诊断学physicalexaminationoftheheadandneck头颈部检查.pptVIP

Head  Wang xinjun 王新军 The inspection is esp, important and useful for PE of head This is because many traits or findings from the head, esp, the face, is so attractively draw our attention when we firstly look at the patient. For Ex, the emotional reactions: Inspect for asymmetry of the skull, ears, eyes, nose, mouth, jaw, and cheeks. Note any masses or deformities. Paralysis of facial Head examination In the general head examination, the examiner should: Identify signs of generalized disease Recognize local lessions within the purview of the generalist Recognize local lesions requiring specialist care HAIR, SCALP AND SKULL changes in the hair Alopecia 脱发 Clinical occurrence: hypothyroidism et al Hirsutism and hypertrichosis多毛症和毛发过多 polycystic ovary, glucocorticoid excess 多囊卵巢、糖皮质激素过多 SKULL MALFORMATION 头颅畸形 Craniosynostosis颅缝早闭: premature union of special sutures leads to skull malformations. Hydrocephalus脑积水 Meningocele脑脊膜膨出 Eyes Eyelids 眼睑 Conjunctiva 结膜 Eye ball 眼球 Cornea 角膜 Sclera 巩膜 Iris and lens and pupils 虹膜、晶状体、瞳孔 eyelids Lid inversion (entropion) 睑内翻 Lid eversion (ectropion)睑外翻 Failure of lid closure (paralysis of orbicularis muscle) 眼睑闭合障碍 Failure of lid opening (ptosis of the lid)上睑下垂 Lid swelling (palpebral edema)眼睑水肿 Failure of lid closure The facial nerve(CN VII) supplies the orbicularis oculi muscle眼轮匝肌. Disorder of this nerve, as in Bell palsy（贝尔麻痹，面神经麻痹）, causes partial or complete paralysis of the orbicularis. Failure of lid opening The congenital form is usually bilateral from paralysis or failure to develop the levator palpebrae superioris提上睑肌. Clinical occurrence: encephalitis, Horner syndrome, paralysis of the levator muscle. ptosis of the lid (Horner syndrome) Interruption of the cervical sympathetic chain interupts sympathetic innervation of the eye and face. The complete syndrome has ptosis上睑下垂, miosis瞳孔缩小,and anhydrosis on the affected side患侧面部无汗. Lid swelling Local infection cause inflammatory edema of the