Extra Oral Examination PDF

Extra Oral Examination Module: Foundations for Clinical Skills and Practice Tutor: Rhona Mann Aim: To deliver the required information in order to gain an understanding of the relevance of the Extra oral examination in clinical practice. Intended learning outcomes By the end of this session stud...

Extra Oral Examination Module: Foundations for Clinical Skills and Practice Tutor: Rhona Mann Aim: To deliver the required information in order to gain an understanding of the relevance of the Extra oral examination in clinical practice. Intended learning outcomes By the end of this session students will be able to: Explain the relevance and importance of the extra oral examination of the patient. Identify areas of particular significance in relation to the extra oral examination. Explore the techniques and observations required in order to carry out a thorough and effective extra oral examination. What do we mean by extra oral examination? This examination forms part of the general initial assessment of the patient. The extra oral examination is carried out to identify any undisclosed or undiagnosed conditions that may include malignancies, Endocrine disorders and indications 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 Let’s start with the neck area: What are we looking and feeling for?  Any swelling Any tenderness Any abnormality We need to PALPATE (feel) for swelling, tenderness and lymph gland enlargement Lymphadenopathy Disease of the Lymph glands, often 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 fixed and often tender to the touch. If an abnormality is detected: make careful notes on size, location, consistency, etc with diagrams Don’t forget: Often the nodes are swollen and tender due to recent infection eg cold….. How do you carry out a lymph node examination? Stand behind patient ideally….. Why? Ensure patient is relaxed…….Why? Their head should be slightly forward, make sure chin is not tipped upward…..Why? Use the pads of the fingertips in a on/off motion….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: eating, talking etc Very used joint! Problems are common and this can result in pain and difficulty opening. What do you think is a common cause of pain and dysfunction of the TMJ?  Teeth Grinding ( Bruxism) often caused by stress: creates pain and stiffness 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 patient to open and close. Is there any of the following………………. Tenderness, pain ,deviation to one side, clicking? Anything else? Stand behind patient to carry out examination and examine both sides at the same time with tips of fingers and gentle pressure. https://www.youtube.com/watch?v=Y_FHVM0hscE&feature=youtu.be&app =desktop 20  The Face  Any deviation from “Normal”  But what is normal? 21  What are we looking for? Symmetry Stand in front of the patient and remember most people’s faces are not completely symmetrical anyway. But significant asymmetries should be noted and discussed with the patient as to the cause. They may be due to previous trauma or surgery, CVA’s, infections, nerve paralysis etc Is there any unexplained swelling, bruising: pallor or excessive sweating? Let’s discuss these findings…… EYES……….. 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 indicative of a condition called Angular Cheilitis Cracking at the corners ( commissures of the mouth) maybe one or both. Inflamed, often red and sore. Possible causes are Fungal infection. Ask patient about history of condition and any treatment they have had. May be difficult and painful for patient to open for dental treatment. 28 What other conditions could we see on the lips? 29 Herpes Labialis ( cold sore) Common condition : mild to severe outbreaks may occur in the individual. Caused by Herpes Simplex Virus : lies dormant in nerve cells but certain situations or conditions will activate it leading to the outbreak of one or more lesions on or near the lips. If a patient presents with a Cold Sore they should not be treated until 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 duration, size , 32 In Summary: We need to look closely at the face, lips, eyes and general appearance of the patient 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 abnormalities. We need to examine the TMJ for signs of malfunction or abnormality. We need to ask the patient about anything we do find, to get a full history and possible explanation of our findings. 33 O r a l Extra – Oral Exam – Make short notes on… O r a l Extra – Oral Exam – Make short notes on… 36 Thank you for your attention! 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 conditions that may present on the lips: 37