At least nine clinical specialties have a major focus on the head and neck: neurology, neurosurgery, ophthalmology, otolaryngology, plastic surgery, radiology, radiation oncology, oral surgery, and dentistry. 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. Presentation of the entire range of potential diagnoses is beyond the scope of this book. Traumatic disorders are not considered.
Examination of the head, neck, and cranial nerves 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 physical examination, symptoms, and signs of the head and neck; for signs of primarily neurologic significance, we refer the reader to the appropriate section of the neurologic examination in Chapter 14 to discuss the finding and its interpretation. The major syndromes specific to the head and neck organs, exclusive of the central nervous system, are discussed in this chapter, while the neurologic syndromes 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.
The head and neck contain a complicated grouping of major structures all within close proximity to one another. The examiner must always be aware of the anatomy and functional physiology of the superficial and deep structures being examined.
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 either problems with the sensory organs, their cranial nerves, 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. ...