{"id":1156,"date":"2022-09-19T11:41:06","date_gmt":"2022-09-19T15:41:06","guid":{"rendered":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/face-neck-and-cranium\/"},"modified":"2024-05-03T15:33:54","modified_gmt":"2024-05-03T19:33:54","slug":"face-neck-and-cranium","status":"publish","type":"chapter","link":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/chapter\/face-neck-and-cranium\/","title":{"raw":"Face, Neck, and Cranium","rendered":"Face, Neck, and Cranium"},"content":{"raw":"<span style=\"color: #000000\">Assessment of the face, neck, and cranium involves inspection, palpation, ROM, and MMT. This assessment is best performed with the client sitting upright on the exam table. However, depending on the client\u2019s situation, it can be performed when they are sitting in a chair\/wheelchair or lying in bed.<\/span>\r\n<h2><span style=\"color: #000000\"><strong>Inspection<\/strong><\/span><\/h2>\r\n<span style=\"color: #000000\">Steps for <strong>inspecting<\/strong> the <strong>face, neck <\/strong>and<strong> cranium<\/strong> include:<\/span>\r\n<ol>\r\n \t<li><span style=\"color: #000000\"><strong>Inspect<\/strong> the <strong>face for colour, symmetry, swelling, masses, <\/strong>and<strong> deformities<\/strong> with a focus on the muscles, bones, and joints.<\/span><\/li>\r\n<\/ol>\r\n<ul>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normally, the face has no discolourations such as erythema and is symmetrical with no swelling, masses, or deformities. Describe the appearance and location of any discolouration, swelling, masses, and deformities.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<span style=\"color: #000000\">2.<strong> Inspect<\/strong> the <strong>anterior, lateral, <\/strong>and<strong> posterior sides<\/strong> of the neck and cranium (as well as the superior side of the cranium). Depending on the reason for assessment, it may be appropriate to request permission to move the client\u2019s hair so that you can directly observe the cranium.<\/span>\r\n<ul>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normally, the head is upright and centred and the cranium and the neck are symmetrical with no masses, swelling, deformities, or discolourations. Describe the appearance and location of any asymmetry, masses, swelling, deformities, and discolourations (these will be further assessed with palpation).<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<span style=\"color: #000000\">3. Note the <strong>findings<\/strong>.<\/span>\r\n<ul>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normal findings might be documented as: \u201cClient\u2019s head is upright and centred. No masses, swelling, deformities or discolouration on the head, face and neck.\u201d<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cClient\u2019s face has swelling over the right zygomatic (cheekbone) area with bluish-purple discolouration.\u201d<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<div class=\"textbox shaded\">\r\n<h2 style=\"text-align: center\"><span style=\"color: #000000\"><strong>Contextualizing Inclusivity<\/strong><\/span><\/h2>\r\n<span style=\"color: #000000\">Consider an inclusive, anti-racist, and trauma-informed approach when assessing the cranium, which may involve touching the hair. Clients may have alopecia due to a medical diagnosis or treatment that has caused hair loss; hair loss can be distressing and make them feel vulnerable. There is also a cultural component to hair and headwear, which can be connected to identity, culture, and body image - this can apply to many people. Be aware that structural racism continues to pervade ideals of beauty and affects Black women in particular (Johnson &amp; Bankhead, 2014). Black women may wear their hair naturally, in locs, braids, wigs, or extensions such as clip-ins and weaves. Black women continue to be affected by structural and interpersonal racism with accompanying discrimination, judgement, and marginalization (Brown, 2018). Additionally, some Indigenous people have a spiritual connection with their hair and for that reason, along with the effects of forced cutting of hair in residential schools, and intergenerational trauma more broadly, some may consider it offensive to have their hair touched. As a healthcare provider, you should be aware of these issues and use an anti-racist and trauma-informed approach. Always ask permission to touch and explain what you are doing and why. Only perform assessments when necessary and engage the client in the process.