Chapter 17: Nose, Mouth, and Throat Assessment Vocabulary

Vocabulary practice flashcards covering structure, function, assessment techniques, cultural variations, and clinical terms related to the nose, mouth, and throat.

nose structure

• Upper third made up of bone; rest is cartilage

Kiesselbach's plexus

A rich vascular network located in the anterior part of the nasal septum that serves as the most common site of nosebleeds.

most common for nose bleeds

Turbinates

Three parallel bony projections (superior, middle, and inferior) located on the lateral walls of each nasal cavity that increase surface area to warm, moisten, and filter air.

Meatus

A cleft or channel underlying each nasal turbinate into which the paranasal sinuses and nasolacrimal ducts drain.

sinuses drains

into middle meatus, and tears from nasolacrimal duct drain into inferior meatus.

ole factory receptors

• lie at roof of nasal cavity and upper third of septum.

the olfactory receptors are

• for smell merge into olfactory nerve, cranial nerve I, which transmits to temporal lobe of brain. 

Paranasal sinuses

Air-filled pockets within the cranium lined with ciliated mucous membrane that lighten skull weight, act as resonators for sound, and drain mucus into the nasal cavity.

Communicate with nasal cavity and are lined with same type of ciliated mucous membrane

Sinus openings are narrow and easily occluded, which may cause inflammation or sinusitis.

Frontal sinuses

Pair of paranasal sinuses located in the frontal bone above and medial to the orbits.

Maxillary sinuses

Pair of paranasal sinuses located in the maxilla (cheekbone) along the side walls of the nasal cavity; present at birth along with ethmoid sinuses.

Ethmoid sinuses

Smaller, deeper paranasal sinuses located between the orbits.

Sphenoid sinuses

Smaller, deeper paranasal sinuses located deep within the skull in the sphenoid bone.

present at birth

maxillary and ethmoid

First segment of digestive system

mouth

Oral cavity

short passage bordered by lips, palate, cheeks, and tongue

Lips

• anterior border of oral cavity, transition zone from outer skin to inner mucous membrane lining the oral cavity

Plate

arching roof of mouth divided into two parts

Hard palate

The anterior, bony portion of the roof of the mouth.

Soft palate

The posterior portion of the roof of the mouth formed by a mobile arch of muscle.

Uvula

A free projection hanging down from the middle of the soft palate.

Cheeks

are the side walls of oral cavity.

floor of the mouth

consists of the horseshoe-shaped mandible bone, tongue, and underlying muscles.

Tongue

striated muscle arranged in a crosswise pattern so that it can change shape and position

Papillae

rough, bumpy elevations on its dorsal surface

Ventral

smooth, shiny and has prominent veins 

Frenulum

A midline fold of tissue connecting the tongue to the floor of the mouth.

Tongue ability

• to change shape and position enhances its functions in mastication, swallowing, cleansing teeth, and the formation of speech.

• Functions in taste sensation

glands secretes

saliva

the clear fluid that moistens and lubricates the food bolus, starts digestion, and cleans and protects the mucosa.

Mouth contains three pairs of salivary glands.

Parotid gland

submandibular

sublingual

Parotid gland

The largest salivary gland, situated within the cheek in front of the ear, which drains via the Stensen duct.

Submandibular

gland lies beneath mandible at angle of jaw.

Sublingual gland

The smallest, almond-shaped salivary gland located in the floor of the mouth under the tongue, opening via multiple ducts along the sublingual fold.

adults have

32 permeant teeth

gums (givingivae) collar of teeth

Oropharynx

The region of the pharynx posterior to the mouth, separated by the anterior tonsillar pillars, containing the palatine tonsils.

Tonsils

• behind folds, each is a mass of lymphoid tissue look more granular, and surface shows deep crypts

Tonsillar tissue

• enlarges during childhood until puberty.

Posterior pharyngeal

wall is seen behind these structures.

Nasopharynx

The upper portion of the pharynx located behind the nasal cavity and above the oropharynx, containing the pharyngeal tonsils (adenoids) and eustachian tube openings.

Pharyngeal tonsils

• (adenoids) and eustachian tube openings are located here.

Gradual loss of subcutaneous fat

• tarts during later middle adult years, making the nose appear more prominent in some people.

• Atrophic tissues

• ulcerate easily

• increasing risk for older people for infections, such as oral moniliasis and malignant lesions.

Natural tooth loss

• exacerbated by inadequate dental care, poor oral hygiene, and tobacco use: can lead to malocclusion leading to further tooth loss and pain

Diminished sense of taste and smell

• decreases an aging person’s interest in food and may contribute to malnutrition.

