Study Guide: Head, Face, Neck, Eyes, Ears, Nose, Mouth, and Throat

Head, Face, and Neck (Including Regional Lymphatics)

Anatomy Overview

1. Head:

   • The skull protects the brain and special sense organs.

   • Bones include cranial (frontal, parietal, occipital, temporal) and facial bones (e.g., nasal, zygomatic, mandible).

   • Sutures (coronal, sagittal, lambdoid) connect cranial bones.

   • Supported by cervical vertebrae (C1 to C7).

2. Face:

   • Facial muscles controlled by CN VII (facial nerve); sensory innervation by CN V (trigeminal nerve).

   • Key landmarks: eyebrows, palpebral fissures, nasolabial folds.

   • Salivary glands: parotid (anterior to ears, not usually palpable), submandibular (beneath mandible), and sublingual (floor of mouth).

3. Neck:

   • Contains major blood vessels (common carotid, internal and external jugular veins).

   • Sternomastoid and trapezius muscles divide neck into anterior and posterior triangles.

   • Thyroid gland: endocrine gland producing T3 and T4 hormones.

4. Lymphatics:

   • 60-70 lymph nodes in the head and neck.

   • Groups include preauricular, posterior auricular, occipital, submental, submandibular, jugulodigastric, superficial cervical, deep cervical, posterior cervical, and supraclavicular nodes.

Assessment Techniques

1. Inspection and Palpation of the Skull:

   • Normal findings: Symmetric, smooth skull, no tenderness, normocephalic.

   • Abnormal findings: Microcephaly, macrocephaly, lumps, depressions.

2. Inspection of the Face:

   • Normal findings: Symmetry of facial features and expressions; no tics or involuntary movements.

   • Abnormal findings: Bell palsy (CN VII dysfunction), asymmetry from stroke, edema, or fasciculations.

3. Inspection and Palpation of the Neck:

   • Normal findings: Symmetry, full ROM, no pain, trachea midline, thyroid not palpable.

   • Abnormal findings: Limited ROM (arthritis), lymphadenopathy, goiter, tracheal deviation (e.g., pneumothorax).

4. Lymph Node Palpation:

   • Palpate in a systematic order using gentle pressure.

   • Normal findings: Movable, discrete, soft, and non-tender nodes.

   • Abnormal findings:

     • Acute infection: Enlarged, warm, tender, and movable.

     • Chronic inflammation: Nodes clumped (e.g., TB).

     • Cancer: Hard, >3 cm, fixed, nontender.

5. Thyroid Examination:

   • Use posterior or anterior approach.

   • Normal findings: Not palpable or smooth, rubbery texture.

   • Abnormal findings: Enlarged lobes, nodules, tenderness.

   • Auscultate for bruit if enlarged (indicates hyperthyroidism).

Eyes

Anatomy Overview

1. External Structures:

   • Eyelids: Protect from injury and light; upper lid covers iris.

   • Conjunctiva: Clear mucous membrane protecting the eye.

   • Lacrimal apparatus: Produces tears, drains into nasolacrimal duct.

2. Internal Structures:

   • Outer layer: Sclera (white, protective) and cornea (transparent, refractive).

   • Middle layer: Choroid, iris (controls pupil size), ciliary body, and lens.

   • Inner layer: Retina with photoreceptors (rods and cones).

Assessment Techniques

1. Visual Acuity:

   • Snellen chart for distance vision; near vision card for presbyopia.

2. Inspection:

   • Eyebrows, eyelids, lashes: Symmetry, no ptosis or redness.

   • Conjunctiva and sclera: Clear, white sclera; no redness or discharge.

   • Pupils: Test PERRLA (pupils equal, round, reactive to light and accommodation).

3. Extraocular Movements (EOM):

   • Six cardinal positions of gaze to assess CN III, IV, VI.

   • Abnormal findings: Nystagmus, strabismus.

4. Fundoscopic Exam:

   • Assess red reflex, optic disc, retinal vessels, and macula.

   • Abnormal findings: Papilledema, hemorrhages, or cotton wool spots (indicates pathology).

Ears

Anatomy Overview

1. External Ear:

   • Auricle (pinna), external auditory canal.

   • Functions to collect and direct sound waves.

2. Middle Ear:

   • Tympanic membrane, ossicles (malleus, incus, stapes).

   • Equalizes air pressure via Eustachian tube.

3. Inner Ear:

   • Contains cochlea (hearing) and vestibular system (balance).

Assessment Techniques

1. Inspection and Palpation:

   • Auricle: No deformities or tenderness.

   • External canal: No discharge or redness.

2. Hearing Tests:

   • Whisper test: Detects hearing loss.

   • Weber test: Tests lateralization of sound.

   • Rinne test: Compares air vs. bone conduction.

3. Otoscopic Exam:

   • Normal findings: Tympanic membrane pearly gray, light reflex present.

   • Abnormal findings: Otitis media (bulging TM), perforation.

Nose, Mouth, and Throat

Anatomy Overview

1. Nose:

   • External nose, nasal cavity, septum, and turbinates.

   • Olfactory receptors (CN I) for smell.

2. Mouth:

   • Lips, teeth, gums, tongue, hard and soft palates.

   • Salivary glands (parotid, submandibular, sublingual).

3. Throat:

   • Oropharynx, tonsils, and laryngopharynx.

Assessment Techniques

1. Inspection of Nose:

   • Symmetry, no deformities.

   • Assess patency, inspect mucosa for redness or discharge.

2. Inspection of Mouth and Throat:

   • Normal findings: Pink, moist lips and gums; tongue midline (CN XII).

   • Throat: Uvula rises midline (CN IX and X), tonsils graded (1+ to 4+).

   • Abnormal findings: Lesions, tonsillar exudate, halitosis.

3. Palpation:

   • Sinuses: Frontal and maxillary for tenderness.

   • Teeth and gums: Check for caries or gingival swelling.

Vocabulary and Definitions

• Normocephalic: A round, symmetric skull appropriate to body size.

• Lymphadenopathy: Enlargement of lymph nodes (>1 cm).

• Goiter: Enlargement of the thyroid gland.

• PERRLA: Pupils Equal, Round, Reactive to Light and Accommodation.

• Nystagmus: Involuntary eye movements.

• Strabismus: Misalignment of the eyes.

• Otitis Media: Inflammation or infection of the middle ear.

• Septum: The dividing wall in the nasal cavity.

• Turbinates: Bony structures in the nasal cavity aiding air filtration.

• Tonsillitis: Inflammation of the tonsils.

• Halitosis: Bad breath.

• Crepitation: A grating sound or sensation in a joint.

• Bell Palsy: Sudden weakness in the muscles on one side of the face.

• Tracheal Tug: Downward movement of the trachea with each heartbeat (indicates aneurysm).

• Papilledema: Swelling of the optic disc due to increased intracranial pressure.

• Fontanel: Soft spot on an infant's skull where bones haven't fused.

Additional Key Points for Quizzes/Exams

• Know cranial nerves associated with each structure (e.g., CN II for vision, CN VIII for hearing).

• Be familiar with normal vs. abnormal findings for all assessments.

• Understand developmental considerations (e.g., fontanel closure in infants, presbyopia in aging adults).

• Differentiate between common conditions: tension headaches vs. migraines vs. cluster headaches.

• Recognize physical signs of hyperthyroidism (e.g., exophthalmos) and hypothyroidism (e.g., myxedema).

• Practice systematic examination techniques to avoid missing abnormalities.