<\/span>\r\n\r\n<\/div>\r\n<h2><span style=\"color: #000000\"><strong>Palpation<\/strong><\/span><\/h2>\r\n<span style=\"color: #000000\">Steps for <strong>palpating <\/strong>the <strong>cranium, face, <\/strong>and<strong> neck<\/strong> include:<\/span>\r\n<ol>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Palpate the <strong>temporomandibular joint<\/strong> (where the maxilla and mandible meet anterior to the tragus). Do both sides at the same time and place two to three finger pads on each side and move in a circular motion in two to three areas. Then, use dorsa of hands and palpate the <strong>posterior side of neck<\/strong> for <strong>temperature<\/strong>. The rest of the facial structures are normally not palpated unless the client has indicated a concern or has experienced a physical injury.<\/span><\/li>\r\n<\/ol>\r\n<ul>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normally, the temperature is equal bilaterally, muscles are firm to touch, and no pain is felt on palpation.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<span style=\"color: #000000\">2. Palpate down the <strong>cervical spine<\/strong> and the<strong> paravertebral muscles<\/strong> on the posterior side of the neck from inferior to the occipital bone (C1) down to C7 (see <strong>Video 1<\/strong>). Then, palpate down the <strong>trapezius muscles <\/strong>followed by the<strong> sternomastoid muscles<\/strong>. Ask the client if they have any pain\/tenderness.<\/span>\r\n<ul>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normally, the cervical spine and muscles are symmetrical with no pain, masses, swelling, deformities, or paravertebral muscle spasms. The description and location of abnormal findings should be noted. Description of masses and swelling may include size and consistency (soft or hard).<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<span style=\"color: #000000\">3. Note the<strong> findings<\/strong>:<\/span>\r\n<ul>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normal findings might be documented as: \u201cTemperature warm to touch and equal bilaterally with no pain on temporomandibular joint. Cervical spine and muscles are symmetrical with no pain, masses, swelling, or deformities noted on palpation.\u201d<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cClient noted pain as a 6\/10 upon palpation of the cervical spine. Swelling palpable from C6\u20137.\u201d<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n&nbsp;\r\n\r\n[embed]https:\/\/youtu.be\/v2wXMi67RP4[\/embed]\r\n\r\n<span style=\"color: #000000\"><strong>Video 1<\/strong>: Palpation of spinous processes and paravertebral muscles from C1 to C7 [0:43]<\/span>\r\n<div><\/div>\r\n<h2><span style=\"color: #000000\"><strong>Range of Motion (ROM)<\/strong><\/span><\/h2>\r\n<span style=\"color: #000000\">ROM related to the face is focused on the temporomandibular joint and includes vertical and lateral motions and protraction and retraction. ROM of the neck involves flexion, extension, lateral bending, and rotation (see <strong>Table 4<\/strong> for normal ranges). For cervical spine ROM, you will assess the gross ROM, which is the cumulative ROM of all of the spinal segments together.<\/span>\r\n\r\n<span style=\"color: #000000\">While performing the assessment, observe the ROM, quality of the movement, listen for crepitus, and ask the client about the presence of pain.<\/span>\r\n\r\n<span style=\"color: #000000\">While demonstrating the movements yourself, the steps in assessing ROM of the temporomandibular joint and the neck are:<\/span>\r\n<ol>\r\n \t<li><span style=\"color: #000000\">Ask the client to open and close their mouth (<strong>vertical motion<\/strong>). Then, place your index and middle fingers on the temporomandibular joints on both sides of the face and ask them to repeat the movement<\/span>\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normally, there should be no pain and the temporomandibular joint should open and close smoothly. Sometimes, you may hear and\/or feel a click (clunk) of the jaw. This is usually not of concern unless associated with pain and affecting the ability to chew food.<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n \t<li><span style=\"color: #000000\">Ask the client to perform <strong>neck flexion<\/strong> by attempting to touch their chin to their chest and bring it back to neutral position.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Ask the client to perform <strong>neck extension<\/strong> by gently tilting their head back and bring it back to neutral position.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Ask the client to perform <strong>neck lateral bending<\/strong> by tilting their head to the right, back to neutral position, and then to the left (e.g., \u201cattempting to touch their ear to their shoulder\u201d).<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Ask the client to perform <strong>neck rotation<\/strong> by turning their head to the right, back to neutral position, and then to the left.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Note the <strong>findings<\/strong>:<\/span><\/li>\r\n<\/ol>\r\n<ul>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Normal findings might be documented as: \u201cClient\u2019s temporomandibular joint and neck has full ROM, movements of joints are smooth and symmetrical with no obvious misalignments, no crepitus or pain noted.