Case History (Intra Oral and Extra Oral) PDF

DEFINITIONS  Clinical diagnosis: made from the history and examination  Pathological diagnosis: provided from the pathology results....

DEFINITIONS  Clinical diagnosis: made from the history and examination  Pathological diagnosis: provided from the pathology results.  Direct diagnosis: made by observing pathognomonic features  Provisional (working) diagnosis: The more usually made CASE HISTORY diagnosis  An initial diagnosis from which further investigations can be planned  Deductive diagnosis: made after due consideration of all facts from the history, examination and investigations.  Differential diagnosis: The process of making a diagnosis by considering the similarities and differences between similar Oral Sciences Department conditions. Mon. Dec. 30. 2024 12/30/2024 11  Diagnosis by exclusion: identification of a disease by TYPES OF EXAMINATION excluding all other possible causes.  Diagnosis ex-juvantibus: made on the results of response  COMPLETE EXAMINATION to treatment.  For example, the pain of trigeminal neuralgia may be  SCREENING EXAMINATION atypical, and the diagnosis can sometimes be confirmed only by a positive response to the drug carbamazepine.  EMERGENCY/LIMITED EXAMINATION  Provocative diagnosis: the induction of a condition in order to establish a diagnosis. 12/30/2024 12 12/30/2024 15 COMPLETE EXAMINATION Go to fullsize image SCREENING EXAMINATION Go to fullsize image 12/30/2024 16 12/30/2024 17 INSPECTION EMERGENCY/LIMITED EXAMINATION  PASSIVE VIZUALIZATION OF THE LESION.  Either done by naked eyes or with the help of:  Mouth Mirror (i.e. indirect visualizations)  Transillumination ( for Maxillary Sinus) PALPATION ACT OF FEELING BY THE SENSE OF TOUCH. Evaluation of tenderness, consistency, scrapability, fixity, etc. 12/30/2024 18 12/30/2024 20  PERCUSSION AUSCULTATION  “Act of striking a portion of the body with the finger or  “Act of listening to the functional sounds of the body”. (e.g. for an instrument to evaluate the condition of the TMJ clicking) underlying structures by careful attention to the sound  CREPITUS : Crackling sensation that can be heard or palpated. or echo produced.” (bone fractures, joint crepitus etc.,)  THRILLS : Palpable vibrations usually caused by flow of blood from one chamber to another by narrowed orifice. cover%2520image%2520stethoscope 3508506748549363 12/30/2024 22 12/30/2024 23 STATISTICS NAME:  Patient registration number Date  Name To communicate with the patient  Age/Sex Address To establish a rapport with the patient  Occupation Marital status Record maintenance  PATIENT REGISTRATION NUMBER Psychological benefits  Useful for-  maintaining a record,  billing purposes, AGE  medico legal aspects. For diagnosis Treatment planning  DATE  Useful for- Behavioral management techniques  Time of admission  reference during follow up visits  Record maintenance. 12/30/2024 29 12/30/2024 30  DISEASE MORE  DISEASE PRESENT IN DISEASE PRESENT IN ADULTS & OLDER PATIENTS COMMONLY PRESENT CHILDREN & YOUNG - Attrision AT BIRTH ADULTS - Abrasion - Micrognathia - Benign migratory glossitis - Gingival recession - Cleft lip & cleft plate - Juvenile periodontitis - Periodontitis - Ankyloglossia - Pemphigus - Lichen planus - Predecidous dentition - Recurrent apthous stomatitis - Ameloblastoma ( 30 – 50) - Teratoma - Dental caries - Trigeminal neuralgia - Hemophilia - Dentigerous cyst - Fibroma - Diptheria - Verrucous carcinoma - Iron deficiency anemia - Diabetes - Hypertension 12/30/2024 31 12/30/2024 32 Diseases more common in females Diseases more common in males Iron deficiency anemia - Pernicious anemia Sickle cell anemia - Caries in deciduous teeth Adenoameloblastoma -Attrition Myasthenia gravis - Liposarcoma CASE HISTORY (INTRA Diseases of thyroid - Herpes simplex Malignant melanoma - Ewing's sarcoma Recurrent apthous stomatitis - Adenolymphoma - Multiple myeloma ORAL AND EXTRA Central giant cell granuloma - Carcinoma- in- situ ORAL) Peripheral ossifying fibroma - Basal cell carcinoma Peripheral cemental dysplasia - Benign osteoblastoma Peripheral giant cell granuloma - Carcinoma of the buccal mucosa Oral Sciences Department Sun. Jan. 22. 