Head, Mouth,

Nose, Throat,
Neck and
Regional Lymph
Nodes
Kristin Clephane, MSN, RN, CPN

The Head

Skull- rigid, bony box (or vault) includes bones of

cranium and face.

Cranial Bones:

Frontal, Parietal, Occipital, and Temporal

Sutures- Immovable Joints (not joined at birth to

allow mobility during birth)
Coronal, Saggittal, Lambdoid Sutures

Facial Bone:

Only the mandible moves (TMJ)

The Head

The Head

Glands of the Head

Salivary- Three pairs of glands,

located bilaterally. (only two
palpable).

Parotid- Largest salivary gland, not

normally palpable.
Submandibular- beneath mandible.
Sublingual- floor of the mouth.

The
Neck

Conduit for passage of:

Vessels, muscles, nerves,

lymphatics, respiratory
organs (air), digestive organs
(food and fluid).

Also contains: Thyroid

Gland

Endocrine gland that controls

metabolism.

Two major muscle groups:

Sternomastoid and
Trapezius.

Anterior triangle- in front

between sternomastoid and
midline, with base along
mandible.
Posterior triangle- between
sternomastoid and trapezius
and base along clavicle.

The Neck

Cartilage/Bones of the neck

Cricoid cartilage

In front of trachea, protects breathing.

Thyroid cartilage

Above cricoid cartilage, protects thyroid.

Adams apple.

Hyoid Bone

High, at the level of the floor of the mouth.

(Remember the vertebrae)

The Neck

Lymphatics

Lymph System drains the immunologic waste products.

Lymph Node in the head and neck:

Preauricular In front of ear.

Posterior auricular (mastoid) Behind the ear.
Occipital - Base of skull
Submental - Under the chin
Submandibular Under the jaw on the sides.
Jugulodigastric Under the bend of the mandible.
Superficial cervical On top of the sternomastoid muscle.
Deep cervical Under the sternomastoid muscle.
Posterior cervical In posterior triangle near trapezius.
Supraclavicular Above and behind the clavicle at the sternomastoid muscle.

Lymph Nodes

Lymphatics

Drainage:

Since the lymph system drains immunologic waste,

look above and below the node for problems
draining.

Basically another vessel (like blood vessels).

Located throughout body, but can only be examined

(without diagnostic testing) in the head, neck, arm,
axillae, and inguinal areas.

Developmental: Infants
and Children

Fontanels- spaces where the sutures in the skull

intersect.

Covered by soft spots, will ossify (close).

Allow for growth during the first year.

Head is 90% its full size by age six, (then the rest of
the body catches up).

Lymphoid tissue well developed at birth.

Developmental:

Preganancy

Thyroid gland enlarges during pregnancy.

Aging Adult

Facial bones and orbits appear more prominent.

Sagging skin.

History/Subjective
Assessment

Ask patient if the have a history of:

Headaches
Onset, Location, Character, Duration, Precipitating Factors,
Alleviating Factors, Pattern, Treatment.
Head Injury
Onset, Location, Duration, Associated symptoms, Pattern,
Treatment.
Dizziness
Lightheadedness vs. Falling vs. Spinning, Onset, Associated
Factors
Neck Pain
Onset, Location, Associated Symptoms, Precipitating Factors,
Treatment.
Lumps or swelling
Recent infection/tenderness, History of: radiation, smoking, chew
tobacco, thyroid problems.
Head or neck surgery
What surgery, when, where, and outcome.

History/Subjective
Assessment

For Aging Adult Add:

If dizziness occurs, how does it affect ADLs? Can you

walk/drive safely?
If neck pain, How does it affect ADLs? Can you
drive/work/do housework/sleep/look down stairs?

For Children Add:

Did mother use ETOH or street drugs? How much and how
often?
Delivery vaginal or C-section? Any problems?
Was babys growth normal?