\u201d<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cClient\u2019s neck has limited ROM in flexion with no crepitus. Pain noted as a 3\/10 while flexing.\u201d<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<span style=\"color: #000000\">NOTE: See <strong>Video 2<\/strong> for ROM of the neck.<\/span>\r\n\r\n&nbsp;\r\n\r\n<span style=\"color: #000000\"><strong>Table 4<\/strong>: Normal ROM of temporomandibular joint and neck (adapted from Luttgens &amp; Hamilton, 1997).<\/span>\r\n<div align=\"left\">\r\n<table class=\"grid landscape\" style=\"height: 306px;width: 825px\">\r\n<tbody>\r\n<tr class=\"shaded\" style=\"height: 46px\">\r\n<td style=\"height: 46px;width: 320.035px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\"><strong>Jo<\/strong><strong>int<\/strong><\/span><\/td>\r\n<td style=\"height: 46px;width: 476.088px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\"><strong>Range of motion<\/strong><\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 61px\">\r\n<td style=\"height: 61px;width: 320.035px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\">Temporomandibular joint<\/span><\/td>\r\n<td style=\"height: 61px;width: 476.088px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\">ROM for the temporomandibular joint is not commonly performed unless there is a concern regarding pain or functionality.<\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 46px\">\r\n<td style=\"height: 46px;width: 320.035px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\">Neck: Flexion<\/span><\/td>\r\n<td style=\"height: 46px;width: 476.088px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\">60 degrees<\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 46px\">\r\n<td style=\"height: 46px;width: 320.035px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\">Neck: Extension<\/span><\/td>\r\n<td style=\"height: 46px;width: 476.088px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\">75 degrees<\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 61px\">\r\n<td style=\"height: 61px;width: 320.035px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\">Neck: Lateral flexion<\/span><\/td>\r\n<td style=\"height: 61px;width: 476.088px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\">45 degrees<\/span><\/td>\r\n<\/tr>\r\n<tr style=\"height: 46px\">\r\n<td style=\"height: 46px;width: 320.035px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\">Neck: Rotation<\/span><\/td>\r\n<td style=\"height: 46px;width: 476.088px;vertical-align: top\">&nbsp;\r\n\r\n<span style=\"color: #000000\">80 degrees<\/span><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/div>\r\n&nbsp;\r\n\r\n[embed]https:\/\/youtu.be\/UvxeG9-l_Pc[\/embed]\r\n\r\n<span style=\"color: #000000\"><strong>Video 2<\/strong>: ROM of neck [0:58]<\/span>\r\n<h2><span style=\"color: #000000\"><strong>Manual Muscle Testing (MMT)<\/strong><\/span><\/h2>\r\n<span style=\"color: #000000\">Assess MMT after ROM. Explain the procedure before applying force. Perform MMT on each joint bilaterally. Grade the resistance according to the institution\u2019s grading scale (e.g., MRC) or just describe it and note whether it is equal bilaterally. Keep in mind that MMT of the neck also provides information about the functioning of cranial nerve XI (spinal accessory nerve) and whether it is innervating the muscles.<\/span>\r\n\r\n<span style=\"color: #000000\">MMT of the face, neck, and cranium is focused only on the neck and is typically performed with the client in sitting position. The steps involve:<\/span>\r\n<ol>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Begin with the client\u2019s head in a neutral position looking straight ahead. To perform <strong>cervical\/neck flexion<\/strong>, stand slightly lateral to the client, place one hand on the thoracic spine for stability and the other on the client\u2019s forehead, ask them to bend their neck bringing their chin to their chest while you apply force with your hand on their forehead. Ask them to resist your force. Release the force and ask them to return their head to neutral. Note if the client tries to move their shoulders or thoracic body during the procedure.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Next, place one hand on the posterior occipital bone and the other on the client\u2019s shoulder for stability. To perform <strong>neck extension<\/strong>, ask the client to look up to the ceiling to extend the cervical spine, while applying force with the hand on the occipital bone. Ask them to resist your force. Release the force and ask them to return their head to neutral. Note if the client tries to use their back during the procedure.