12/11/2013

WHY????
Many diseases (systemic or local) have signs

that appear on the face, head & neck or intraorally.

create a differential diagnosis in cases of abnormalities and make treatment recommendations based on accurate assessment of the signs & symptoms of disease
2

Making a complete examination can help you

12/11/2013

Scope of examination
Diseases of the head & neck Diseases of the supporting hard & soft tissues Diseases of the lips, tongue, salivary glands, oral mucosa Diseases of the oral tissues which are a component of systemic disease
12/11/2013 3

12/11/2013

12/11/2013

12/11/2013

AGE
AGE Congenital Vitamin deficiency and malnutrition Carcinoma of buccal mucosa, lips, tongue
12/11/2013 7

OCCUPATION
OCCUPATION
COUNTRY MANS LIP

RESIDENCE
Australia Caucasians Negroes

12/11/2013

SYMPTOMS

12/11/2013

SWELLING / ULCER
Mode of onset Duration
Progress

12/11/2013

10

PAIN
PAINLESS LESIONS Leukoplakia, mucous retention cysts, early carcinomas.
PAINFUL LESIONS Apthous ulcers, dental ulcers, abscess. Localized / radiating to ear
12/11/2013 11

SIALORIA
Excessive Salivation Painful lesions Mass lesions irritation Inability/difficulty to swallow due to ankyloglossia
12/11/2013 12

HISTORY
Ankyloglossia Tongue Tie Dysarthria

Hoarseness of voice
Cough with expectoration
12/11/2013 13

HISTORY
Trismus Ear pain Eye pain Dysphagia Hearing loss History of leukoplakia / erythroplakia

12/11/2013

14

MOKING PIRIT EPSIS UPERFICIAL GLOSSITIS YPHILIS PICES HARP TOOTH

12/11/2013 15

PERSONAL HISTORY
SMOKING
Type Pack Years Mode Of Smoking

ALCOHOL INTAKE TOBACCO CHEWING

12/11/2013 16

GENERAL EXAMINATION
Build and Nourishment Pallor

12/11/2013

17

12/11/2013

18

INSPECTION
REQUIREMENTS

12/11/2013

19

LIPS
Exterior surface of lips Cleft lip Pigmentation Swelling / ulcer
12/11/2013 20

LIPS
Evert the lip and examine the tissue. Observe frenulum attachment.

12/11/2013

21

LIPS
Clear mucous filled pockets may be seen on the inner side of the lip (mucocele). This is a frequent, nonpathologic entity which represents a blocked minor salivary gland
12/11/2013 22

GUMS
To examine the gums lip must be everted fully. Healthy gums are bright pink in colour.

12/11/2013

23

GINGIVA GUMS
Note color, tone, texture, architecture & mucogingival relationships

12/11/2013

24

GINGIVA

GUMS

How would you describe the gingiva?

Marginal vs. generalized? Erythematous vs. fibrous

Drug reactions: Anti-epileptic, calcium channel blockers, immunosuppressant

12/11/2013

25

GUMS
Cancrum oris is infective ulceration affecting alveolous and progresses to produce orocutaneous fistula.

12/11/2013

26

BUCCAL MUCOSA
Observe color, character of the mucosa Stensons duct

12/11/2013

27

BUCCAL MUCOSA
LEUKOPLAKIA / ERYTHROPLAKIA

12/11/2013

28

BUCCAL MUCOSA

Lesions white, red Lichen Planus, Submucous fibrosis

12/11/2013

29

PALATE
Congenital cleft Perforation Ulceration swelling

12/11/2013

30

TONGUE
VOLUME Macroglossia

COLOUR White Red glazed tongue Blue black

12/11/2013 31

TONGUE
ULCER Tuberculous tip and lateral borders

Gummatous dorsum
Carcinomatous anywhere Dental lateral borders and ventral surface
12/11/2013 32

TONGUE
Lingual thyroid swelling at foramen caecum

Mobility of tongue Ankyloglossia

12/11/2013

33

TONGUE
The tongue and the floor of the mouth are the most common places for oral cancer to occur. It can occur other places; so visualize all areas You may observe:
Circumvallate papillae, epiglottis

12/11/2013

34

TONGUE
Wrap the tongue in a dry gauze and gently pull it from side to side to observe the lateral borders

12/11/2013

35

TONGUE
You may observe lingual varicosities

12/11/2013

36

Exam: Tongue TONGUE

geographic tongue (erythema migrans)

12/11/2013

37

Exam: Tongue TONGUE

You may observe drug reaction

12/11/2013

38

TONGUE
Observe signs of nutritional deficiencies, immune dysfunction

12/11/2013

39

TONGUE
Ulceration, proliferative growth

12/11/2013

40

FLOOR OF MOUTH
Frenulum Ranula Sublingual dermoid

12/11/2013

41

PALPATION

12/11/2013

42

LIP
Any lesion of lip should be palpated
Benign neoplasms are firm & lobulated Carcinoma hard

12/11/2013

43

 Apthous ulcers small discrete shallow tender ulcers with a rim of inflammation

12/11/2013

44

LIP
Hunterian chancre - in primary syphilis is rubbery hard

12/11/2013

45

LIP
Carcinoma of lip hard in consistency restricted mobility fixity
12/11/2013 46

TONGUE
Method of palpation

12/11/2013

47

TONGUE
Dental ulcers are very tender with no induration of edge / base. Carcinomatous ulcers show induration of base and edge.

12/11/2013

48

PALATE
Hard irregular swelling on hard palate with normal appearing overlying mucosa minor salivary gland tumor Malignant lesions of hard palate are hard fixed ulcerative or proliferative lesions

12/11/2013

49

ALVEOLUS AND GINGIVA

12/11/2013

50

ALVEOLUS AND GINGIVA

GINGIVITIS GINGIVAL HYPERTROPHY EPULIS ALVEOLAR CARCINOMA
12/11/2013 51

FLOOR OF MOUTH
UNIDIGITAL PALPATION BIDIGITAL PALPATION RANULA

12/11/2013

52

RANULA

12/11/2013

53

BUCCAL MUCOSA

12/11/2013

54

MANDIBLE
Bidigital palpation of mandible Temporo mandibular joint Movements at TMJ

12/11/2013

55

12/11/2013

56

PALPATION OF LYMPH NODES

12/11/2013

57

12/11/2013

58

12/11/2013

59

12/11/2013

60

DIFFERENTIAL DIAGNOSIS OF ULCERS ONN TONGUE

Apthous ulcers Dental ulcers Carcinomatous Syphilis Tuberculous

12/11/2013

61

INVESTIGATIONS
HAEMOGRAM WEDGE BIOPSY FROM EDGE OF ULCER FNAC OF LYMPH NODES CECT OF NECK ORTHOPANTOMOGRAM

12/11/2013

62

ORTHOPANTOMOGRAM

12/11/2013

63

12/11/2013

64

12/11/2013

65