Extra Oral Examination Overview

Extra Oral Examination

• Aim: To provide understanding of the extra oral examination's clinical relevance.

Intended Learning Outcomes

• Explain the relevance and importance of extra oral patient examination.
• Identify significant areas related to an extra oral examination.
• Explore techniques and observations needed for an effective extra oral examination.

What is Extra Oral Examination?

• Part of the general initial patient assessment.
• Carried out to identify undisclosed or undiagnosed conditions, including malignancies, endocrine disorders, and indications of cardiovascular risk.

Areas of Examination

• Upper Face: Forehead, eyes, cheeks/cheekbones, upper part of nose
• Lower Face: Lower part of nose, lips, chin, general facial symmetry

Neck Examination

• Palpation: Feel for swelling, tenderness, and any abnormalities in lymph nodes.
• Lymphadenopathy: Lymph node disease often presents as swollen and tender lymph nodes.

Lymph Node Anatomy

• Diagram shows lymph nodes in the head and neck.
• Specific lymph node groups are listed: Posterior auricular, Occipital, Superficial cervical, Deep cervical, Supraclavicular, Preauricular, Parotid, Tonsillar, Submental, Submandibular, etc.

What Should Lymph Nodes Feel Like?

• Normal lymph nodes are small (pea-sized), not tender, and mobile.
• Abnormal lymph nodes are fixed and often tender.
• If abnormality detected, note size, location, consistency, and diagram.
• Swelling and tenderness due to infection.

How to Perform a Lymph Node Examination

• Stand behind the patient; this is ideal.
• Ensure patient is relaxed.
• Head should be slightly forward, chin not tipped upward.
• Use finger pads in an on/off motion.

Temporomandibular Joint (TMJ)

• Formed by the mandible and temporal bone.
• Composed of capsules and ligaments.
• Responsible for jaw movement (eating, talking, etc.)
• A frequently used joint, common problems involve pain and difficulty opening.

Common Causes of TMJ Pain and Dysfunction

• Teeth grinding (Bruxism): Often caused by stress.
• Pain and stiffness on opening, headaches, neck aches, and other intra-oral problems are possible symptoms.

TMJ Examination

• Palpate both sides to assess for: tenderness, pain, deviation, clicking.
• Ask patient to open and close the mouth.
• Examine both sides simultaneously using finger tips and gentle pressure.

Facial Symmetry

• Assess facial symmetry, noting any deviations from the "normal".
• Significant asymmetries need to be noted and discussed with the patient.
• Causes can include previous trauma/surgery, CVA, infections, neural paralysis etc.
• Look for unexpected swelling, bruising, pallor, and excessive sweating.

Other Important Considerations

• Examine the eyes for any unusual features.
• Evaluate the lips for dryness, chapping, or signs of cracking (angular cheilitis).
• Be alert for possible cold sores or malignant lesions.
• List the possible conditions from slides 33-34.
• Conduct further research.

Summary

• Thorough examination includes the face/lips/eyes/general appearance.
• Detailed lymph node examination, along with TMJ examination.
• Patient history and details related to current issues are essential.
• Note all important observations meticulously.

This quiz aims to enhance your understanding of the clinical relevance of extra oral examinations. You'll learn about the significance of assessing various facial areas and lymph nodes for identifying potential health issues. The objective is to equip you with effective techniques and observations for thorough patient evaluations.