Exam 3 Study Guide
Chapter 14: Head, Face, Neck, and Regional Lymphatics
VOCABULARY
Photophobia: Abnormal sensitivity or intolerance to light, often causing eye discomfort, pain,
and an urge to squint or close your eyes in bright, artificial, or in severe cases, dim lighting.
Tinnitus: the perception of sound, like ringing or buzzing, when there’s no external source
Bruit: an abnormal, whooshing, or blowing sound heard with a stethoscope over an artery,
indicating turbulent blood flow, usually from a partial blockage (stenosis) due to conditions
atherosclerosis
Dysphagia: a disorder characterized by difficulty, discomfort, or inability to safely and
efficiently move food or liquid from the mouth to the stomach, often involving impairment in the
oral, pharyngeal, or esophageal stages of swallowing
Dysphasia: a language impairment that significantly compromises the ability to communicate
orally, through signs, or in writing
Lymphadenopathy: the abnormal enlargement of lymph nodes due to proliferation of
lymphocytes, infection, or malignancy, often presenting as tender or fixed lumps in the neck,
axilla, or groin
Normocephalic: a patient’s head if of normal shape, size, and proportion, without signs of
deformity, trauma, or abnormal enlargement/reduction
- Macrocephaly: an occipitofrontal head circumference greater than 2 standard deviations
above the mean or above the 98th percentile for a child’s age, sex, and gestation
- Microcephaly: a neurological, often congenital, condition characterized by a head
circumference that is significantly smaller than normal for an infant’s or child’s age, sex,
and gestational age
Torticollis: an abnormal, asymmetrical head or neck positions, characterized by a persistent tilt,
rotation, or flexion, usually caused by the contraction or shortening of the sternocleidomastoid
muscle
Goiter: an abnormal, non-cancerous enlargement of the thyroid gland, resulting in a visible or
palpable swelling at the base of the neck
Vertigo: a subjective, hallucinatory sensation of motion, typically spinning or whirling, where
the patient feels they or their surroundings are moving
STRUCTURE AND FUNCTION: HEAD
● Skull is a rigid box that protects brain
○ Includes bones of skull and face
○ Supported by cervical vertebra
○ A rigid bony box that protects the brain and special sense organs, and it includes
the bones of the cranium and the face
● Cranial bones
○ Frontal
○ Parietal
, ○ Occipital
○ Temporal
● Sutures– adjacent cranial bones mesh at sutures
○ Coronal
■ Crowns the head from ear to ear at the union of the frontal and parietal
bones
○ Sagittal
■ Separates the head lengthwise between the two parietal bones
○ Lambdoid
■ Separates the parietal bones crosswise from the occipital bone
● Cranial Nerve VII- the facial nerve: Facial expressions formed by facial muscles
● Two pairs of salivary glands can be examined on the face:
○ Parotid glands located over the mandible, in the cheeks, in front of and below the
ear; largest but usually not palpable
○ Submandibular glands located under the mandible at the jaw angle
● Third pair, sublingual glands, are in the floor of the mouth
● Temporal artery is above the temporalis muscle and can be felt pulsating in front of the
ear
● The bones are not firmly joined at birth; this allows for the mobility and change in shape
needed for the birth process
● The 14 facial bones also articulate at sutures. The cranium is supported by the cervical
vertebrae: C1 (the atlas), C2 (the axis), and down to C7 (vertebra prominens)
● Inside the skull the brain is held by membranous meninges. These suspend and support
the brain and are shock absorbers in case of trauma
● Facial structures are symmetric; the eyebrows, eyes, ears, nose, and mouth appear about
the same on both sides. The palepebral fissures– the openings between the eyelids– are
equal bilaterally. Also the nasolabial folds.
