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The comprehensive head and neck exam is typically performed when patients have symptoms, concerns, or risk factors for disorders related to this area.
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Although students and providers may not necessarily think of the face and neck as a sensitive region in the same context of other portions of our anatomy, they are nonetheless considered very personal space for many people, and the examiner should remain mindful of this. As such, the exam should be approached in a trauma informed fashion, describing each maneuver, the rationale, moving slowly and providing the patient with an opportunity to stop or opt out.
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Communicate your actions with the patient simply and clearly throughout the examination, and consider starting with some of the less intimate portions of the examination (eg, observation, cranial nerves) prior to “moving in close” for aspects such as palpation of the neck and the intraoral exam.
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Good lighting is critical for proper oral examination. A headlight is optimal, as this allows maximal illumination while freeing both hands for palpation and manipulation of the tissues. If a flashlight or otoscope is used, ensure that it is turned to the brightest setting.
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Head and neck review of systems is covered in Chapter 2. See Chapter 1 for directions about how to obtain historical information related to a head and neck concern.
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The patient should be comfortably seated on the end of the exam table to provide the examiner with easy access to both sides of the head and neck (eg, for palpation of the neck or inspection of the scalp) (Figure 4-1).
During the initial portion of the visit while speaking with the patient, observe the face and neck for any evidence of asymmetry. Are there visible masses, swelling, or skin lesions? Is there any asymmetry of motion, particularly around the eyes, brow, or mouth (areas that are most animated when we speak)?
Listen to how the patient sounds. Is the voice quality altered? Is it rough, breathy, strained, or muffled? Are there any audible alterations in speech?
Hair on the face or scalp can make inspection of the underlying skin challenging. If there is concern for cutaneous pathology, such as malignancy, rash, or an autoimmune disorder, a thorough inspection may require using fingers to manipulate the hair and allow for a systematic examination.
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Findings and Their Meaning: Changes in Speech and Superficial Abnormalities
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Alterations in voice quality could represent pathology of the vocal folds (eg, laryngitis, benign or malignant lesions) or pathology higher in the larynx or pharynx (eg, epiglottitis, tonsillitis).
Normal speech patterns vary, and breaks in fluency such as hesitance or ...