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">Move in front of the client. For stability, place one hand on their right shoulder and the other on the client\u2019s head above the left ear over the temporal bone structures. To perform <strong>lateral bending<\/strong>, ask the client to touch their left ear to their left shoulder, while you apply force to the movement. Ask them to resist your force. Release the force and ask them to return their head to neutral. Repeat the procedure on the opposite side. Note if the client tries to flex the lateral thoracic spine during the procedure.<\/span><\/li>\r\n \t<li style=\"font-weight: 400\"><span style=\"color: #000000\">To perform <strong>rotation<\/strong>, place one hand on the right shoulder for stability and the other on the lateral side of the client\u2019s face with fingers pointing toward the temporal bone structures. Ask the client to look left to rotate the cervical spine while you apply force. Ask them to resist your force. Release the force and ask them to return their head to neutral. Repeat the procedure on the opposite side. Note if the client tries to rotate the thoracic spine during the procedure.<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Note the findings:<\/span><\/li>\r\n<\/ol>\r\n<ul>\r\n \t<li style=\"list-style-type: none\">\r\n<ul>\r\n \t<li><span style=\"color: #000000\">Normal findings might be documented as: \"\u201cfull resistance equal bilaterally on all neck ROM with no pain.\u201d<\/span><\/li>\r\n \t<li><span style=\"color: #000000\">Abnormal findings might be documented as: \"partial resistance equal bilaterally on all neck ROM with mild pain.\u201d<\/span><\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<span style=\"color: #000000\">NOTE: See <strong>Video 3<\/strong> for MMT of the neck.<\/span>\r\n\r\n&nbsp;\r\n\r\n[embed]https:\/\/youtu.be\/RsTNFEVd7aY[\/embed]\r\n\r\n<span style=\"color: #000000\"><strong>Video 3:<\/strong> MMT of the neck [1:34]<\/span>\r\n\r\n&nbsp;\r\n<div class=\"textbox textbox--learning-objectives\"><header class=\"textbox__header\">\r\n<h2 class=\"textbox__title\" style=\"text-align: center\"><strong>Priorities of Care<\/strong><\/h2>\r\n<\/header>\r\n<div class=\"textbox__content\"><span style=\"color: #000000\">If a fracture or internal trauma is suspected when inspecting the head, face, or neck, call for immediate assistance and stabilize the head and neck. Your initial suspicions will usually be based on the client\u2019s reason for seeking care. Monitor vital signs for any internal damages caused by bone fragments, such as changes in respiration due to damage of the larynx or nasal bone\/cartilage. Monitor for reduced consciousness, disorientation, or dilated pupils due to swelling in the brain. Monitor for loss of sensation or paralysis due to a severed cranial nerve. Do not perform palpation, ROM and MMT as this manipulation can increase the risk of permanent damage or life-threatening conditions. You will also do a neurological assessment, which will be introduced in another chapter; neurological involvement may be suspected if the client has limited ability to blink their eyes, stick out their tongue, raise their eyebrows, or smile.<\/span><\/div>\r\n<\/div>\r\n<h2><span style=\"color: #000000\"><strong>Activity: Check your Understanding\u00a0<\/strong><\/span><\/h2>\r\n<div class=\"postbox h5p-sidebar\">\r\n<div class=\"h5p-action-bar-settings h5p-panel\">[h5p id=\"84\"]<\/div>\r\n<\/div>\r\n<h2 style=\"text-align: left\"><span style=\"color: #000000\"><strong>References<\/strong><\/span><\/h2>\r\n<span style=\"color: #000000\">Brown, S. (2018). \u201cDon\u2019t touch my hair\u201d: Problematizing representations of Black women in Canada. Africology: The Journal of Pan African Studies, 12(8), 64-85.<\/span>\r\n\r\n<span style=\"color: #000000\">Johnson, T., &amp; Bankhead, T. (2014). Hair it is: Examining the experiences of Black women with natural hair. Open Journal of Social Sciences, 2, 86-100.<\/span> <a href=\"https:\/\/doi.org\/10.4236\/jss.2014.21010\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.4236\/jss.2014.21010<\/a>\r\n\r\n<span style=\"color: #000000\">Luttgens, K. &amp; Hamilton, N. (1997). Kinesiology: Scientific Basis of Human Motion, 9th Ed., Madison, WI: Brown &amp; Benchmark<\/span>","rendered":"<p><span style=\"color: #000000\">Assessment of the face, neck, and cranium involves inspection, palpation, ROM, and MMT. This assessment is best performed with the client sitting upright on the exam table. However, depending on the client\u2019s situation, it can be performed when they are sitting in a chair\/wheelchair or lying in bed.<\/span><\/p>\n<h2><span style=\"color: #000000\"><strong>Inspection<\/strong><\/span><\/h2>\n<p><span style=\"color: #000000\">Steps for <strong>inspecting<\/strong> the <strong>face, neck <\/strong>and<strong> cranium<\/strong> include:<\/span><\/p>\n<ol>\n<li><span style=\"color: #000000\"><strong>Inspect<\/strong> the <strong>face for colour, symmetry, swelling, masses, <\/strong>and<strong> deformities<\/strong> with a focus on the muscles, bones, and joints.