Learning Objectives Chapter 18

Describe the structure & function of the mouth and throat.

-first part of digestive system

-responsible for ingestion, tasting, preparing food for digestion, & aiding in speech

-Trigeminal (V), Facial (VII), glossopharyngeal (IX), hypoglossal (XII)

Describe the structure & function of the nose and paranasal sinuses.

-first part of respiratory system

-responsible for receiving, filtering, warming, and moistening air

-olfactory (I)

Describe the oral cavity.

-also known as mouth

-formed by lips, cheeks, hard/soft palate, uvula, & tongue muscles

-contains tongue, teeth, gums, & salivary gland openings

*parotid, submandibular, sublingual

Describe normal tongue variations: fissured tongue

-not painful

-doesn't indicate disease

Describe normal tongue variations: Fordyce granules

-benign

-bottom of tongue

Describe the throat.

-also known as pharynx

-located behind nose and mouth

-muscular passage for food and air

-nasopharynx, oropharynx, laryngopharynx

Describe tonsils.

-masses of lymphoid tissue located in pharynx

-palatine tonsils: most commonly removed

-lingual tonsils: base of the tongue

-pharyngeal tonsils (adenoids): up towards nasopharynx

Describe physical variations of the oral cavity: torus palatinus

-benign

-boney structure

Describe physical variations of the oral cavity: bifid uvula

split uvula, looks like two

Describe physical variations of the oral cavity: shortened frenulum

-seen in children

-tongue tied: creates speech problems

-can get it clipped

Describe the nose.

-external portion & internal nasal cavity

-external nose: bridge, tip, two oval openings called nares

-internal nose: nasal cavity, septum, Kieselbach area, superior, middle, inferior turbinates

-olfactory nerve receptors located in upper part of nasal cavity and septum

Describe the sinuses.

-four pairs

-frontal, maxillary, ethmoidal, sphenoidal

-decrease the weight of skull, act as resonance chambers during speech

-normally filled with air --> fluid during illness or allergies

Describe biological and cultural variations.

-color differences

-structure of uvula, teeth, lips, palate

-hyperpigmentation of buccal mucosa by age 50

-benign leukoedema

-cleft uvula, lip, or palate

-number and size of teeth

-periodontal disease varies in number and severity by ethnic group

-oral disease, cancer, sinusitis

Describe older adult considerations.

-smell & taste abilities decrease (medications & neurodegenerative diseases)

-gums recede and become ischemia and fibrotic

-tooth surfaces worn and more susceptible to tooth loss and periodontal disease

-difficulty in teeth/denture hygiene

-teeth may appear longer due to age related gingival recession

-oral mucosa drier and frailer due to degeneration of epithelial lining in salivary glands

-varicose veins on tongue ventral surface

Describe the collection of subjective data.

Lifestyle and Health Practices:

-smoking or tobacco-less practices

-alcohol

-dental care

Describe equipment needed for the physical examination.

-nasal speculum

-tongue depressor

-short, wide-tipped speculum attached to head of otoscope

Describe how to prepare to obtain objective data.

Preparation:

-refine examination technique

-aware ethnocultural phenomena

-know age related changes

-identify and understand relationship between structures

Describe how to collect objective data relating to the mouth.

-inspect lips, teeth, buccal mucosa, Stensen ducts (inside cheeks), Wharton ducts (under tongue)

-inspect and palpate tongue

-check tongue strength, anterior tasting ability

-inspect hard/soft palate

-note odor

-inspect tonsils, uvula, posterior pharyngeal wall

Describe how to collect objective data relating to the nose and sinuses.

Nose:

-inspection and palpation: inspect and palpate external nose, check airflow patency through nostrils, inspect internal nose

Sinuses:

-palpation: palpate sinuses (cannot inspect)

Describe nose abnormalities.

-nasal polyp: growth in nasal cavity

-perforated septum: opening between right and left parts of nasal cavity; seen in piercings, snorting drugs, and extended nasal spray use

Describe tonsilitis.

Grading scale:

1+: visible

2+: midway between tonsillar pillars and uvula

3+: touch uvula

4+: touch each other

Describe abnormalities of the mouth and throat.

Mouth:

-herpes simplex type I (cold sores)

-cheilosis of lips: cracking at the corners of the mouth

-lip carcinoma

-leukoplakia: white tint on tongue underside

Throat:

-hairy leukoplakia: yeast looking on tongue side

-candida albicans infection: yeast infection

-vitamin B12 deficiency: smoothing taste buds

-black hairy tongue: antibiotics destroy normal mouth flora

-tongue carcinoma

-canker sore: ulceration of gum tissue

-gingivitis: gums are inflamed and bleed easily

-receding gums: aging

-Kaposi sarcoma lesions: AIDs

-acute tonsilitis: inflammation, white spots

-streptococcal pharyngitis: strep throat; very red, sore throat

Describe Oropharyngeal cancer.

Risk factors:

-tobacco/marijuana use

-heavy and frequent alcohol use

-HPV virus; oral sex

-prolonged sun exposure/fair skin

-gender: male

-over the age of 45

-poor oral hygiene, diet/nutrition

-weakened immune system

-chewing betel nut

Describe sinusitis (sinus infection).

Risk factors:

-nasal passage abnormality

-aspirin sensitivity

-medical condition (COPD, cystic fibrosis) or weakened immune system

-hay fever, allergic condition

-asthma

-regular exposure to pollutants

Seek medical advice if...

-shortness of breath

-stiff neck

-vision changes

-confusion

-severe headache and swollen forehead

-pain of swelling around eyes

-repeated episodes not responding to treatment