Assessment/Objective Data

Inspect and Palpate the Skull

Normocephalic normal size and shape.

Temporal Area- Palpate the temporal artery.
TMJ- palpate this joint.

Assessment/Objective Data

Inspect the Face

Facial Structures- appropriateness to behavior and

mood.

Note symmetry

Note involuntary movements.

Note abnormal features or swelling.

Assessment/Objective Data

Inspect and Palpate the Neck

Symmetry head midline, muscles symmetrical

ROM ask pt to:

Touch chin to chest, turn head left and right, touch ear to
each shoulder, extend head backwards (look up).
Test strength (Cranial nerve XI) by adding resistance to
persons attempt to shrug shoulders.
Look for enlargement of salivary glands, thyroid gland and
lymph nodes.

Assessment/Objective Data

Inspect and Palpate the

Neck
Symmetry, ROM

LYMPH NODES

Use gentle circular

motion of fingerpads to
palpate lymph nodes.
Begin with preauricular
lymph nodes and follow
side to side and
downward assessment.
P 261 in text.

Assessment/Objective Data

Lymph Nodes

If any nodes are palpable,

note location, size, shape,
delimitation, mobility,
consistency, and
tenderness.
(Normal- Movable,
discrete, soft and
nontender).
If abnormal, assess
drainage vessels for
problems: such as
pulsating, absent pulse,
weak pulse.

Assessment/ Objective
Data

Trachea

Should be midline.

Slide finger from sternal notch to either side,

should be equal.

Assessment/Objective Data

Thyroid gland
Posterior approach- move
behind the pt., Push with left
hand, palpate with right. (then
reverse)
Anterior approach- Push with
right thumb, palpate with left
thumb (then reverse). Ask pt to
swallow.
Thyroid assessment
Auscultate Listen for bruit
(this is abnormal).
Link: Bruits in thyroid
Slide 13-21

Questions?

Nose, Mouth and Throat

The Nose

First segment of respiratory system.

Nasal Cavity- Extends back over the roof of the mouth,

covered with virissae(hair) and cilliated mucous
membranes.

Septum- Divides the nose, most common site of nose

bleeds, highly vascular.

Turbinates- Three bony projections that increase surface

area for humidification, filtration, and warmth.

Meatus- cleft in the turbinates, allows drainage.

Nares- Nostrils

Nasal Cavity

The Sinuses

Paranasal Sinuses- air-filled pockets in the head.

Lined with mucous membranes.

Drain mucous (EASILY BLOCKED).
Resonate sound (upon percussion)
Include the frontal, maxillary, ethmoid and sphenoid
sinuses.

The Sinuses

Only two pairs of sinuses are easily assessable:

Frontal and Maxillary.

Sinuses mature and develop as we age, only

maxillary and ethmoid sinuses are present at birth.

Mouth

Oral Cavity- contains teeth, tongue, salivary

glands, bordered by lips, palate, cheeks and tongue.

Hard Palate- In front part of mouth (anterior)

made of bone.

Soft Palate- Farther back in mouth, made of

muscle.

Uvula- The dangling thing in the back of your

mouth.

Mouth

Mouth

Tongue- Large muscle, use for taste, speech, aids in

mastication.

Frenulum- Connects the tongue to floor of the mouth.

Parotid gland- Bilateral cheeks, opens in buccal mucosa

(sides of mouth).

Submandibular gland- Walnut sized, bilateral under jaw,

opens under tongue on floor of mouth.

Sublingual gland- Under the tongue on floor of the

mouth. Many small openings.

Permanent Teeth- 32 teeth

Gums (gingivae)- hold teeth in place, covered with

mucous membranes.

ThroAT

Pharynx (throat)- area behind mouth and nose.

Oropharynx- separated from mouth by a fold of tissue.

Tonsils- located in oropharynx, made of lymphoid tissue.

Nasopharynx- continuous with oropharynx, located behind

nasal cavity. Contains pharyngeal tonsils (adenoids) and
eustacian tube opening.