<\/span><\/li>\n<\/ol>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li><span style=\"color: #000000\">Normally, the face has no discolourations such as erythema and is symmetrical with no swelling, masses, or deformities. Describe the appearance and location of any discolouration, swelling, masses, and deformities.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span style=\"color: #000000\">2.<strong> Inspect<\/strong> the <strong>anterior, lateral, <\/strong>and<strong> posterior sides<\/strong> of the neck and cranium (as well as the superior side of the cranium). Depending on the reason for assessment, it may be appropriate to request permission to move the client\u2019s hair so that you can directly observe the cranium.<\/span><\/p>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li><span style=\"color: #000000\">Normally, the head is upright and centred and the cranium and the neck are symmetrical with no masses, swelling, deformities, or discolourations. Describe the appearance and location of any asymmetry, masses, swelling, deformities, and discolourations (these will be further assessed with palpation).<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span style=\"color: #000000\">3. Note the <strong>findings<\/strong>.<\/span><\/p>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li><span style=\"color: #000000\">Normal findings might be documented as: \u201cClient\u2019s head is upright and centred. No masses, swelling, deformities or discolouration on the head, face and neck.\u201d<\/span><\/li>\n<li><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cClient\u2019s face has swelling over the right zygomatic (cheekbone) area with bluish-purple discolouration.\u201d<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<div class=\"textbox shaded\">\n<h2 style=\"text-align: center\"><span style=\"color: #000000\"><strong>Contextualizing Inclusivity<\/strong><\/span><\/h2>\n<p><span style=\"color: #000000\">Consider an inclusive, anti-racist, and trauma-informed approach when assessing the cranium, which may involve touching the hair. Clients may have alopecia due to a medical diagnosis or treatment that has caused hair loss; hair loss can be distressing and make them feel vulnerable. There is also a cultural component to hair and headwear, which can be connected to identity, culture, and body image &#8211; this can apply to many people. Be aware that structural racism continues to pervade ideals of beauty and affects Black women in particular (Johnson &amp; Bankhead, 2014). Black women may wear their hair naturally, in locs, braids, wigs, or extensions such as clip-ins and weaves. Black women continue to be affected by structural and interpersonal racism with accompanying discrimination, judgement, and marginalization (Brown, 2018). Additionally, some Indigenous people have a spiritual connection with their hair and for that reason, along with the effects of forced cutting of hair in residential schools, and intergenerational trauma more broadly, some may consider it offensive to have their hair touched. As a healthcare provider, you should be aware of these issues and use an anti-racist and trauma-informed approach. Always ask permission to touch and explain what you are doing and why. Only perform assessments when necessary and engage the client in the process.<\/span><\/p>\n<\/div>\n<h2><span style=\"color: #000000\"><strong>Palpation<\/strong><\/span><\/h2>\n<p><span style=\"color: #000000\">Steps for <strong>palpating <\/strong>the <strong>cranium, face, <\/strong>and<strong> neck<\/strong> include:<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Palpate the <strong>temporomandibular joint<\/strong> (where the maxilla and mandible meet anterior to the tragus). Do both sides at the same time and place two to three finger pads on each side and move in a circular motion in two to three areas. Then, use dorsa of hands and palpate the <strong>posterior side of neck<\/strong> for <strong>temperature<\/strong>. The rest of the facial structures are normally not palpated unless the client has indicated a concern or has experienced a physical injury.<\/span><\/li>\n<\/ol>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li><span style=\"color: #000000\">Normally, the temperature is equal bilaterally, muscles are firm to touch, and no pain is felt on palpation.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span style=\"color: #000000\">2. Palpate down the <strong>cervical spine<\/strong> and the<strong> paravertebral muscles<\/strong> on the posterior side of the neck from inferior to the occipital bone (C1) down to C7 (see <strong>Video 1<\/strong>). Then, palpate down the <strong>trapezius muscles <\/strong>followed by the<strong> sternomastoid muscles<\/strong>. Ask the client if they have any pain\/tenderness.