mouth , nose, throat and sinuses

• Cranial nerves assisting with function of mouth and throat

  • Trigeminal (Cranial V)
  • Facial (Cranial VII)
  • Glossopharyngeal (Cranial IX)
  • Hypoglossal (Cranial XII)

  
• Nose and paranasal sinuses

  First part of respiratory system
• Functions of nose and paranasal sinuses


  • Receiving, filtering, warming, and moistening air
• Olfactory Nerve (Cranial I)


  Receptors located in nose and related to sense of smell
• Mouth and throat


  First part of digestive system, responsible for receiving food (ingestion), taste, preparing food for digestion, aiding in speech
• Salivary glands


  • Parotid
  • Submandibular
  • Sublingual
• Pharynx


  Located behind the mouth and nose, serves as muscular passage for food and air
• Components of pharynx


  • Nasopharynx
  • Oropharynx
  • Laryngopharynx
• Structures of pharynx


  • Soft palate
  • Anterior and posterior pillars
  • Uvula
  • Tonsils (palatine, lingual, pharyngeal (adenoids))

  
• External nose


  • 
    
• Internal nose


  • Contains turbinates (superior, middle, inferior)
  • Anterior and posterior nares (nostrils)
  • Septum (separates cavity into two parts; contains Kiesselbach's area)
• Nose and pharynx structures increase surface area that is exposed to air, meatus receive drainage from nasolacrimal and paranasal sinuses
• Paranasal sinuses


  • 4 Pairs
• Collecting Subjective Data


  1. Interview approach (COLDSPA)

  2. Collecting subjective data
• Questions for subjective data on tongue and mouth

  • Ask for any lesions or sores. Is it painful? How long?
  • Any redness, swelling, bleeding or pain? How long?

  
• Abnormal findings for tongue and mouth

  • Apthous stomatitis (canker sores, herpes simplex)
  • Lumps and thickening, mouth or tongue sores that do not heal
  • Red or white patches that persist
  • Rough, crusty or eroded areas
  • Gingivitis
  • Periodontitis(destruction of the gum with tooth loss)

  
• Questions for subjective data on nose and sinuses

  • Do you have pain over your sinuses?
  • Do you have nose bleeds? How much bleeding?
  • What about clear or mucous drainage from nose?
  • Can you breath through both of your nostril? Allergies?
  • Have you experienced a changed in your ability to smell.
• Abnormal findings for nose and sinuses

  • Sinusitis
  • Nose bleeding due to HPN. leukemia, thrombocytopenia
  • Rhinorrhea
  • Nasal congestion, obstruction, deviated septum; seasonal rhinitis
• Questions for subjective data on throat

  • Any difficulty of chewing or swallowing?
  • Any sore throat? Sore throat that persist is a danger signal of cancer.
  • Any hoarseness? If persist for more than 2 weeks need referral.

  
• Past, Family history and health practices

  • Use of cigarette increases risk for cancer
  • Tobacco use and alcohol consumption lead to oral cancer
  • Grinding teeth (bruxism)
• Equipment and supplies for objective data collection

  • Gloves
  • Penlight
  • Tongue depressor
  • 4x4 gauze pad
  • Nasal speculum
  • Otoscope with short, wide-tipped speculum attached

  
• Physical Assessment: Mouth


  1. Inspect: lips (color, consistency)

  2. Inspect: teeth (number, color, condition, alignment)

  3. Inspect: gums (color, consistency)

  4. Inspect: buccal mucosa (color, consistency, Stenson's ducts)

  5. Inspect: tongue (color, moisture, size, texture; fasciculations (fine tremors))

  
• Lip, Teeth and Gum Abnormalities

  • Red, swollen gums (Gingivitis, scurvy, leukemia)
  • Receding red gums (Periodontitis)
  • Enlarged, reddened gums (hyperplasia) (Dilantin toxicity)
  • Bluish-black or grey-white line along gum line (Lead poisoning)
  • Cheilosis
  • Lip Cancer
  • Gingivitis
  • Periodontitis
  • Kaposi's Sarcoma

  
• Buccal Mucosa abnormalities


  • Koplik's spots (Measles)
  • Canker sores
• Physical Assessment: Tongue


  1. Check for midline protrusion

  2. Inspect ventral surface, frenulum, area under tongue

  3. Inspect Wharton's ducts and sides of tongue

  4. Check tongue strength

  5. Check anterior tongue (taste)

  6. Palpate lesions for induration (hardness)

  
• Tongue Abnormalities


  • Fissures (Dehydration)
  • Black tongue (Bismuth toxicity)
  • Red beefy tongue (Vitamin B12 (niacin) deficiency, anemias, cancer therapy)
  • Enlarged tongue (Hypothyroidism, acromegaly, Down's syndrome)
  • Very small tongue (Malnutrition)
  • Atrophied tongue or fasciculations (Hypoglossal nerve damage)
  • Oral thrush/candidiasis
  • Leukoplakia, persistent lesions, ulcers or nodules (may be cancer)
  • Fissured Tongue
  • Black Hairy Tongue
  • Thrush
  • Red, beefy tongue
  • Leukoplakia
  • Carcinoma of the Tongue
• Palpating Area Under the Tongue

  Varicose Veins