6. Investigation of disease: extra-and intraoral status. Diagnosis, type of diagnosis, differential diagnosis, treatment plan.

Question 1

Initial observations made during the clinical examination of a patient

Answer 1

• Patient’s gait, composure, and speech=>
• Reflect their general condition and psychological status

Question 2

Vital signs recorded after history taking

Answer 2

• Blood pressure
• Pulse, temperature, and respiratory rate

Question 3

Four aspects of examination should a clinician be well-versed in

Answer 3

• Inspection
• Palpation
• Percussion
• Auscultation

Percussion has the least importance in the maxillofacial region

Question 4

Main components of an extraoral examination

Answer 4

• Inspection and palpation of the face, skin and soft tissue
• Skull, bony skeleton of the face
• TMJ, lymph nodes, salivary glands
• Eyes.

Question 5

Aspects of the face are observed

Answer 5

• Signs of asymmetry
• Swelling
• Proportion of the upper, middle, and lower thirds of the face, and their relation to each other

Question 6

Skin and soft tissue characteristics important to note

Answer 6

• Color and texture of the skin=>
• Indicative of many underlying systemic problems

Question 7

How skull inspected

Answer 7

• Starts from the cranium and the frontal bone=>
• Moves downwards
• Abnormalities in size and shape
• Signs of head injuries
• Edema, laceration, swelling noted

Question 8

Important points to observe in the eyes

Answer 8

• Soft tissue injury to the cornea or conjunctiva
• Pallor (indicative of anemia)
• Icterus (indicative of jaundice)
• Exophthalmus (suggestive of thyroid disorders).

Question 9

What is inspected in the nose

Answer 9

• Inspect for depression of the nasal bridge
• Deviation of the nasal septum
• Obliteration of the lateral wall of the nose
• Nasal discharge
• Loss of smell.

Question 10

Abnormalities that might be seen in the ears during inspection

Answer 10

• Bleeding from the ears (indicative of condyle fractures)
• Signs of Goldenhar syndrome (external ear abnormalities)
• Infection
• Pus discharge, tinnitus, and hearing impairment

Question 11

lesions that might be observed in the lips

Answer 11

• Clefts
• Ulcerative and nonulcerative growths
• Angular chelitis, and herpes infections

Question 12

How palpation conducted

Answer 12

• Gentle to avoid distressing the patient
• Helps the clinician establish a primary diagnosis

Question 13

How the temporomandibular joints (TMJ) examined

Answer 13

• Placing the index fingers anteroinferior to the tragus of the ear
• Check for tenderness, clicking, crepitus=>
• On opening or closing the mouth, range of opening, and left and right lateral excursions

Question 14

Palpation indicators of a fracture in trauma patients

Answer 14

• Abnormal mobility of fragments, tenderness, and reduced TMJ movements

Question 15

Distinguishes a facial swelling that is infective from one that is neoplastic or cystic

Answer 15

• Infective swelling is soft, fluctuant, warm, and tender
• Neoplastic or cystic swelling=> firm to bony hard=>
• w/ cortical plate expansion and variable tenderness

Question 16

Presence of eggshell crackling sound on palpation indicates

Answer 16

• Thinning of the buccal cortex
• Often seen in certain conditions affecting the jaw

Question 17

How salivary gland disorders examined

Answer 17

• Parotid and submandibular glands are palpated extraorally=>
• Parotid gland palpated in the preauricular, inferior auricular, and postauricular regions
• Submandibular gland is checked by bimanual palpation

Question 18

What is evaluated when palpating the lymph nodes

Answer 18

• Preauricular
• Submandibular, submental, and cervical lymph nodes=>
• for enlargement, tenderness, mobility, and consistency

Question 19

Main uses of auscultation in the orofacial region

Answer 19

• Detect bruits in vascular lesions
• Hear movements and pathological processes of the temporomandibular joint (TMJ).

Question 20

Structures examined during an intraoral examination

Answer 20

• Buccal, labial, and alveolar mucosa.
• Hard and soft palate
• Floor of the mouth and tongue
• Retromolar region
• Salivary glands and their orifices
• Dentition and occlusion

Question 21

Specific aspects of the mucosa inspected

Answer 21

• Color, texture
• Presence of ulceration, growth, or draining sinuses

Question 22

How the tongue examined

Answer 22

• Size, mobility, and surface of the tongue inspected
• Tongue then depressed to visualize the uvula, soft palate, and the lateral and posterior pharyngeal walls

Question 23

Findings in the floor of the mouth that are significant

Answer 23

• Examined for inflammation, masses, and hematomas
• A raised floor of the mouth in a patient with an abscess suggests Ludwig’s angina

Question 24

What is looked for at salivary gland orifices

Answer 24

Signs of inflammation or pus discharge