Head Face and Neck

Examination of the head and neck should include evaluation of cranial sutures, anterior and posterior fontanelles, facial symmetry, hard and soft palate, patency of the ear canal, patency of both nares, position of the nasal septum, placement of the ears, and intercanthal distance of the eyes.

The fontanelles should be flat and soft, and cranial sutures should be slightly mobile. The cranial sutures may override each other, and there may be temporary skull asymmetry after prolonged labor or vaginal delivery. Caput succeda-neum and cephalohematoma (subperiosteal hemorrhage) are also common complications of labor and vaginal delivery. A cephalohematoma is a result of bleeding in the sub-periosteal space and does not extend across a suture line, whereas caput succedaneum is caused primarily by subcutaneous edema and can involve any amount of the scalp. Caput succedaneum is present at delivery, and cephalohematoma is not evident until a few hours of age.

Many infants have transient skin lesions on the face and neck, and these should be noted and discussed with caregivers. Some birthmarks, however, can be a sign of underlying disease. For example, a port-wine stain occurring in the distribution of the first branch of the trigeminal nerve may be associated with Sturge-Weber syndrome. Hemangiomas are not always present at birth and might not be visible until 1 month of age. Most hemangiomas spontaneously regress during childhood and need no specific management. Periocular hemangiomas, however, should be managed with ophthalmologic consultation and aggressive therapy (Thureen et al., 2005).

The eyes, nose, mouth, and ears should be symmetric. Using a gloved finger, the hard and soft palate should be palpated and found to be fully merged. The oropharynx should be visualized, and the uvula should be single and midline. The ear canals should be inspected with an otoscope and found to be patent, and a small nasogastric tube should pass freely through each nare to the oropharynx. The helix of the ear (top portion) should be above the position of the inner canthi of the eyes.

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