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THE NOSE

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  • pg 1
									   THE MOUTH,
THROAT,NOSE AND
     SINUS
Mouth Structures
              Mouth
• Formed by the lips, cheeks, hard
  and soft palates, uvula, and the
  tongue and its muscles
• Oral cavity contains tongue, teeth,
  gums, and the openings of the
  salivary glands
       Throat Structures
• Located behind the mouth and
  nose, serves as a muscular
  passage for food and air
• Nasopharynx, oropharynx and
  laryngopharynx
Throat
NOSEY
         Nasal Structures
• Consists of an external portion
  covered with skin and an internal
  nasal cavity
• External nose - a bridge, tip, and two
  oval openings called nares
• Internal nose - nasal cavity, nasal
  septum, Kiesselbach’s area, superior,
  middle, and inferior turbinates
Sinus Structures
           Sinus Structures
• Four pairs - frontal, maxillary, ethmoidal,
  and sphenoidal located in the skull
• Decrease the weight of the skull and act
  as resonance chambers during speech
           Subjective Data
•   History of present health concern
•   Past health history
•   Family history
•   Lifestyle and health practices
           Oral Cancers
• Risk factors
  –Tobacco use, alcohol consumption,
   age over 40, male gender, genetic
   predisposition, family history,
   occupation - nickel refining,
   woodworking, textile fibers, vitamin
   A deficiency, UV exposure
   Oral Cancer Teaching Tips
• Risk reduction teaching tips
  –Stop smoking, limit alcohol
   consumption; balanced diet,
   precautionary measures at
   workplace
  –Avoid excessive exposure to
   ultraviolet (UV) light, avoid sources
   of oral irritation
        Oral Cancer Tips
• Cultural considerations
  –More common in Hungary and
   France and less common in Mexico
   and Japan than in the United States
  –Rates of oral cavity and base-of-
   tongue cancers are high in
   Bombay, India
          Objective Data
• Gathering Equipment
  –Gloves; 4 × 4-inch gauze pad;
   penlight
  –Short wide-tipped speculum
   attached to the head of an otoscope
  –Tongue depressor, nasal speculum
MOUTH
  • Inspect
    –   Odors
    –   Lips
    –   Teeth & Gums
    –   Buccal mucosa
    –   Hard & Soft Palate
    –   Uvula
    –   Tongue
  • Test tongue strength
                    THROAT
Directions: Open mouth
• Use wooden tongue
• Inspect Tonsils &
  Pharynx
• Check uvula rise
  – Clarity of speech
  – Ability to swallow
• Check gag reflex if
  needed
        Grading the Tonsils
• + 1 – Just visible
• +2 – Clearly visible
• +3 – Extend ½ distance between wall and
       uvula
• +4 – Almost touch
Throat
• Motor
  – Ability to swallow
  – Clarity of speech
  – Uvula rises with
    “ah”
  – Gag reflex
• Sensory
  – Taste Test:
    posterior 1/3
• Taste: Anterior 2/3 of tongue
  – Substances
     • Salty = Salt            Sweet = Sugar
     • Sour = Lemon Juice      Bitter =
         Procedure
     •   Not routinely done
     •   Done with CN IX Glossopharyngeal
         [Taste posterior 1/3 of tongue –
         difficult to do!]
     •   Apply the solutions by applicators to
         the tongue.
     •   Do not close mouth before identifying
     •   Drink water if needed.
ASSESSMENT OF THE NOSE
           External Inspection
• Inspect the nose, noting any trauma,
  bleeding, lesions, masses, swelling, and
  asymmetry
• The shape maybe altered by genetics or
  trauma
ASSESSMENT OF THE NOSE
                  Patency
• Have the patient occlude one nostril with a
  finger
• Have patient breathe in and out -- listen
  for sound
• Repeat on the other side
• Altered with a deviated septum, foreign
  body, URI, allergies, and nasal polyps
           Olfactory Sense
• Test patency first
• Close eyes to identify smells
• Smells should be easily identifiable and
  non-noxious
  – Coffee, chocolate, tobacco
  – Vanilla, peppermint, orange
  – Toothpaste, soap
ASSESSMENT OF THE NOSE
              Internal Inspection
It is often convenient to examine the nose after the
    ears
• Tilt the person’s head back slightly and hold
    breath for a few seconds.
• Place the nondominant hand on top of the
    patient’s head
• Using the thumb of the same hand gently lift the
    tip of the nose
• Insert otoscope into the nostril
• Inspect septum, turbinates, mucosa and
    drainage
NASAL PATHOLOGY
     Rhinitis
         • Nasal mucosa is red
           and swollen with
           copious clear, watery
           discharge
         • Findings with
           common cold (coryza)
       NASAL PATHOLOGY
• Allergic rhinitis membrane pale
• After head trauma clear fluid -- Cerebral
  spinal fluid -- positive for glucose
• Purulent material -- infection or foreign
  body
• Septal perforation -- nasal cocaine,
  amphetamines, overuse of nasal spray
   Abnormalities of the Mouth
         and Throat
• Herpes simplex type I; carcinoma of
  lip, leukoplakia; cheilosis of lips,
  hairy leukoplakia
• Candida albicans infection,
  carcinoma of tongue, canker sore
• Black hairy tongue, gingivitis,
  receding gums, Kaposi’s sarcoma
  lesions, bifid uvula
  Abnormalities of the Nose
• Nasal polyp
• Perforated septum

								
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