Head & Neck

(Mouth, Pharynx,Thyroid,L.N.,Neck)

Mouth & Pharynx anatomy

The mouth, pharynx and neck: Health history:

Sore throat How frequent? Since when? Cough, fever, fatigue, headache, hoarseness,

postnasal drip Worse when arising? Humidity, dryness?

Sores or lesions in mouth or tongue For how long? Single or multiple? Stress, food, season change?

Altered taste Bleeding gums--gingivitis Toothache

The mouth, pharynx and neck: Health history:

Hoarseness—Acute or chronic Altered quality voice; rough or harsh

Overuse of voice Allergy, smoking, other inhaled irritants Hypothyroidism Tumors

Dysphagia—difficulty swallowing Gastroesophageal reflux disease, neurological,

esophageal cancer Pharyngitis-- Swollen glands or lumps in neck

The mouth, pharynx and neck: Health history:

Enlarged thyroid gland—goiter Thyroid function—

Temperature intolerance Do you prefer hot or cold weather Do you dress more warmly or less warmly than other

people? Palpitations? Change in weight?

PE: The mouth, pharynx and neck: The Lips

Color, moisture, cracking, Scaliness, lesions.(herpes simplex)

Angular chelitis, softening of the skin at the angles of mouth followed by fissuring.

The oral mucosa: Inspect using penlight Mucosa—

color: pallor anemia, cyanosis if structures are intact, any lesions, ulcer, white

patches and nodules.

PE: The mouth, gum, teeth Gum:

Note the colour of the gum, swelling or ulceration

Teeth:

Condition of teeth, missing, discolored, absent, abnormally positioned teeth, dentures, check for loosening

The roof of the mouth:

colour, architecture of the hard palate

PE: The mouth, gum, teeth

Tongue: colour, texture, symmetry, Ask the patient to protrude the tongue

(cranial nerve 12; hypoglossal ).

A symmetry suggest lesion of the cranial nerve. Inspect the sides and under-surface of the tongue and

the floor of mouth.

(wear gloves & grasp the tip of tongue with gauze)

Note any white or reddened area, nodules, or ulcerations

Palpate for hardiness( induration)

The mouth and pharynx

Abnormalities: Herpes simplex (cold sore,

fever blister)

Fissured tongue:

Smooth tongue;

The Pharynx

Ask the patient to say ‘ah’ or yawn or use tongue blade. normally you will see the movement of Pharynx and the soft palate the (test for Vagus nerve (CN10).

Inspect soft palate, anterior and posterior pillars, uvula, tonsils, and pharynx — color, symmetry, exudates, swelling, ulceration, tonsillar enlargement

If possible palpate for tenderness

Pharynx

Enlarged Tonsils (Normal, Tonsillitis, Lymphoma) Unilateral red bulge and painful: (Peritonsillar

abscess) Grade tonsils

(1+) visible, (2+) halfway between tonsillar pillars and uvula, (3+) Touching the uvula, (4+) touching each other

(1+) and (2+) sometimes in healthy people

The Neck

Inspect the neck : Noting symmetry Any masses Scars Enlargement of the parotid or submandibular

glands Any visible lymph node.

The parotid and submandibular glands

Lymph nodes

Lymph nodes

Palpate the lymph nodes using your index and middle fingers, move the skin over the underlying tissue in each area.

The patient should be relaxed, with neck flexed slightly forward or toward the side being examined.

You can examine both sides at once

PE: Lymph Nodes

Palpate and note Size Shape Delimitation( discrete or matted)

Mobility Consistency( firm, soft, hard)

Tenderness

PE: Lymph Nodes

Small, mobile, discrete, soft, non-tender nodes are common finding

Enlarged or tender nodes: Re-examine of the regions they drain Careful assessment of the lymph nodes else

where to distinguish between localized from generalised

Do not mistaken the nodes with muscles or any artery!

The Trachea and The Thyroid gland: Anatomy

Thyroid gland Thyroid cartilage Hyoid bone Trachea

Trachea : PE

Inspect the trachea for any deviation from the midline position

Feel for any deviation Place your finger along one side of the trachea

and note the space between it and the sternomastiod: the space should be symmetric.

Examples of deviation; atelectasis, large pneumothrax

PE: Thyroid gland

Inspect the neck for the thyroid gland Tip the patient’s head back a bit Inspect the region below the cricoid cartilage for

the gland/ use pin light Ask the patient to sip some water and to extend

the neck again and swallow; watch for upward movement of the thyroid gland.

Noting its contour and symmetry Note that : the thyroid gland, thyroid cartilage and

the cricoid cartilage will all rise with swallowing and then fall to their resting positions.

PE: Thyroid gland

palpate the thyroid gland Find your landmarks: the cricoid and the

thyroid cartilage. Flex the neck slightly forward Place your both hands on the patient’s neck Ask the patient to swallow sips of water To palpate the lobes; Displace the trachea to the right by fingers of

left hand and palpate by the right hand. Repeat for the other side.

Note the size, shape, consistency of the gland and identify any nodules or tenderness.

Soft in Graves disease, firm in hashimotos thyrioditis, and malignancy

Benign and malignant nodules, tenderness in thyroiditis.

If thyroid gland is enlarged, listen over lateral lobes with a stethoscope to detect bruits, a sound similar to cardiac murmur but of noncardiac origin.

Thyroid gland