Reformas al Código Civil

To ensure the most effective treatment of the area possible, it is necessary to know the location of some important soft tissue structures ( Fig. 5-2 ).

The glabella is located on the midfrontal bone; it is the area of skin between the eyebrows. Find the superfi cial temporal artery/pulse by mov- ing under the eye along the orbit and tracing the zygomatic arch to just in front of the ear. Move just superior to the arch, and use light pressure since the artery is very superfi cial.

Move inferiorly from the arch to locate the parotid gland, a salivary gland located superfi cially over the posterior portion of the masseter muscle; it envelops the angle of the mandible. Palpate over the angle in a circular motion with the fi ngertips; the gland should feel like a small cluster of nodules. The duct for the parotid gland, the parotid duct , runs horizontally from the gland into the mouth. To fi nd it, locate the anterior border of the masseter muscle by having the client clench his or her teeth. Palpate just below the zygomatic arch at the anterior border of the mas- seter in an up-and-down fashion; the duct should feel like a small tube running horizontally.

The submandibular gland is a salivary gland located up and under the mandible. It sits about halfway between the angle of the mandible and the mental protuberance, and it feels like a round nodule. Have the client press his or her tongue to the roof of the mouth to make the gland more prominent. The submandibular lymph nodes are located in the same area as the submandibular salivary gland. They are smaller and rounded and are responsible for draining the forehead and anterior face region, as well as the lateral upper lip and chin.

The facial artery/pulse lies on the body of the mandible at the anterior border of the masseter muscle. Locate the anterior border of the masseter by having the client bite down. At the most

anterior border of the muscle, trace

down to the body of the mandible and palpate using very light pressure while feeling for a pulse. Trace the body of the mandible distally to the chin at the

mental protuberance to fi nd the sub-

mental lymph nodes up and under the

jaw; these drain the central portion of the lower lip and chin.

jur10939_ch05_094-155.indd Sec1:99

Helix Triangular fossa Antihelix External acoustic meatus Tragus Antitragus Lobule (earlobe) Preauricular lymph nodes Postauricular lymph nodes Auricle Temporal Zygomatic Buccal Mandibular Cervical

Figure 5-3 The branch-

es of the facial nerve.

Figure 5-4 The surface

anatomy structures of the ear.

100 Part II Regional Approach to Treatment

The facial nerve is responsible for the face and neck ( Fig. 5-3 ). To identify its branches, stand behind the client and place an open hand on the side of his or her face so that the ear is under your palm. Place your thumb and fi ngers as described below to locate the branches:

Temporal branch: Thumb just above the orbit of the eye Zygomatic branch: Index fi nger over the zygomatic arch Buccal branch: Middle fi nger between the nose and the upper lip

Mandibular branch: Ring fi nger under the bottom lip above the chin

Cervical branch: Little fi nger down and anterior across the neck

There are numerous structures relative to the ear ( Fig. 5-4 ):

Auricle: The cartilaginous outer portion of the ear Helix: The outer ring of the auricle

Antihelix: The inner smaller ring of the auricle running parallel to the helix

Triangular fossa: An anterior/superior fossa dividing the helix and an- tihelix

External auditory meatus: The external opening of the ear canal Tragus: A posterior-facing projection that partially covers the external auditory meatus

Antitragus: The projection that sits opposite and inferior to the tragus Lobule: The earlobe

Located just in front of the ear canal and just behind the ears, the pre- and

postauricular lymph nodes are very small and diffi cult to palpate. Use

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Chapter 5 Conditions of the Head and Neck 101 very light pressure in a circular fashion to fi nd them, keeping in mind

that they are often not palpated in healthy individuals.

On the posterior head (see Fig. 5-2 ), the suboccipital lymph nodes are located at the base of the occiput on either side. They are posterior to the mastoid process but not all the way to the midline. Have the client tuck his or her chin slightly to help in locating them.

Lastly, the greater occipital nerve is located at the midpoint between the mastoid process and the external occipital protuberance along the oc- ciput. This nerve runs vertically, so it should be palpated in a transverse direction. It is easiest to locate while the client is in the prone position with relaxed muscles, but it can also be located with the client in the sit- ting position.