Trouble with mastication

• can lead to dietary pattern changes which may place the older adult at risk for nutritional deficits (protein, vitamins, and minerals).

Bifid uvula

A condition in which the uvula is partially or completely split; present in approximately 10% of certain American Indian groups.

• Cleft lip and cleft palate

• Most common in Asians, intermediate in whites, and least common in blacks

Torus palatinus

A normal variation consisting of a benign nodular bony ridge running down the middle of the hard palate.

Leukoedema

A benign, grayish-white lesion occurring on the buccal mucosa, seen more commonly in Black individuals.

Dental caries

An infectious process resulting in tooth decay due to the interaction of bacteria on teeth.: Due to socioeconomic status, lack of access and comorbidities

Complications r/t periodontal disease: Linked to type 2 diabetes

• Increased incidence of oral cancers

• Linked to HPV and changes in sexual norms

Epistaxis

The clinical term for a nosebleed.

subjective

• Discharge

• Frequent colds (upper respiratory infections)

• Sinus pain

• Trauma

• Epistaxis (nosebleeds)

• Allergies

• Altered smell

Dysphagia

Difficulty swallowing.

PQRST mnemonic

A nursing clinical mnemonic used to systematically evaluate a patient's symptom: Provocative/palliative, Quality/quantity, Region/radiation, Severity, and Timing.

tools for objective data

• Preparation

  • Position a person sitting up straight with his or her head at your eye level.

  • If the person wears dentures, offer a paper towel and ask the person to remove them.

• Equipment 

  • Otoscope with short, wide-tipped nasal speculum

  • Penlight

  • Two tongue blades

  • Cotton gauze pad, 4 × 4 inches

  • Gloves

External nose

• Normally nose is symmetric, in midline, and in proportion to other facial features.

• Inspect for any deformity, asymmetry, inflammation, or skin lesions.

  • If an injury is reported or suspected, palpate gently for any pain or break in contour.

• Test patency of nostrils. 

• Sense of smell, mediated by cranial nerve I, is usually not tested in a routine examination.

Nasal cavity

• Attach short wide-tipped speculum to otoscope head and insert apparatus into nasal vestibule. 

• View each nasal cavity with the person’s head erect and then with head tilted back.

nasal

• Inspect nasal mucosa, noting its normal red color and smooth moist surface.

• Note any swelling, discharge, bleeding, or foreign body.

nasal septum

• Observe nasal septum for deviation.

• Note any perforation or bleeding in septum.

• Nasal turbinates

• Inspect turbinates.

• Superior turbinate may not be in view.

• Middle and inferior turbinates appear the same light red color as nasal mucosa; note any swelling but do not try to push speculum past it.

• Turbinates are quite vascular and tender if touched.

• Note any polyps, benign growths that accompany chronic allergy, and distinguish them from normal turbinates.

Anterior hard palate

white irregular transverse rugae

Posterior soft palate

• pinker, smooth, and upwardly movable.

Torus palatinus

• normal variation, is a nodular bony ridge down middle of hard palate; benign growth arises after puberty and is more common finding in American Indians, Inuits, and Asians

Observe uvula

• Normally looks like fleshy pendant hanging in midline; ask a person to say “ahhh” and note soft palate and uvula rise in midline

• Tests one function of cranial nerve X, the vagus nerve

Tonsil grading scale

A 1+ to 4+ rating scale for tonsillar size: 1+ is visible, 2+ is halfway between pillars and uvula, 3+ touches the uvula, and 4+ indicates tonsils touching each other.

Touching posterior wall with tongue blade elicits gag reflex

• tests cranial nerves IX and X, the glossopharyngeal and vagus.

Asking a person to stick out tongue; should protrude in midline; note any tremor, loss of movement, or deviation to side

Notice any breath odor, halitosis.

Test cranial nerve XII, hypoglossal nerve

Halitosis

Noticeable or foul breath odor, usually caused by local factors such as poor oral hygiene, specific foods, alcohol, smoking, or dental infection.

Nose may appear more prominent

• on face from loss of subcutaneous fat.

