At least nine clinical specialties have a major focus on the head and neck. Each specialty has developed detailed examinations to meet their needs, often with the use of specialized instruments. We describe examinations that can be made with the resources available to the general clinician. Traumatic disorders are not considered.
Examination of the head, neck, and cranial nerves (CNs) is an essential part of the neurologic examination. Interpretation of physical examination findings is done with an eye to both the local findings and the pattern of neurologic abnormalities. This chapter discusses the symptoms, physical examination, signs, and syndromes related to the head and neck. Symptoms, physical examination, signs, and syndromes primarily of neurologic significance are discussed in Chapter 14. By necessity, these distinctions are somewhat arbitrary.
In the general head and neck examination, the examiner should: (1) identify signs of generalized disease, (2) recognize local lesions within the purview of the generalist, and (3) recognize local lesions requiring specialist care.
Major Systems of the Head and Neck
The head and neck contain a complicated grouping of major structures all with close proximity to one another. The examiner must always be aware of the anatomy and functional physiology of the superficial and deep structures.
The skull, facial bones, and scalp provide protection and insulation to the deeper structures. The scalp and face are rich in blood vessels that vasodilate in response to cold to maintain normal body temperatures within these vital structures. The head contains the organs of special sense: the eyes, ears, olfactory nerve, and taste buds of the tongue. Impairment of the special senses suggests problems with the sensory organs, their CNs, or the brain. The tongue, pharynx, and larynx are the organs of speech. Changes in articulation suggest anatomic or functional problems with these structures. The nose, mouth, pharynx, larynx, and trachea form the upper airways; any compromise of these structures may impair effective respiration and effect changes in the tone or volume of voice. The mouth, teeth, mandible and maxilla, tongue, salivary glands, pharynx, and upper esophagus are the upper alimentary tract necessary for mastication and swallowing of food. The head and neck are highly vascular. The superficial structures have rich anastomoses from branches of the external carotid, so ischemic injury is unusual. The internal carotid and vertebral arteries supply blood to the brain. The head and neck have a rich lymphatic network draining to discrete regional lymph node beds. The tonsils and adenoids are lymphatic organs surrounding the upper aerodigestive tract. The neck contains the thyroid and parathyroid glands, major structures of the endocrine system.
Functional Anatomy of the Head and Neck
The scalp has five layers: the skin, subcutaneous connective tissue, epicranius, a subfascial cleft with loose connective ...