Chapter Outline Rationale Components Landmarks Sequence Morphologic Categories Oral Cancer Biopsy Determination Documentation Everyday Ethics Factors to Teach the Patient 2 Learning Objectives ID: 1000674
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1. Chapter 12 Extraoral and Intraoral Examination
2. Chapter OutlineRationale ComponentsLandmarksSequenceMorphologic CategoriesOral CancerBiopsy DeterminationDocumentationEveryday EthicsFactors to Teach the Patient2
3. Learning ObjectivesExplain the rationaleExplain the systematic sequenceIdentify normal anatomyDescribe physical characteristicsIdentify suspicious conditions3
4. Rationale For The Extraoral And Intraoral ExaminationEarly identificationTo detect cancerThyroid disordersEating disordersNutritional deficienciesSexually transmitted diseases Systemic conditions 4
5. Components of the ExaminationConcept of total patient being treatedExamination is all-inclusivePhysicalMentalPsychologicalRoutine, thorough examinationAssessment of health-related risk factors5
6. I. Types of Examinations Complete Screening Limited examination Follow- upContinuing care/reevaluation6
7. II. Methods for ExaminationVisual examinationPalpationInstrumentationPercussionElectrical testAuscultation7
8. FIGURE 12-1 Bidigital Palpation8
9. FIGURE 12-2 Bimanual Palpation. A: Examination of the buccal mucosa by simultaneouspalpation on extraorally and intraorally. B: Examination of the floor of themouth by simultaneous palpation with fingers of each hand in apposition9
10. FIGURE 12-4 Assessment of the Temporomandibular Joint10
11. III. Signs and SymptomsSignsObjective SymptomsSubjective11
12. IV. Preparation for Examination Review the patient’s histories Examine radiographs Patient understanding Cultural sensitivity12
13. Anatomical Landmarks Of The Oral CavityOral MucosaMasticatory MucosaLining MucosaSpecialized Mucosa13
14. 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. Sequence of ExaminationOverall appraisal of patientFaceSkinEyesNodesGlandsTemporomandibular jointLips15
16. Sequence of ExaminationBreath odorLabial and buccal mucosaTongueFloor of mouthSalivaHard palateSoft palate, uvulaTonsillar region, throat16
17. FIGURE 12-7 Anatomical Landmarks of the Oral Cavity-Ventral Tongue View17
18. Lymph Nodes18
19. I. Extraoral Examination. Observe patient during reception and seating to notephysical characteristics and abnormalities, and make anoverall appraisal.2. Observe head, face, eyes, and neck, and evaluate theskin of the face and neck.3. Request the patient remove prosthesis prior to performingthe intraoral examination. Explain how this willimprove the ability to inspect all areas of the mouthadequately.4. Palpate the salivary glands and lymph nodes. Figure 12-8shows the location of the major lymph nodes of the face,oral regions, and neck. Palpation is a significant componentof the extra-/intraoral examination (Figure 12-9).19
20. I. Extraoral ExaminationPain or discomfort upon palpation and/or uponswallowing.Persistent difficulty swallowing in the absence of pain.Any recent noticeable lumps the patient may haveexperienced without pain.Persistent earache or hoarseness of voice.Observe mandibular movement and palpate TMJ20
21. II. Intraoral ExaminationLips & intraoral mucosaView/palpate lips, labial and buccal mucosa, and mucobuccal folds.Examine and palpate the tongueMucosa 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. Documentation of FindingsA. HistoryB. Location and ExtentC. Physical Characteristics22
23. Morphologic CategoriesElevated LesionsBlisterformVesiclePustuleBulla NonblisterformPapuleNoduleTumorPlaque23
24. II. Depressed LesionsUlcerLoss of continuity of epitheliumErosionShallowDoes not extend through epithelium to underlying tissue24
25. III. Flat LesionsMaculeCircumscribedNot elevated above surrounding skin or mucosaIdentified by color25
26. IV. Other Descriptive TermsCrustErythemaInduratedPapillary PetechiaePseudomembranePolypPunctateTorusVerrucous26
27. Oral CancerLocationAppearance of Early CancerLeukoplakiaRed areasVelvetyErythroplakiaUlcersMassesPigmentation27
28. Procedure For Determining when ASuspicious Lesion requires a biospyBrush cytology toluidine blueDiffuse tissue reflectance laser-induced auto fluorescence 28
29. I. Exfoliative CytologyCytological SmearLiquid-Based CytologyOral Brush Cytology29
30. II. SpectroscopyLaser-Induced AutofluorescenceVELscope Diffuse Reflectance Spectroscopy30
31. III. Biopsy Indications for biopsy Pathology report Class I : NormalClass II : Atypical, but not suggestive of malignant cells.Class III: Uncertain (possible for cancer)Class IV: Probable for cancer.Class V: Positive for cancer31
32. DocumentationEvery detail of the oral examinationRecommendations for frequency of examReview of all lifestyle habitsProgress note of first maintenance appt. 32
33. Factors to Teach the PatientGuidance and supportSelf-examination monthlyDietary and nutritional influencesOral cavity reflects general healthWarning signs of oral cancer 33