  • In edentulous person, mouth and lips fold in, giving a “purse-string” appearance

nose abnormalities

• Epistaxis

• Sinusitis

• Seasonal allergic rhinitis (AR or hay fever)

• Furuncle

• Acute rhinitis (nonallergic)

• Foreign body

• Perforated septum

• Nasal polyps

Epistaxis

nose bleed

keisselbach

caused by truaume infection hypertension hf local tumor

posterior hemmorage is less common

sinusitis

bacterial infection signs of 10 days

facial pain drainage fever malaise nasal obstruction

maxillary sinusitis dull throbbing pain in cheek and teeth pain with palpation

seasonal allergic rhinitis (ar or hay fever)

ar is a normal response from repeated exposure to antigens with rhinorrhea itching of nose and eye lacrimal

nasla congestion sneezing note edema swelling of turbinates to fill space

actue rhinitis ( nonallergic )

first clear and watery discharge sneezing nasal itching simulation off cough reflexes and inflamed mucosa cause nasla obsuctrction

turbinates dark red and swollen

nasal polyps

benign overgrowth that looks smooth grape like grey or yellow

appearing with chronic asthma exposed to dust or genetic factors

often in middle meatus

multiple ay grow to obstruct passage airways

symptom are absent of sense of small disturbed sleep postnasal drip and valve moves a a person breathes

furuncle

small boil located in the skin of mucous memebrane

appears red and swollen and is quiet painful

avoid any manipulation or trauma that may spread the infection

Lips abnormalities

• Cleft lip

• Herpes simplex 1 (HSV-1)

• Carcinoma

• Retention “cyst” (mucocele)

cleft lip

maxillofical clefts common congenital deformities

occur with a strong family hx of phenytoin , acholol, certain drugs diabetes

hsv 1

could scores on the lip

rapture weep crust heal in 4-10 days

infection occurs in same sight

highly contagious and spread by direct contact

triggers are sunlight fever colds allergy

carcinoma

crusted ad ulcerated with elevated border

outer and middle thirds of lip

if not healed after 2 weeks refer them

• Retention “cyst” (mucocele)

a round defend translucent nodule that me be very small or top to 1 or 2 cm

pocket mucus that forms a duct of a minor salivary gland ruptures

benign lesions also may occur on the buccal mucosa on floor of mouth under the ip of the tongue

Teeth and gum abnormalities

• Baby bottle tooth decay

• Dental caries

• Tooth avulsion

• Epulis

• Gingival hyperplasia

• Gingivitis

• Meth mouth

baby bottle tooth decay

going to sleep with a bottle in their mouth

acid breakdown teeth enamel

dental caries

tooth decay looks chalky later turns brown or black and forms a cavity

early decay shows on x ray

surfaces where food debris bacteria plaque and saliva collection

tooth avulsion

traumatic energy caused tooth to dislodge from alveolar socket

tooth stored in milk

epulis

a benign nontender fibrous nodule of the gum

emerging between the teeth overgrowth of vascular granulation tissue

gingival hyperplasia

painless enlargement of the gums

overreaching the teeth

occurs in puberty and preangcy leukemia and therapeutic use of phenytoin

Gingivitis

vitmain c defenciy

Tongue abnormalilties

• Ankyloglossia

• Geographic tongue (migratory glossitis) 

• Smooth, glossy tongue 

(atrophic glossitis) 
Black hairy tongue

• Carcinoma

• Fissured or scrotal tongue

• Enlarged tongue (macroglossia)

Ankyloglossia

tongue tie

limits mobilty and speech

contgential defects

Geographic tongue (migratory glossitis) 

changes with time

no significant cause or known

Smooth, glossy tongue (atrophic glossitis) 

decreased papillae

dryness burning

vitmain b and folic acid and iron and anemia deficiency

note angular cheilitis

Black hairy tongue

elongation of filiform papillae and painless overgrowth of mycelial thread of fungus infection on the tongue

color varies black to brown to yellow

occurs after long use of antibiotics which inhibits normal bacteria and allow profiltraction of fungus with very heavy smoking

carcinoma

uncle rolled edges daily on the sides or under the tongue

associated with leukoplakia

rich lymphatic drainage increases risk for early metastasis

smoking and acholol use most causes for oral cancer hpv related oral pharyngeal cancers also increased

Fissured or scrotal tongue

downsyndrome

vertical or longitudinal fissures

occurs with dehydration because the recede of tongue volume

Enlarged tongue (macroglossia)

painfull and impair speech

down syndrome

cretinism myxedema acromegaly

occur from local infection

Oropharynx abnomalilties

• Bifid uvula

• Oral Kaposi’s sarcoma

• Peritonsillar abscess

• Acute tonsillitis and pharyngitis

• Cleft palate

bifid uvula

affect speech

and may indicate a broader condition such as a cleft palate. It involves a split or forked appearance of the uvula.

Oral Kaposi’s sarcoma

bruise like ark red to violet

confluent macule on hard plate or soft or gums margin

oral lesions may be among the earliest lesions to develop with aids

• Peritonsillar abscess

untreated acute streptococcal pharyngitis cause suppurative complication

thrombophlebitis ia lemierre syndrome ear but life threating conditions cause by gram negative f. necrophorum leading to sepsis

worsen symptoms or swollen neck fever and decreased rom