2023 12/30/2024 34  Pulse PALLOR  Paleness of skin and mucous membrane either as a result of diminished circulating rbc or diminished blood supply  Normal pulse rate is 60-80 beeats/min  causes:  Average pulse is 72 beats/min anemia  Physiologic increase in infants, after exertion. decrease iron, folic acid, vitamin deficiency, pregnancy  Pathologic increase in fever, cardiopulmonary diseases. malignancy  Important index of severity of illness, abnormalities of heart lower palapebral conjunctiva, tongue, soft palate, palm and nails. and vascular system. e.g. hypertension, hypotension, shock, fever  pulse rhythm: regular/irregular e.g. irregularly irregular in atrial fibrillation regularly irregular in ventricular failure. 1/5/2025 14 1/5/2025 16 CLUBBING CYANOSIS  Bulbous enlargement of soft parts of the terminal phalanges with Bluish discoloration of nails due to increased amount of reduced hemoglobin (>5mg %) in capillary blood. both transverse and longitudinal curving of the nail.  swelling of terminal phalanges occurs due to interstitial edema and  TYPES: dilation of the arterioles and capillaries.  central  Clubbing anterior and lateral view  peripheral  cyanosis due to abnormal pigments  Mixed  SITES: palate, tongue, inner sides of lip and conjunctiva (warm areas) 1/5/2025 17 1/5/2025 18 SCHAMROTHS SIGN Palpation of pre tragus area  Normally when two fingers are held together with facing each other, a space is seen at the level proximal nail fold. this is lost in  Patient is asked to slowly open and close the mouth palpating case of clubbing. with index finger, placed in the pre tragus depression. 1/5/2025 19 1/5/2025 25 Intra auricular palpation  Masseter muscle  performed by inserting little finger into the ear canal and pressing  Origin: from lower portion of the zygomatic arch. anteriorly.  Insertion: on the lateral surface of the angle and coronoid process of the mandible.  while palpating with this method check whether condyle moves symmetrically, with the rotation and translation phase.  This muscle has a deep and superficial portion as with the temporalis  palpation is also used to detect the tenderness clicking and muscle, it can be located when the patients jaws are forcibly closed. crepitus.  PALPATION-The body of the masseter can be palpated with thumb and the index finger. 1/5/2025 26 1/5/2025 28  Internal pterygoid muscle  EXTERNAL PTERYGOID MUSCLE  Origin: medial side of the lateral pterygoid plate and the tuberosity of the maxilla  Origin: in two parts ,one begins on the greater wing of the sphenoid bone and they cannot be palpated. and the other issues from the lateral surface of the pterygoid plates.  Insertion: on the lower medial surface of the ramus of the mandible.  Insertion:on the neck of the condyle and the articular disc of the TMJ. PALPATION  Anterior part of the insertion can be palpated by placing the index finger at a 45  PALPATION degree angle in the base of the relaxed tongue.  The muscle is palpated by using the index or  The opposite hand can be used extraorally to palpate the posterior and inferior portions of the insertion. little finger and placing it lateral to the  The body of the muscle can be palpated by rotating the index finger upward maxillary tuberosity and medial to the against the muscle to near its origin on the tuberosity. coronoid process.  The finger presses upward and inward and a painful response can be determined. 1/5/2025 29 1/5/2025 30 PREAURICULAR LYMPH NODES POSTAURICULAR LYMPH NODES  Location – in front of ear  Location – behind the ear , near the insertion of sternomastoid  Lymphatic drainage - Eyelids and conjunctivae, temporal region, muscle. pinna  Lymphatic drainage: external auditory meatus, pinna, scalp  For palpation of Preauricular lymph nodes, roll your finger in front  digital palpation is done by pressing against the skull. of the ear, against the maxilla.  Enlarged due to infection of scalp, temporal & frontal areas.  Enlarged - External auditory canal infection. 1/5/2025 32 1/5/2025 33 SUBMENTAL LYMPH NODE OCCIPITAL LYMPH NODES  Located below the chin.  Location: Located at the junction between the back of the head and  Lymphatic drainage: Lower lip, floor of mouth, teeth, submental neck. salivary gland, tip of tongue, skin of cheek.  Lymphatic drainage: Scalp and head.  Roll the fingers below and lingual to the chin, against the mylohyoid  Enlarged in infection of scalp & syphilis. muscle.  Enlarged in disorders in the anterior portion of the mouth and the lower lip. 1/5/2025 34 1/5/2025 35 SUB MANDIBULAR LYMPH NODE Inspection: Color:  Located medial to the inferior border of mandible.  white -leukoplakia, Oral candidiasis  Lymphatic drainage: Tongue, submaxillary gland, lips and mouth.  Black - Black hairy tongue(due to hyperkeratosis of mucous membrane in  Roll your fingers against inner surface of Mandible with patient's heavy smokers) head gently tilted towards one side.  