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Extraoral and intraoral examination

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Extraoral and intraoral examination

  1. 1. Chapter 12 Extraoral and Intraoral Examination
  2. 2. Copyright © 2017 Wolters Kluwer • All Rights Reserved Chapter Outline • Rationale • Components • Landmarks • Sequence • Morphologic Categories • Oral Cancer • Biopsy Determination • Documentation • Everyday Ethics • Factors to Teach the Patient 2
  3. 3. Copyright © 2017 Wolters Kluwer • All Rights Reserved Learning Objectives • Explain the rationale • Explain the systematic sequence • Identify normal anatomy • Describe physical characteristics • Identify suspicious conditions 3
  4. 4. Copyright © 2017 Wolters Kluwer • All Rights Reserved Rationale For The Extraoral And Intraoral Examination • Early identification • To detect cancer • Thyroid disorders • Eating disorders • Nutritional deficiencies • Sexually transmitted diseases • Systemic conditions 4
  5. 5. Copyright © 2017 Wolters Kluwer • All Rights Reserved Components of the Examination • Concept of total patient being treated • Examination is all-inclusive – Physical – Mental – Psychological • Routine, thorough examination • Assessment of health-related risk factors 5
  6. 6. Copyright © 2017 Wolters Kluwer • All Rights Reserved I. Types of Examinations • Complete • Screening • Limited examination • Follow- up • Continuing care/reevaluation 6
  7. 7. Copyright © 2017 Wolters Kluwer • All Rights Reserved II. Methods for Examination • Visual examination • Palpation • Instrumentation • Percussion • Electrical test • Auscultation 7
  8. 8. Copyright © 2017 Wolters Kluwer • All Rights Reserved FIGURE 12-1 Bidigital Palpation 8
  9. 9. Copyright © 2017 Wolters Kluwer • All Rights Reserved FIGURE 12-2 Bimanual Palpation. A: Examination of the buccal mucosa by simultaneous palpation on extraorally and intraorally. B: Examination of the floor of the mouth by simultaneous palpation with fingers of each hand in apposition 9
  10. 10. Copyright © 2017 Wolters Kluwer • All Rights Reserved FIGURE 12-4 Assessment of the Temporomandibular Joint 10
  11. 11. Copyright © 2017 Wolters Kluwer • All Rights Reserved III. Signs and Symptoms • Signs • Objective • Symptoms • Subjective 11
  12. 12. Copyright © 2017 Wolters Kluwer • All Rights Reserved IV. Preparation for Examination • Review the patient’s histories • Examine radiographs • Patient understanding • Cultural sensitivity 12
  13. 13. Copyright © 2017 Wolters Kluwer • All Rights Reserved Anatomical Landmarks Of The Oral Cavity I. Oral Mucosa – Masticatory Mucosa – Lining Mucosa – Specialized Mucosa 13
  14. 14. Copyright © 2017 Wolters Kluwer • All Rights Reserved FIGURE 12-6 Anatomical Landmarks of the Oral Cavity-Dorsal Tongue View. A: View of hard and soft palate. B: View of uvula and oro-pharynx. 14
  15. 15. Copyright © 2017 Wolters Kluwer • All Rights Reserved Sequence of Examination 1. Overall appraisal of patient 2. Face 3. Skin 4. Eyes 5. Nodes 6. Glands 7. Temporomandibular joint 8. Lips 15
  16. 16. Copyright © 2017 Wolters Kluwer • All Rights Reserved Sequence of Examination 9. Breath odor 10.Labial and buccal mucosa 11.Tongue 12.Floor of mouth 13.Saliva 14.Hard palate 15.Soft palate, uvula 16.Tonsillar region, throat 16
  17. 17. Copyright © 2017 Wolters Kluwer • All Rights Reserved FIGURE 12-7 Anatomical Landmarks of the Oral Cavity-Ventral Tongue View 17
  18. 18. Copyright © 2017 Wolters Kluwer • All Rights Reserved Lymph Nodes 18