<\/span><\/p>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li><span style=\"color: #000000\">Normally, the cervical spine and muscles are symmetrical with no pain, masses, swelling, deformities, or paravertebral muscle spasms. The description and location of abnormal findings should be noted. Description of masses and swelling may include size and consistency (soft or hard).<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span style=\"color: #000000\">3. Note the<strong> findings<\/strong>:<\/span><\/p>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li><span style=\"color: #000000\">Normal findings might be documented as: \u201cTemperature warm to touch and equal bilaterally with no pain on temporomandibular joint. Cervical spine and muscles are symmetrical with no pain, masses, swelling, or deformities noted on palpation.\u201d<\/span><\/li>\n<li><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cClient noted pain as a 6\/10 upon palpation of the cervical spine. Swelling palpable from C6\u20137.\u201d<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-1\" title=\"Palpation of Spinous Processes and Paravertebral Muscles from C1 to C7 - MSK Chapter\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/v2wXMi67RP4?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"color: #000000\"><strong>Video 1<\/strong>: Palpation of spinous processes and paravertebral muscles from C1 to C7 [0:43]<\/span><\/p>\n<div><\/div>\n<h2><span style=\"color: #000000\"><strong>Range of Motion (ROM)<\/strong><\/span><\/h2>\n<p><span style=\"color: #000000\">ROM related to the face is focused on the temporomandibular joint and includes vertical and lateral motions and protraction and retraction. ROM of the neck involves flexion, extension, lateral bending, and rotation (see <strong>Table 4<\/strong> for normal ranges). For cervical spine ROM, you will assess the gross ROM, which is the cumulative ROM of all of the spinal segments together.<\/span><\/p>\n<p><span style=\"color: #000000\">While performing the assessment, observe the ROM, quality of the movement, listen for crepitus, and ask the client about the presence of pain.<\/span><\/p>\n<p><span style=\"color: #000000\">While demonstrating the movements yourself, the steps in assessing ROM of the temporomandibular joint and the neck are:<\/span><\/p>\n<ol>\n<li><span style=\"color: #000000\">Ask the client to open and close their mouth (<strong>vertical motion<\/strong>). Then, place your index and middle fingers on the temporomandibular joints on both sides of the face and ask them to repeat the movement<\/span>\n<ul>\n<li><span style=\"color: #000000\">Normally, there should be no pain and the temporomandibular joint should open and close smoothly. Sometimes, you may hear and\/or feel a click (clunk) of the jaw. This is usually not of concern unless associated with pain and affecting the ability to chew food.<\/span><\/li>\n<\/ul>\n<\/li>\n<li><span style=\"color: #000000\">Ask the client to perform <strong>neck flexion<\/strong> by attempting to touch their chin to their chest and bring it back to neutral position.<\/span><\/li>\n<li><span style=\"color: #000000\">Ask the client to perform <strong>neck extension<\/strong> by gently tilting their head back and bring it back to neutral position.<\/span><\/li>\n<li><span style=\"color: #000000\">Ask the client to perform <strong>neck lateral bending<\/strong> by tilting their head to the right, back to neutral position, and then to the left (e.g., \u201cattempting to touch their ear to their shoulder\u201d).<\/span><\/li>\n<li><span style=\"color: #000000\">Ask the client to perform <strong>neck rotation<\/strong> by turning their head to the right, back to neutral position, and then to the left.<\/span><\/li>\n<li><span style=\"color: #000000\">Note the <strong>findings<\/strong>:<\/span><\/li>\n<\/ol>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Normal findings might be documented as: \u201cClient\u2019s temporomandibular joint and neck has full ROM, movements of joints are smooth and symmetrical with no obvious misalignments, no crepitus or pain noted.\u201d<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Abnormal findings might be documented as: \u201cClient\u2019s neck has limited ROM in flexion with no crepitus. Pain noted as a 3\/10 while flexing.\u201d<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span style=\"color: #000000\">NOTE: See <strong>Video 2<\/strong> for ROM of the neck.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><span style=\"color: #000000\"><strong>Table 4<\/strong>: Normal ROM of temporomandibular joint and neck (adapted from Luttgens &amp; Hamilton, 1997).