Nose, Mouth, and Throat Review

Nose, Mouth, and Throat

Chapter Overview

• Discussed by Prof. Picarello, Advent Health University

Anatomy of the Nasal Cavity

Key Structures

• Frontal Sinus: Located above the orbit of the eye.

• Superior Turbinate (concha) and its Meatus: Bony projections along the lateral wall of the nasal cavity that help filter, warm, and humidify air.

• Middle Turbinate and its Meatus: Also important for air flow and drainage.

• Inferior Turbinate and its Meatus: Lowest turbinate, contributes to airflow and olfaction.

• Vestibule: Anterior part of the nasal cavity.

• Hard (Bony) Palate: Forms the floor of the nasal cavity and separates it from the mouth.

• Olfactory Nerve (CNI): Responsible for the sense of smell.

• Pharyngeal Tonsil and Palatine Tonsil in oropharynx: Lymphatic tissue involved in immune response.

• Eustachian Tube Opening in nasopharynx: Connects the middle ear to the nasopharynx to equalize pressure.

• Soft Palate: Muscle structure that contributes to the separation of the oral cavity from the nasal cavity during swallowing.

Structure and Function of Nose

Respiratory System Contributions

• Upper Segment: Consists of bony structures; lower part is made up of cartilage.

• The nasal cavity is divided medially by the septum into two passages.

Nosebleeds

• The anterior part of the septum houses Kiesselbach’s plexus, which is highly vascular and the most common site of nosebleeds.

• The lateral walls contain three parallel bony projections (turbinates).

• Each turbinate has an associated meatus for drainage of sinuses.

Olfactory Functions

• Olfactory Receptors: Located at the roof of the nasal cavity and upper part of septum; crucial for the sense of smell.

• The olfactory nerve (CNI) transmits signals to the temporal lobe of the brain.

Paranasal Sinuses

• Function: Air-filled pockets communicate with the nasal cavity, lighter than the skull's weight, resonate sounds, and provide mucus.

• Sinus Openings: Can become occluded, leading to sinusitis.

Types of Sinuses

1. Frontal Sinuses: Found in the frontal bone above the orbits.

2. Maxillary Sinuses: Located in the maxilla along the sides of the nasal cavity.

3. Ethmoid Sinuses: Situated between the orbits.

4. Sphenoid Sinuses: Deep within the sphenoid bone of the skull.

• Development: Maxillary and ethmoid sinuses present at birth; other sinuses develop later.

Structure and Function of the Mouth

Oral Cavity

• First part of the digestive system and a conduit for air in respiration.

• Borders: Formed by the lips, palate, cheeks, and tongue.

Palate

• Hard Palate: Anterior roof of the mouth; comprised of bone.

• Soft Palate: Posterior arch made of muscle; includes the uvula hanging at its center.

Tongue

• Composed of striated muscle, allowing intricate movement.

• Papillae: Elevations on the dorsal surface of the tongue important for tasting.

• Frenulum: Tissue connecting tongue to the floor of the mouth; affects mobility and use.

Salivary Glands

• Contain three pairs of glands:

  1. Parotid Gland: Located in the cheeks; opens at the buccal mucosa near the second molar (via Stensen’s duct).

  2. Submandibular Gland: Lies beneath the mandible; drains via Wharton’s duct.

  3. Sublingual Gland: Smallest, located under the tongue with multiple small openings along the sublingual fold.

Functions of Saliva

• Moistens food, begins digestion, and protects mucosa.

• Adults possess 32 permanent teeth: Divided into the crown, neck, and root.

• The gums (gingivae) provide support and protection to teeth.

Structure and Function of the Throat (Pharynx)

Pharyngeal Regions

• Oropharynx: Behind the mouth, separated by anterior tonsillar pillars.

  • Tonsils: Granular lymphoid tissue behind the folds enlarges during childhood.

• Nasopharynx: Continuous with oropharynx and behind the nasal cavity; contains adenoids and eustachian tube openings.

• Rich lymphatic network contributes to immune surveillance.

Developmental Competence in Aging Adults

Changes Observed

• Loss of subcutaneous fat leads to a more prominent nose.