Aging Adult

Decreased sense of smell.

Nose hair longer and coarse. (should not clip, may

cause infection).

Decreased sense of taste (loss of taste buds).

Higher risk of oral infections due to thinning

of tissue.

Increased tooth loss.

Malocclusion- related to tooth loss (difficulty

chewing, pain with chewing). May not be able
to fully open the mouth. Encourage soft foods.

Cross-Cultural

Native Americans and Asians- bifid uvula (split in

two) more common.

Native Americans and Asians- cleft lip and cleft

palate more common.

Native Americans, Asians, and Inuits- Torus

palatinus (bony ridge on hard palate) more common.

Blacks- Leukoedema (benign) grey-white lesion on

buccal mucosa (68-90%) very common.

Whites- most likely to have tooth decay.

However, African-Americans, Hispanics, Native

Americans, and Alska Natives more likely to loose
teeth or have untreated cavities.

African-American males- highest rate of oral and

pharyngeal cancers, with much poorer prognosis.

Health History/Subjective
Data

Nose:

Discharge
Frequent colds
Sinus pain
Trauma
Epistaxis
Allergies
Altered smell

Health History/Subjective
Data

Mouth

Sores/lesions
Sore throat
Bleeding gums
Toothache
Hoarseness
Dysphagia
Altered taste
Smoking/Alcohol
Self-Care behaviors (dentist, dentures)

Slide 16-36

Health History/Subjective Data

Additional history for
infants and children

Additional history for

the aging adult

Mouth infection

Mouth dryness

Sore throat

Tooth loss

Tooth eruption

Care of teeth, dentures

Self-care

Taste, smell

Slide 16-37

Objective DataPhysical Exam

Preparation

Positioning- sitting upright, head at eye level.

Equipment

Otoscope with short, wide-tipped nasal speculum

attachment

Penlight

Two tongue blades

Cotton gauze pad (4 4 inches)

Gloves

Long-stem light attachment for otoscope (occasionally)

Objective DataPhysical Exam

(cont.)

NoseInspect and palpate

External nose

Symmetric, midline, proportional.

Any deformities?

Nasal cavity

Patent- occlude one nare at a time.

Nasal septum- Deviated?
Turbinates- Swelling? Color?

Slide 16-38

Objective DataPhysical Exam

(cont.)

Sinus AreasPalpate

Frontal and maxillary

sinuses (Press gently with
thumbs)

Slide 16-39

Objective DataPhysical Exam

MouthInspect

Lips- color, moisture, cracking,

lesions.

Teeth and gums- White,

straight, and evenly spaced,
clean and free of debris or
decay.

Tongue- color, surface

characteristics, moisture. Look
for patches or lesions.

Palpate U-shape under tongue

(most likely place for cancer.)

Buccal mucosa- Color,

nodules,lesions, moisture.

Pat Thomas, 2006.

Slide 16-40

Objective Data/Physical
Exam

Hard Palate- Hard, white

with rugae.

Soft Palate- Soft, pink,

smooth, and upwardly
mobile.

Uvula- Should rise up when

person says Ahh. (Cranial
Nerve X)

Objective DataPhysical
Exam
ThroatInspection

Tonsils grading (pictured)

1+=Visible, 2+ halfway
between tonsillar pillars
and uvula, 3+ touching
the uvula, 4+ touching
each other.

Posterior pharyngeal wallwill trigger the GAG

REFLEX!! (cranial nerves
IX and X)

Stick out your tongue

should be midline. (cranial
nerve XII)
Slide
16-42

Objective Data: Mouth

Gloved hand > hold

tongue with gauze >
move tongue out and to
each side > with pen
light, look for any
lesions/patches

Gloved hands > one

under jaw to stabilize >
other hand, one finger
palpates under tongue
around jaw line for any
lumps, pain

Questions?