<\/span><\/p>\n<div style=\"text-align: left;\">\n<table class=\"grid landscape\" style=\"height: 306px;width: 825px\">\n<tbody>\n<tr class=\"shaded\" style=\"height: 46px\">\n<td style=\"height: 46px;width: 320.035px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\"><strong>Jo<\/strong><strong>int<\/strong><\/span><\/td>\n<td style=\"height: 46px;width: 476.088px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\"><strong>Range of motion<\/strong><\/span><\/td>\n<\/tr>\n<tr style=\"height: 61px\">\n<td style=\"height: 61px;width: 320.035px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\">Temporomandibular joint<\/span><\/td>\n<td style=\"height: 61px;width: 476.088px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\">ROM for the temporomandibular joint is not commonly performed unless there is a concern regarding pain or functionality.<\/span><\/td>\n<\/tr>\n<tr style=\"height: 46px\">\n<td style=\"height: 46px;width: 320.035px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\">Neck: Flexion<\/span><\/td>\n<td style=\"height: 46px;width: 476.088px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\">60 degrees<\/span><\/td>\n<\/tr>\n<tr style=\"height: 46px\">\n<td style=\"height: 46px;width: 320.035px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\">Neck: Extension<\/span><\/td>\n<td style=\"height: 46px;width: 476.088px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\">75 degrees<\/span><\/td>\n<\/tr>\n<tr style=\"height: 61px\">\n<td style=\"height: 61px;width: 320.035px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\">Neck: Lateral flexion<\/span><\/td>\n<td style=\"height: 61px;width: 476.088px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\">45 degrees<\/span><\/td>\n<\/tr>\n<tr style=\"height: 46px\">\n<td style=\"height: 46px;width: 320.035px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\">Neck: Rotation<\/span><\/td>\n<td style=\"height: 46px;width: 476.088px;vertical-align: top\">&nbsp;<\/p>\n<p><span style=\"color: #000000\">80 degrees<\/span><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-2\" title=\"Range of Motion (Neck) - MSK Chapter\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/UvxeG9-l_Pc?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"color: #000000\"><strong>Video 2<\/strong>: ROM of neck [0:58]<\/span><\/p>\n<h2><span style=\"color: #000000\"><strong>Manual Muscle Testing (MMT)<\/strong><\/span><\/h2>\n<p><span style=\"color: #000000\">Assess MMT after ROM. Explain the procedure before applying force. Perform MMT on each joint bilaterally. Grade the resistance according to the institution\u2019s grading scale (e.g., MRC) or just describe it and note whether it is equal bilaterally. Keep in mind that MMT of the neck also provides information about the functioning of cranial nerve XI (spinal accessory nerve) and whether it is innervating the muscles.<\/span><\/p>\n<p><span style=\"color: #000000\">MMT of the face, neck, and cranium is focused only on the neck and is typically performed with the client in sitting position. The steps involve:<\/span><\/p>\n<ol>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Begin with the client\u2019s head in a neutral position looking straight ahead. To perform <strong>cervical\/neck flexion<\/strong>, stand slightly lateral to the client, place one hand on the thoracic spine for stability and the other on the client\u2019s forehead, ask them to bend their neck bringing their chin to their chest while you apply force with your hand on their forehead. Ask them to resist your force. Release the force and ask them to return their head to neutral. Note if the client tries to move their shoulders or thoracic body during the procedure.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Next, place one hand on the posterior occipital bone and the other on the client\u2019s shoulder for stability. To perform <strong>neck extension<\/strong>, ask the client to look up to the ceiling to extend the cervical spine, while applying force with the hand on the occipital bone. Ask them to resist your force. Release the force and ask them to return their head to neutral. Note if the client tries to use their back during the procedure.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">Move in front of the client. For stability, place one hand on their right shoulder and the other on the client\u2019s head above the left ear over the temporal bone structures. To perform <strong>lateral bending<\/strong>, ask the client to touch their left ear to their left shoulder, while you apply force to the movement. Ask them to resist your force. Release the force and ask them to return their head to neutral. Repeat the procedure on the opposite side. Note if the client tries to flex the lateral thoracic spine during the procedure.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"color: #000000\">To perform <strong>rotation<\/strong>, place one hand on the right shoulder for stability and the other on the lateral side of the client\u2019s face with fingers pointing toward the temporal bone structures. Ask the client to look left to rotate the cervical spine while you apply force. Ask them to resist your force. Release the force and ask them to return their head to neutral. Repeat the procedure on the opposite side. Note if the client tries to rotate the thoracic spine during the procedure.