● Facial sensations of pain or touch are mediated by the 3 sensory branches of cranial nerve
V, the trigeminal nerve
THE NECK
● The neck is delimited by the base of the skull and inferior border of the mandible above
and by the manubrium sterni, the clavicle, the first rib, and the first thoracic vertebra
below
● Anatomy and landmarks
○ The neck contains vital structures packed closely together
■ Major blood vessels (carotid arteries, jugular veins)
■ Muscles (sternomastoid, trapezius)- CN XI: head rotation and flexion
■ Thyroid gland- Endocrine: produces thyroxine (T4 and triiodothyronine
T3) hormones that stimulate the rate of cellular metabolism
● An important endocrine gland with a rich blood supply
, ● Straddles the trachea in the middle of the neck
■ Trachea and esophagus
○ Surface landmarks help locate structures:
■ Thyroid cartilage (Adam’s apple)
■ Cricoid cartilage below it
■ Thyroid gland isthmus lies over the 2nd - 3rd tracheal rings
LYMPHATIC SYSTEM
● Key lymph nose groups to know and locate on assessment
○ Preauricular
○ Postauricular
○ Occipital
○ Submental
○ Submandibular
○ Jugulodigastric
○ Superficial cervical
○ Deep cervical
○ Supraclavicular
● Palpate accessible nodes for swelling, tenderness, or enlargement- which can signal
infection, inflammation or malignancy
● Lymph nodes drain tissue fluid (lymph) and filter out pathogens (check “upstream” areas
for causes-above or closer to the periphery)
DEVELOPMENTAL COMPETENCE
● Aging Adult
○ Facial appearance changes with age due to:
■ Skin elasticity
■ Subcutaneous fat
■ Skin moisture
○ Results in:
■ Sagging skin
■ More prominent facial bones and eye orbits
■ Smaller- looking lower face if teeth are missing
GENETICS, ENVIRONMENT, AND HEADACHES
● Headache overview:
○ Common reason for outpatient and emergency visits
○ Classified into:
■ Primary headache
● Tension headache (TTH)- most common (stress, poor posture)
● Migraines- 2nd most common (strong genetic link-triggered by
food, chemicals, sensory stimuli)
, ● Cluster- least common but very severe (environmental
exposure-paints, perfumes)
■ Secondary headaches
● Caused by other conditions (injury, infection, substance use,
cranial disorders, mental health)
● Chronic vs Episodic headaches
○ Chronic: occurs > 15 days/month, more disabling, impacts
daily living, work, and relationships
○ Episodic: occurs a few times a year up to several
times/month
SUBJECTIVE DATA: HEALTH HISTORY
● Headache
● Head Injury
● Dizziness
● Neck pain, limitation of motion
● Lumps or swelling
● History of head or neck surgery
OBJECTIVE DATA
● Size and shape
○ Normocephalic: round and symmetric
○ Abnormal findings: microcephaly, macrocephaly, lumps, depressions, protrusions
● Temporal area
○ Palpate temporal artery above zygomatic (cheek) bone between eye and top of ear
○ Abnormal findings: tenderness, crepitation, limited ROM
● Facial structures
● The neck
● Lymph nodes
● Trachea
● Thyroid gland- anterior vs posterior approach
THE AGING ADULT: HEAD AND NECK CHANGES
● Facial and arterial changes
○ Temporal arteries may appear twisted and prominent
■ Isolated head tremors (nodding, tongue protrusion) can be benign and
normal
■ Tooth loss- lower face appears smaller and sunken
● Neck changes
○ Increased anterior cervical curve (kyphosis)
○ Dizziness during neck movement- perform ROM slowly
○ Drooping (prolapsed) submandibular glands
■ Can be mistaken for tumors, but benign
Chapter 14: Head, Face, Neck, and Regional Lymphatics
VOCABULARY
Photophobia: Abnormal sensitivity or intolerance to light, often causing eye discomfort, pain,
and an urge to squint or close your eyes in bright, artificial, or in severe cases, dim lighting.
Tinnitus: the perception of sound, like ringing or buzzing, when there’s no external source
Bruit: an abnormal, whooshing, or blowing sound heard with a stethoscope over an artery,
indicating turbulent blood flow, usually from a partial blockage (stenosis) due to conditions
atherosclerosis
Dysphagia: a disorder characterized by difficulty, discomfort, or inability to safely and
efficiently move food or liquid from the mouth to the stomach, often involving impairment in the
oral, pharyngeal, or esophageal stages of swallowing
Dysphasia: a language impairment that significantly compromises the ability to communicate
orally, through signs, or in writing
Lymphadenopathy: the abnormal enlargement of lymph nodes due to proliferation of
lymphocytes, infection, or malignancy, often presenting as tender or fixed lumps in the neck,
axilla, or groin
Normocephalic: a patient’s head if of normal shape, size, and proportion, without signs of
deformity, trauma, or abnormal enlargement/reduction
- Macrocephaly: an occipitofrontal head circumference greater than 2 standard deviations
above the mean or above the 98th percentile for a child’s age, sex, and gestation
- Microcephaly: a neurological, often congenital, condition characterized by a head
circumference that is significantly smaller than normal for an infant’s or child’s age, sex,
and gestational age
Torticollis: an abnormal, asymmetrical head or neck positions, characterized by a persistent tilt,
rotation, or flexion, usually caused by the contraction or shortening of the sternocleidomastoid
muscle
Goiter: an abnormal, non-cancerous enlargement of the thyroid gland, resulting in a visible or
palpable swelling at the base of the neck
Vertigo: a subjective, hallucinatory sensation of motion, typically spinning or whirling, where
the patient feels they or their surroundings are moving
STRUCTURE AND FUNCTION: HEAD
● Skull is a rigid box that protects brain
○ Includes bones of skull and face
○ Supported by cervical vertebra
○ A rigid bony box that protects the brain and special sense organs, and it includes
the bones of the cranium and the face
● Cranial bones
○ Frontal
○ Parietal
, ○ Occipital
○ Temporal
● Sutures– adjacent cranial bones mesh at sutures
○ Coronal
■ Crowns the head from ear to ear at the union of the frontal and parietal
bones
○ Sagittal
■ Separates the head lengthwise between the two parietal bones
○ Lambdoid
■ Separates the parietal bones crosswise from the occipital bone
● Cranial Nerve VII- the facial nerve: Facial expressions formed by facial muscles
● Two pairs of salivary glands can be examined on the face:
○ Parotid glands located over the mandible, in the cheeks, in front of and below the
ear; largest but usually not palpable
○ Submandibular glands located under the mandible at the jaw angle
● Third pair, sublingual glands, are in the floor of the mouth
● Temporal artery is above the temporalis muscle and can be felt pulsating in front of the
ear
● The bones are not firmly joined at birth; this allows for the mobility and change in shape
needed for the birth process
● The 14 facial bones also articulate at sutures. The cranium is supported by the cervical
vertebrae: C1 (the atlas), C2 (the axis), and down to C7 (vertebra prominens)
● Inside the skull the brain is held by membranous meninges. These suspend and support
the brain and are shock absorbers in case of trauma
● Facial structures are symmetric; the eyebrows, eyes, ears, nose, and mouth appear about
the same on both sides. The palepebral fissures– the openings between the eyelids– are
equal bilaterally. Also the nasolabial folds.