COATED TONGUE one covered with a whitish or yellowish layer consisting of desquamated epithelium, debris, bacteria, fungi, etc.  Enlarged in Infections of head, neck, sinuses, ears, eyes, scalp,  Fissures, cracks in the tongue: pharynx.  Congenital fissures> Transverse direction  Syphilitic fissures> longitudinal  Any ulcer  Site of ulcer is usually characteristic 1/5/2025 36 1/5/2025 42  TOLUIDINE BLUE STAINING LABORATORY INVESTIGATIONS IN DENTISTRY (HISTOPATHOLOGY AND MICROBIOLOGY) Basic Sciences Mon. Jan.13. 2025 1/12/2025 9 EXCISIONAL BIOPSY Type of lesion Biopsy Lesional area to biopsy Preferred  Total excision of a small lesion for microscopic examination is method Blister Incisional Margin/perilesional Scalpel called as excisional biopsy. or whole blister  It is a therapeutic as well as diagnostic procedure Carcinoma (suspected) Margin  Normal tissue on the margins of the lesions should be included Erosion Margin/perilesional Erythroplakia Margin/perilesional Punch or scalpel Granulomatous Deep  INDICATION Leukoplakia Any red area Lichenoid Lesion  it is indicated when the lesion is relatively small and less then 1cm Lump (mucosal) Excisional Scalpel in diameter, sessile or pedunculated and well circumscribed Mucocele Excisional Pigmented Excisional  Freely movable tissue and located above the mucosa or just Salivary major gland FNAC or US guidance beneath the surface FNAB swelling  It is the preferred treatment if, the size of lesion is such that it may Salivary minor gland Palate – Labial gland biopsy Scalpel incisional be removed along with the margins of normal tissue and wound swelling for xerostomia Lip – can be closed primarily. diagnosis – incisional excisional Ulcer Incisional 1/12/2025 Margin/perilesional scalpel 13 1/12/2025 17 INCISIONAL BIOPSY  Incisional biopsy can be perfomed by removing a wedge shaped PUNCH BIOPSY specimen of the pathological tissue along with surrounding normal  It is rarely necessary in the oral cavity as most of the oral lesions zone are easily accessible ,with this technique the surgical defect that is  INDICATIONS produced is small and does not require suturing.  A surgical instrument is used to punch out a representative portion  if the lesion is large and diffuse and extends deeply in to the of tissue. surrounding tissue so that total removal can not be obtained easily  Since the resulting specimen is often damaged by the procedure, with local anaesthesia biopsy by scalpel is preferred. INTRAOSSEOUS BIOPSY Needle/trephine/drill It is less frequently performed. It may be in the form of exploratory These techniques have been employed to biopsy deep seated fibro- curettage in which the representative tissue is obtained to determine osseous lesions. the nature of large radiological alterations. The resulting specimen is small may be non representative and again often damage by the procedure they are not often used. 1/12/2025 18 1/12/2025 19 ASPIRATION BIOPSY CYTOLOGY  This procedure is used to obtain information about the nature of  It is the microscope study of cells exfoliated or scraped from the the fluid content of a large ,deep seated relatively inaccessible soft surface of a lesion. tissue mass or an intra-osseous cystic lesion.  Is an adjust to biopsy not a substitute.  It may be used either alone or prior to one of the other procedure.  Is indicated when biopsy cannot be undertaken , is refused by  It is done in cases of lesion either situated in deep inaccessible the patient , where multiple lesions needs investigation. sites like in metastasis and cystic lesions.  If interpretation of a cytological specimen is in doubt a biopsy  Aspiration of the air from the molar region of the maxilla suggest is indicated that the needle is the maxillary sinus. 1/12/2025 20 1/12/2025 24   Types of cytology-  Exfoliative cytology  Fine needle aspiration cytology  Exfoliative cytology- i. cytology is not a substitute for, but an adjunct to, the surgical biopsy. ii. It is a quick, simple, painless and bloodless procedure Fine needle aspiration cytology(FNAC)- it is the microscopic examination of an aspirate obtained by inserting a fine needle in to the lesion. it is painless and a safe procedure for rapid diagnosis. i. Indications- FNAC of salivary glands is a useful procedure for evaluation of salivary gland tumors ii. For examination of enlarged clinically suspicious lymph nodes. iii. Detection of metastatic squamous cell carcinoma within cervical nodes. 1/12/2025 26