Extra Oral Examination GN PDF

Extra Oral Examina,on Module: Founda,ons for Clinical Skills and Prac,ce Tutor: Rhona Mann Aim: To deliver the required informa2on in order to gain an understanding of the relevance of the Extra oral examina2on in clinical prac2ce. Intended learning outcomes By the end of this session students w...

Extra Oral Examina,on Module: Founda,ons for Clinical Skills and Prac,ce Tutor: Rhona Mann Aim: To deliver the required informa2on in order to gain an understanding of the relevance of the Extra oral examina2on in clinical prac2ce. Intended learning outcomes By the end of this session students will be able to: Explain the relevance and importance of the extra oral examina2on of the pa2ent. Iden2fy areas of par2cular signi@cance in rela2on to the extra oral examina2on. Explore the techniques and observa2ons required in order to carry out a thorough and eAec2ve extra oral examina2on. What do we mean by extra oral examina,on? This examina2on forms part of the general ini2al assessment of the pa2ent. The extra oral examina2on is carried out to iden2fy any undisclosed or undiagnosed condi2ons that may include malignancies, Endocrine disorders and indica2ons of cardiovascular risk. What areas will we be looking at? Upper Face: Forehead Eyes Cheeks/cheekbones Upper part of nose Lower Face Lower part of nose Lips Chin General symmetry  ‘’Physical examination of neck region…’’ Abnormalities; Swellings Let’s start with the neck area: Lumps Tenderness What are we looking and feeling for? Lymph nodes  Any swelling Any tenderness Any abnormality We need to PALPATE (feel) for swelling, tenderness and lymph gland enlargement Lymphadenopathy Disease of the Lymph glands, oPen recognised as swelling and tenderness Accessed Nov 2020 What should lymph nodes feel like? Normal, healthy nodes should feel small( pea size) and not tender to touch. Also usually mobile. Abnormal nodes will feel @xed and oPen tender to the touch. If an abnormality is detected: make careful notes on size, loca2on, consistency, etc with diagrams Don’t forget: OPen the nodes are swollen and tender due to recent infec2on eg cold….. How do you carry out a lymph node examina,on? Stand behind pa2ent ideally….. Why? Ensure pa2ent is relaxed…….Why? Rigid may be distorted Their head should be slightly forward, make sure chin is not 2pped upward…..Why? Use the pads of the @nger2ps in a on/oA mo2on….Why? Moving onto the Temporomandibular joint( TMJ) What is it?  Formed by the mandible and temporal bone. Made up of capsules and ligaments. Responsible for movement of the jaw: ea2ng, talking etc Very used joint! Problems are common and this can result in pain and di]culty opening. What do you think is a common cause of pain and dysfunc,on of the TMJ? Bruxism  Teeth Grinding ( Bruxism) oPen caused by stress: creates pain and s2Aness on opening, headaches, neck aches etc as well as other intra oral problems…..What do you think these might be? What are we feeling for when we examine the TMJ? We need to palpate both sides and ask pa2ent to open and close. Is there any of the following………………. Tenderness, pain ,devia2on to one side, clicking? Anything else? Stand behind pa2ent to carry out examina2on and examine both sides at the same 2me with 2ps of @ngers and gentle pressure. https://www.youtube.com/watch?v=Y_FHVM0hscE&feature=youtu.be&app =desktop 20  The Face  Any devia2on from “Normal”  But what is normal? 21  What are we looking for? Symmetry Stand in front of the pa2ent and remember most people’s faces are not completely symmetrical anyway. But signi@cant asymmetries should be noted and discussed with the pa2ent as to the cause. They may be due to previous trauma or surgery, CVA’s, infec2ons, nerve paralysis etc Is there any unexplained swelling, bruising: pallor or excessive swea2ng? Let’s discuss these Tndings……  EYES……….. Best to ask patient if normal or abnormal Can be due to thyroid problems, drugs, infection, medical condition Make a note of anything abnormal and discuss with patient. 25 Lips………………… Are they moist or dry and chapped? 26 Or there may be signs of cracking at the corners of the mouth ( commissures) 27 This is indica,ve of a condi,on called Angular Cheili,s Cracking at the corners ( commissures of the mouth) maybe one or both. In`amed, oPen red and sore. Possible causes are Fungal infec2on. Ask pa2ent about history of condi2on and any treatment they have had. May be di]cult and painful for pa2ent to open for dental treatment. 28 What other condi,ons could we see on the lips? 29  DO NOT TREAT PATIENTS WITH COLD SORES PRESENT Herpes Labialis ( cold sore) Common condi2on : mild to severe outbreaks may occur in the individual. Caused by Herpes Simplex Virus : lies dormant in nerve cells but certain situa2ons or condi2ons will ac2vate it leading to the outbreak of one or more lesions on or near the lips. If a pa2ent presents with a Cold Sore they should not be treated un2l it has completely healed. 30 We also need to be aware of any lesion on or near the lips that looks suspicious 31 Squamous cell Carcinoma Malignant lesion. May present as a sore, ulcer, blister, red or white patch on the lip that hasn’t gone away/healed. May be associated swelling of the lymph nodes or surrounding structures If SCC suspected needs urgent referral: details of dura2on, size , 32 In Summary: We need to look closely at the face, lips, eyes and general appearance of the pa2ent and note anything that appears unusual or abnormal. We need to carefully examine all lymph nodes of the neck area as discussed, looking for signs of abnormali2es. We need to examine the TMJ for signs of malfunc2on or abnormality. We need to ask the pa2ent about anything we do @nd, to get a full history and possible explana2on of our @ndings. 33 O r a l Extra – Oral Exam – Make short notes on… O r a l Extra – Oral Exam – Make short notes on… Thank you for your aZen,on! Anything you wish to discuss further: [email protected] Some self directed learning for you: Make short notes on the part of the face as listed on slides 33 and 34. Research these 2 condi,ons that may present on the lips: 37