uag.mx
Clinical Skills Development
NOSE
EXAMINATION
 Common Chief
Complaints
• Obstruction of airflow
• Discharge (rhinorrhea)
• Facial (nasal area) pain
• Nosebleeding (epistaxis)
• Sinus pain and localized headache
• Itching
• Loss of smell (anosmia)
• Nasal trauma
• Stuffy nose (congestion)
• Sneezing + watery eyes
Nose Examination

• I. Inspection
• II. Palpation
• III. Sinuses Palpation
• IV. Airway Permeability / Patency
• V. Rhinoscopy
 • Observe in 3 angles: front, side, below

Inspection • Symmetry, deviation, swelling, trauma, congenital malformation,

perforation, traces of blood, substances, scaring, strange body
outline (if stated).
• Tilt patient’s head to the back to examine the nares.
 • Index and thumb gently press the nose path, from the nasal
Nose Palpation bone to the cartilages.
• If discomfort or pain is elicited, detail of it should be noted.
Sinuses Palpation

The sphenoid sinus is not palpable

Sinuses Palpation
Airway
Patency/Permeabili
ty
• Occlude one nostril and ask the
patient to inhale with his/her mouth
and exhale through the non-occluded
nostril, do this for each nostril.

• Asses permeability and potency.

Rhinoscopy

• Tilt patient’s head slightly to the

back.
• Ask him/her to breathe through the
mouth.
• Dominant hand holds the
Rhinoscope, non dominant hand
holds gently patient’s nose.
• With light on, introduce rhinoscope
(1cm) into vestibule, one nostril at a
time.
• Note hydration state, mucous
membranes, swelling, masses,
perforation, deviation, vascular
engorgement or crusting, strange
body.
Making a note
with your findings.
• I. Inspection
• II. Palpation
• III. Sinuses Palpation
• IV. Airway Permeability / Patency
• V. Rhinoscopy
ORAL CAVITY
EXAMINATION
Anatomy
Common Chief
Complaints
• Sore throat
• Difficulty swallowing (dysphagia)
• Painful swallowing (odynophagia)
• Lump
• Opression
• Hoarseness (dysphonia)
• Lack of voice (aphonia)
• Changes in voice
• Cough
• Dry Mouth (xerostomía)
Mouth & Oral
Cavity Examination
• I. Inspection
• II. Gums, Hard & Soft Palates
• III. Stensen’s & Wharton’s Ducts
• IV. Lingual Movements
• V. Pharynx, Pharyngeal Pillars &
Gag Reflex

Required equipment: penlight.

Inspection
• Symmetry, lesions, haematomas, ulcers, fisure, bleeding, swelling,
artifacts.
Gums, Hard & Soft Palates
Stensen’s & Wharton’s Duct
STENSEN´S DUCT

WHARTON´S DUCT
 Lingual
Movements

Assess mobility and

tongue characteristics.
Pharynx, Pharyngeal Pillars & Gag Reflex
Pharynx, Pharyngeal Pillars & Gag Reflex
 What did you
came across?
• I. Inspection
• II. Gums, Hard & Soft Palates
• III. Stensen’s & Wharton’s Ducts
• IV. Lingual Movements
• V. Pharynx, Pharyngeal Pillars & Gag
Reflex
NECK
EXAMINATION
Common Chief Complaints

• Neck stiffness (nuchal rigidity)

• Pain (most common and with its
associations)
• Mechanical problems with movements
• Muscle contraction
• Headache involving the neck
• Neck swelling
• Neck mass (anterior or
posterior)GOITER
The Examination
• I. Inspection
• II. Lymph Node Group Palpation
• III. Trachea Assessment
• IV. Thyroid Gland Palpation
(Posterior Approach)
• V. Neck Muscular Palpation &
Motion
 Inspection
• Visual assessment of neck’s
symmetry, masses, deviation of
trachea, muscular contraction,
deviation of the neck or
enlargement of thyroid gland, skin
lesions are to be noted as well.
 Palpation
• Using a consistent order, one-handed approach palpate the chains,
beginning with right side and then switch to left; or vice versa:
• Submental
• Submandibular (L&R)
• Preauricular
• Posterior Auricular
• Jugular Nodes (Sternocleidomastoids)
• Occipital
• Posterior Cervical
• Supraclavicular
• Indraclavicular
Right lymph node group
palpation sequence.
Trachea
• Should be central, not deviated.
• Gently palpate it and slide it
sideways, have the patient swallow
while palpating so deglutition muscle
group is assessed.
• Shouldn’t be painful.
Thyroid Palpation (Posterior)
• Identify thyroid and cricoid cartilages, over the third
tracheal ring lies the Thyroid Gland.
• Position yourself behind the patient.
• Place first two digits of both hands just below
cricoid cartilage so that left and right fingers
meet on the patient’s midline. Place thumbs
posterior to patient’s neck and flatten all fingers
against the neck. Use finger pads, not tips, to
palpate.
• Identify the isthmus.
• Gently draw fingers laterally 1-2cm. Gently
palpate lateral lobes.
• NOW ask patient to swallow (give them a glass
of water if possible). Assess for asymmetrical
elevation of lobes (suggests nodularity).
• When you are done with above, move to next
phase, which is displacing the soft tissues on
one side to the midline while assessing for size
with the other hand. Repeat in opposite
direction.
Neck Muscular Palpation
• Palpate sternocleidomastoid and trapezius (comparative)
assessing muscle pain, stiffness or severe muscle contraction.
Neck Motion
• Have your patient do the following:
• Note for limitation.
 A good note is better
than a lawsuit.
• I. Inspection
• II. Lymph Node Group Palpation
• III. Trachea Assessment
• IV. Thyroid Gland Palpation (Posterior
Approach)
• V. Neck Muscular Palpation & Motion
Quiz
• Mis Cursos  Clinical Skills Developmente  Head and Neck 2

• 6 questions. 6 minutes. 1 attempt

• Closes at 10:00 am (Guadalajara Time)