Anatomy and Physiology: Nose, Sinuses, Mouth, Throat

Anatomy and Physiology of the Nose, Sinuses, Mouth, and Throat

• Nose: The external nose directs air into the respiratory system. Its structure is supported by bone (upper third) and cartilage (lower two-thirds). The nasal septum divides the nasal cavities. Turbinates (inferior, middle, superior) are scroll-like structures warming, filtering, and humidifying inhaled air. The ostiomeatal complex is where frontal, ethmoid, and maxillary sinuses drain into the nasal cavity. The nasal cavity is lined with ciliated mucosa aiding in filtering and preventing infection.
• Sinuses: Hollow air-filled cavities within the skull. They lighten the skull and affect voice resonance. Sinuses produce mucus that drains into nasal cavities. Proper sinus function depends on open sinus ostia, healthy cilia, and appropriate mucus production.
• Mouth: The floor of the nose rests on the hard palate, separating it from the mouth. The oral cavity includes the tongue (with taste buds), roof (palate), and sides and floor (muscles).
• Throat: The throat, or pharynx, connects the nose and mouth to the rest of the respiratory and digestive systems.
• Clinical Significance: Trauma to the ethmoid bone can cause severe illness/death; holes allow bacteria entry to the brain. Unilateral nasal drainage suggests potential cerebrospinal fluid leakage requiring immediate diagnostic testing (CT or MRI). The Kiesselbach plexus in the anterior nasal septum is a common site of nosebleeds (epistaxis).

Health Promotion and Risk Reduction

• Oral and Dental Health: Oral health is a key aspect of overall health, especially in hospitalized patients. Inspecting the mouth regularly is crucial.
• Assessment: Thorough assessment includes identifying and documenting any oral symptoms, like cracked lips, redness, white patches, pain while chewing/swallowing, xerostomia, and dysphagia. This is especially critical for those with decreased activity tolerances and those hospitalized for extended periods.
• Medication Considerations: Medications like diuretics and beta-blockers can affect the mucous membranes.

Assessing Medical History and Symptoms

• Patient History: Gather detailed medical histories. Document symptoms (e.g., allergies, sinusitis, dysphagia, taste impairment, and weight loss).
• Key Symptoms: Pay attention to xerostomia, dysphagia, and impaired taste, as these are significant symptoms potentially impacting the patient's ability to eat, drink, and overall quality of life. Oral discomfort, white patches, and cracked corners of the mouth also warrant investigation.

Physical Assessment Techniques

• Objective Data: Focus on proper inspection, palpation, and percussion using standardized techniques.

Differentiating Normal from Abnormal Findings

• Normal vs. Abnormal: Distinguish between normal structures and potential abnormalities. Identify problems with oral and nasal cavities and sinuses.

Analyzing Data and Considering Diagnosis

• Analysis: Integrate subjective (history) and objective (exam) data to consider potential diagnoses and their systemic impacts.

Documentation and Communication

• Record Keeping: Accurately and comprehensively document findings using standardized terminology and principles of healthcare recording.

Patient Considerations (Age, Gender, Culture)

• Individualization: Tailor the assessment considering the patient's age, gender, and cultural background to improve sensitivity to individual needs.

Developing a Holistic Treatment & Discharge Plan

• Holistic Care: Use assessment findings to develop individual treatment approaches and a discharge plan, ensuring the holistic well-being and needs of the patient are met.