● Facial sensations of pain or touch are mediated by the 3 sensory branches of cranial nerve
V, the trigeminal nerve
THE NECK
● The neck is delimited by the base of the skull and inferior border of the mandible above
and by the manubrium sterni, the clavicle, the first rib, and the first thoracic vertebra
below
● Anatomy and landmarks
○ The neck contains vital structures packed closely together
■ Major blood vessels (carotid arteries, jugular veins)
■ Muscles (sternomastoid, trapezius)- CN XI: head rotation and flexion
■ Thyroid gland- Endocrine: produces thyroxine (T4 and triiodothyronine
T3) hormones that stimulate the rate of cellular metabolism
● An important endocrine gland with a rich blood supply
, ● Straddles the trachea in the middle of the neck
■ Trachea and esophagus
○ Surface landmarks help locate structures:
■ Thyroid cartilage (Adam’s apple)
■ Cricoid cartilage below it
■ Thyroid gland isthmus lies over the 2nd - 3rd tracheal rings
LYMPHATIC SYSTEM
● Key lymph nose groups to know and locate on assessment
○ Preauricular
○ Postauricular
○ Occipital
○ Submental
○ Submandibular
○ Jugulodigastric
○ Superficial cervical
○ Deep cervical
○ Supraclavicular
● Palpate accessible nodes for swelling, tenderness, or enlargement- which can signal
infection, inflammation or malignancy
● Lymph nodes drain tissue fluid (lymph) and filter out pathogens (check “upstream” areas
for causes-above or closer to the periphery)
DEVELOPMENTAL COMPETENCE
● Aging Adult
○ Facial appearance changes with age due to:
■ Skin elasticity
■ Subcutaneous fat
■ Skin moisture
○ Results in:
■ Sagging skin
■ More prominent facial bones and eye orbits
■ Smaller- looking lower face if teeth are missing
GENETICS, ENVIRONMENT, AND HEADACHES
● Headache overview:
○ Common reason for outpatient and emergency visits
○ Classified into:
■ Primary headache
● Tension headache (TTH)- most common (stress, poor posture)
● Migraines- 2nd most common (strong genetic link-triggered by
food, chemicals, sensory stimuli)
, ● Cluster- least common but very severe (environmental
exposure-paints, perfumes)
■ Secondary headaches
● Caused by other conditions (injury, infection, substance use,
cranial disorders, mental health)
● Chronic vs Episodic headaches
○ Chronic: occurs > 15 days/month, more disabling, impacts
daily living, work, and relationships
○ Episodic: occurs a few times a year up to several
times/month
SUBJECTIVE DATA: HEALTH HISTORY
● Headache
● Head Injury
● Dizziness
● Neck pain, limitation of motion
● Lumps or swelling
● History of head or neck surgery
OBJECTIVE DATA
● Size and shape
○ Normocephalic: round and symmetric
○ Abnormal findings: microcephaly, macrocephaly, lumps, depressions, protrusions
● Temporal area
○ Palpate temporal artery above zygomatic (cheek) bone between eye and top of ear
○ Abnormal findings: tenderness, crepitation, limited ROM
● Facial structures
● The neck
● Lymph nodes
● Trachea
● Thyroid gland- anterior vs posterior approach
THE AGING ADULT: HEAD AND NECK CHANGES
● Facial and arterial changes
○ Temporal arteries may appear twisted and prominent
■ Isolated head tremors (nodding, tongue protrusion) can be benign and
normal
■ Tooth loss- lower face appears smaller and sunken
● Neck changes
○ Increased anterior cervical curve (kyphosis)
○ Dizziness during neck movement- perform ROM slowly
○ Drooping (prolapsed) submandibular glands
■ Can be mistaken for tumors, but benign
