头眼耳鼻喉课件.ppt

Locate the TMJ with your fingertips placed just anterior to the tragus of each ear. Allow your fingertips to slip into the joint space as the patient’s mouth open and gently palpate the joint space An audible or palpable snapping or clicking in the TMJ is not unusual, but pain, crepitus, locking or popping may indicate TMJ syndrome Feel in sequence for the following nodes Preauricular –in front of the ear Posterior auricular – superficial to the mastoid process Occipital – at the base of the skull Tonsillar – at the angle of the mandible Submandibular – midway between the angle and the tip of the mandible 6. Submental – in the midline 7. Superficial cervical – superficial to the SCM 8. Posterior cervical chain –along the anterior edge of the trapezius 9. Deep cervical chain –deep into the SCM but often inaccessible to examination 10. Supraclavicular –deep in the angle formed by the clavicle and the SCM Locate for the carotid pulse, in the neck just medial to and below the angle of the jaw ( do not palpate simultaneously) Excessive carotid massage can cause slowing of the pulse or a drop in blood pressure If you have difficulty feeling the pulse, rotate the patient’s head to the side being examined to relax the SCM muscle Examine the arterial pulse with the distal part of the 2nd and 3rd fingers Compare it with the other side. The spaces should be symmetrical. If asymmetrical there is deviation HEADACHE - refers to pain perceived more than momentarily in the cranial vault , orbits and the nape. Pain elsewhere in the face is not included Mechanisms of Headache 1. infection – meningitis, encephalitis 2. arterial dilatation – Malignant Hypertension 3. hemorrhage – intracebral , subdural and SAH 4.Expanding mass lesion – brain tumor 5. Trauma – head trauma , inc. ICP 6. Tissue Ischemia – hypoxia, hypoglycemia Hypertensive headache - due to segmental dilatation of branches of external carotid artery - headache occurs in half of patients with accelerate