• Higher risk of infections due to atrophic tissues and weakened immune response.

• Oral Health Decline: Connections to inadequate dental care, poor hygiene, and tobacco use; leads to malocclusion and further issues.

• Taste and Smell: Diminished abilities decrease interest in food, possibly leading to malnutrition.

Genetics and Environment Impacts

Common Conditions

1. Bifid Uvula: Occurs in ~10% of some American Indian groups.

2. Cleft Lip and Palate: Exhibit ethnic variations.

3. Torus Palatinus: Bony ridge in hard palate, found in 20-35% of the US population (more common in females).

4. Leukoedema: Benign lesion on buccal mucosa; more frequent in black populations.

5. Dental Caries: Leading chronic disease in children; associated with various risk factors including socioeconomic status.

6. Periodontal Disease: Linked to type 2 diabetes and can lead to systemic complications.

7. Oral Cancers: Increasing incidence linked to HPV and changing sexual norms.

Subjective Data Collection

Nose Examination

• Symptoms to Ask About:

  • Discharge: Nature of discharge (watery, bloody, etc.).

  • Frequency of Colds: Any history of upper respiratory infections?

  • Sinus Pain: Presence and treatment of sinusitis.

  • Trauma: Inquires into previous nose injuries.

  • Epistaxis (Nosebleeds): Frequency, volume, color, and treatment.

  • Allergies: Inquiry about allergic reactions, triggers, and management.

  • Altered Smell: Changes in olfactory senses.

Mouth and Throat Examination

• Common Symptoms:

  • Sores or lesions: Appearance and duration of lesions in oral cavity.

  • Sore Throat: Frequency and symptoms associated with sore throat.

  • Bleeding Gums/Toothache: History of dental pain or bleeding.

  • Hoarseness: Duration, triggers, and vocal strain.

  • Dysphagia: Difficulty in swallowing and associated pain.

  • Altered Taste: Changes in taste sensation.

  • Smoking and Alcohol Consumption: History and quantity.

  • Patient Centered Care: Dental hygiene practices and appliance usage.

Additional History for Aging Adult

• Considerations:

  • Dry mouth symptoms, medications (prescription/OTC), and history of tooth loss.

  • Assess ability to chew and oral health maintenance.

  • Any noticeable changes in taste or smell.

Objective Data Collection

Equipment Needed

1. Otoscope with a nasal speculum.

2. Penlight.

3. Two tongue blades.

4. Cotton gauze pads.

5. Gloves.

Nose Inspection and Palpation

• External Nose Examination:

  • Assess symmetry, detect deformities, and check for lesions.

  • Test nostril patency.

• Nasal Cavity Examination:

  • Use an otoscope with a speculum to view nasal mucosa, septum, and turbinates.

  • Note color, swelling, discharge, and any abnormalities.

• Sinus Area Palpation:

  • Apply pressure to frontal and maxillary sinus areas.

  • Use transillumination: should produce a diffuse red glow.

Mouth Inspection

• Initial Examination: Begin at the anterior and move posteriorly.

• Inspect Lips: Assess color, moisture, and potential lesions.

• Teeth and Gums: Record overall dental health and gum condition; note alignment and occlusion.

• Tongue Examination: Check color, surface, and lesions; palpate for induration if lesions are present.

• Buccal Mucosa: Look for Stensen's duct and leukoedema signs.

• Palate Inspection: Observe for normal variations such as torus palatinus.

• Throat Examination: Check tonsils and posterior pharyngeal wall; assess for halitosis.

Inspection Grading of Tonsils

• 1+: Visible.

• 2+: Halfway to uvula.

• 3+: Touching the uvula.

• 4+: Touching each other.

Summary Checklist: Nose, Mouth, and Throat Examination

• Nose:

  • Inspect for symmetry, deformities, lesions, and patency of nostrils.

  • Examine nasal mucosa, septum, and turbinates.

  • Palpate sinus areas.

• Mouth and Throat:

  • Inspect oral structures and tonsils; palpate when necessary.

  • For adults: Bimanual palpation; for infants: assess integrity of palate.