  19. 19. Copyright © 2017 Wolters Kluwer • All Rights Reserved I. Extraoral Examination • . Observe patient during reception and seating to note • physical characteristics and abnormalities, and make an • overall appraisal. • 2. Observe head, face, eyes, and neck, and evaluate the • skin of the face and neck. • 3. Request the patient remove prosthesis prior to performing • the intraoral examination. Explain how this will • improve the ability to inspect all areas of the mouth • adequately. • 4. Palpate the salivary glands and lymph nodes. Figure 12-8 • shows the location of the major lymph nodes of the face, • oral regions, and neck. Palpation is a significant component • of the extra-/intraoral examination (Figure 12-9). 19
  20. 20. Copyright © 2017 Wolters Kluwer • All Rights Reserved I. Extraoral Examination • Pain or discomfort upon palpation and/or upon • swallowing. • Persistent difficulty swallowing in the absence of pain. • Any recent noticeable lumps the patient may have • experienced without pain. • Persistent earache or hoarseness of voice. • Observe mandibular movement and palpate TMJ 20
  21. 21. Copyright © 2017 Wolters Kluwer • All Rights Reserved II. Intraoral Examination • Lips & intraoral mucosa • View/palpate lips, labial and buccal mucosa, and mucobuccal folds. • Examine and palpate the tongue • Mucosa of the floor of the mouth. • Hard and soft palates, tonsillar areas, and pharynx • Use a mirror • oropharynx, nasopharynx, and larynx. 6. Note amount and consistency of the saliva and evidence of dry mouth (xerostomia). 21
  22. 22. Copyright © 2017 Wolters Kluwer • All Rights Reserved Documentation of Findings A. History B. Location and Extent C. Physical Characteristics 22
  23. 23. Copyright © 2017 Wolters Kluwer • All Rights Reserved Morphologic Categories I. Elevated Lesions II. Blisterform I. Vesicle II. Pustule III. Bulla IV. Nonblisterform I. Papule II. Nodule III. Tumor IV. Plaque 23
  24. 24. Copyright © 2017 Wolters Kluwer • All Rights Reserved II. Depressed Lesions • Ulcer • Loss of continuity of epithelium • Erosion • Shallow • Does not extend through epithelium to underlying tissue 24
  25. 25. Copyright © 2017 Wolters Kluwer • All Rights Reserved III. Flat Lesions • Macule • Circumscribed • Not elevated above surrounding skin or mucosa • Identified by color 25
  26. 26. Copyright © 2017 Wolters Kluwer • All Rights Reserved IV. Other Descriptive Terms • Crust • Erythema • Indurated • Papillary • Petechiae • Pseudomembrane • Polyp • Punctate • Torus • Verrucous 26
  27. 27. Copyright © 2017 Wolters Kluwer • All Rights Reserved Oral Cancer I. Location II. Appearance of Early Cancer – Leukoplakia – Red areas • Velvety – Erythroplakia – Ulcers – Masses – Pigmentation 27
  28. 28. Copyright © 2017 Wolters Kluwer • All Rights Reserved Procedure For Determining when A Suspicious Lesion requires a biospy • Brush cytology • toluidine blue • Diffuse tissue reflectance • laser-induced auto fluorescence 28
  29. 29. Copyright © 2017 Wolters Kluwer • All Rights Reserved I. Exfoliative Cytology A. Cytological Smear B. Liquid-Based Cytology C. Oral Brush Cytology 29
  30. 30. Copyright © 2017 Wolters Kluwer • All Rights Reserved II. Spectroscopy • Laser-Induced Autofluorescence – VELscope • Diffuse Reflectance Spectroscopy 30
  31. 31. Copyright © 2017 Wolters Kluwer • All Rights Reserved III. Biopsy • Indications for biopsy • Pathology report • Class I : Normal • Class II : Atypical, but not suggestive of malignant cells. • Class III: Uncertain (possible for cancer) • Class IV: Probable for cancer. • Class V: Positive for cancer 31
  32. 32. Copyright © 2017 Wolters Kluwer • All Rights Reserved Documentation • Every detail of the oral examination • Recommendations for frequency of exam • Review of all lifestyle habits • Progress note of first maintenance appt. 32
  33. 33. Copyright © 2017 Wolters Kluwer • All Rights Reserved Factors to Teach the Patient • Guidance and support • Self-examination monthly • Dietary and nutritional influences • Oral cavity reflects general health • Warning signs of oral cancer 33

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