<\/span><\/li>\n<li><span style=\"color: #000000\">Note the findings:<\/span><\/li>\n<\/ol>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li><span style=\"color: #000000\">Normal findings might be documented as: &#8220;\u201cfull resistance equal bilaterally on all neck ROM with no pain.\u201d<\/span><\/li>\n<li><span style=\"color: #000000\">Abnormal findings might be documented as: &#8220;partial resistance equal bilaterally on all neck ROM with mild pain.\u201d<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><span style=\"color: #000000\">NOTE: See <strong>Video 3<\/strong> for MMT of the neck.<\/span><\/p>\n<p>&nbsp;<\/p>\n<p><iframe loading=\"lazy\" id=\"oembed-3\" title=\"Manual Muscle Testing (Neck) - MSK Chapter\" width=\"500\" height=\"281\" src=\"https:\/\/www.youtube.com\/embed\/RsTNFEVd7aY?feature=oembed&#38;rel=0\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p><span style=\"color: #000000\"><strong>Video 3:<\/strong> MMT of the neck [1:34]<\/span><\/p>\n<p>&nbsp;<\/p>\n<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<h2 class=\"textbox__title\" style=\"text-align: center\"><strong>Priorities of Care<\/strong><\/h2>\n<\/header>\n<div class=\"textbox__content\"><span style=\"color: #000000\">If a fracture or internal trauma is suspected when inspecting the head, face, or neck, call for immediate assistance and stabilize the head and neck. Your initial suspicions will usually be based on the client\u2019s reason for seeking care. Monitor vital signs for any internal damages caused by bone fragments, such as changes in respiration due to damage of the larynx or nasal bone\/cartilage. Monitor for reduced consciousness, disorientation, or dilated pupils due to swelling in the brain. Monitor for loss of sensation or paralysis due to a severed cranial nerve. Do not perform palpation, ROM and MMT as this manipulation can increase the risk of permanent damage or life-threatening conditions. You will also do a neurological assessment, which will be introduced in another chapter; neurological involvement may be suspected if the client has limited ability to blink their eyes, stick out their tongue, raise their eyebrows, or smile.<\/span><\/div>\n<\/div>\n<h2><span style=\"color: #000000\"><strong>Activity: Check your Understanding\u00a0<\/strong><\/span><\/h2>\n<div class=\"postbox h5p-sidebar\">\n<div class=\"h5p-action-bar-settings h5p-panel\">\n<div id=\"h5p-84\">\n<div class=\"h5p-iframe-wrapper\"><iframe id=\"h5p-iframe-84\" class=\"h5p-iframe\" data-content-id=\"84\" style=\"height:1px\" src=\"about:blank\" frameBorder=\"0\" scrolling=\"no\" title=\"H5P Course Presentation: MSK - Face, neck, and Cranium\"><\/iframe><\/div>\n<\/div>\n<\/div>\n<\/div>\n<h2 style=\"text-align: left\"><span style=\"color: #000000\"><strong>References<\/strong><\/span><\/h2>\n<p><span style=\"color: #000000\">Brown, S. (2018). \u201cDon\u2019t touch my hair\u201d: Problematizing representations of Black women in Canada. Africology: The Journal of Pan African Studies, 12(8), 64-85.<\/span><\/p>\n<p><span style=\"color: #000000\">Johnson, T., &amp; Bankhead, T. (2014). Hair it is: Examining the experiences of Black women with natural hair. Open Journal of Social Sciences, 2, 86-100.<\/span> <a href=\"https:\/\/doi.org\/10.4236\/jss.2014.21010\" target=\"_blank\" rel=\"noopener\">https:\/\/doi.org\/10.4236\/jss.2014.21010<\/a><\/p>\n<p><span style=\"color: #000000\">Luttgens, K. &amp; Hamilton, N. (1997). Kinesiology: Scientific Basis of Human Motion, 9th Ed., Madison, WI: Brown &amp; Benchmark<\/span><\/p>\n","protected":false},"author":34,"menu_order":6,"template":"","meta":{"pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":"cc-by-nc"},"chapter-type":[],"contributor":[85],"license":[56],"class_list":["post-1156","chapter","type-chapter","status-publish","hentry","contributor-january-2023","license-cc-by-nc"],"part":1139,"_links":{"self":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/1156","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/users\/34"}],"version-history":[{"count":2,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/1156\/revisions"}],"predecessor-version":[{"id":1560,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/1156\/revisions\/1560"}],"part":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/parts\/1139"}],"metadata":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapters\/1156\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/media?parent=1156"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/pressbooks\/v2\/chapter-type?post=1156"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/contributor?post=1156"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.library.torontomu.ca\/assessmentnursingmain\/wp-json\/wp\/v2\/license?post=1156"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}