6. Investigation of disease: extra-and intraoral status. Diagnosis, type of diagnosis, differential diagnosis, treatment plan. Flashcards
Initial observations made during the clinical examination of a patient
- Patient’s gait, composure, and speech=>
- Reflect their general condition and psychological status
Vital signs recorded after history taking
- Blood pressure
- Pulse, temperature, and respiratory rate
Four aspects of examination should a clinician be well-versed in
- Inspection
- Palpation
- Percussion
- Auscultation
Percussion has the least importance in the maxillofacial region
Main components of an extraoral examination
- Inspection and palpation of the face, skin and soft tissue
- Skull, bony skeleton of the face
- TMJ, lymph nodes, salivary glands
- Eyes.
Aspects of the face are observed
- Signs of asymmetry
- Swelling
- Proportion of the upper, middle, and lower thirds of the face, and their relation to each other
Skin and soft tissue characteristics important to note
- Color and texture of the skin=>
- Indicative of many underlying systemic problems
How skull inspected
- Starts from the cranium and the frontal bone=>
- Moves downwards
- Abnormalities in size and shape
- Signs of head injuries
- Edema, laceration, swelling noted
Important points to observe in the eyes
- Soft tissue injury to the cornea or conjunctiva
- Pallor (indicative of anemia)
- Icterus (indicative of jaundice)
- Exophthalmus (suggestive of thyroid disorders).
What is inspected in the nose
- 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.
Abnormalities that might be seen in the ears during inspection
- Bleeding from the ears (indicative of condyle fractures)
- Signs of Goldenhar syndrome (external ear abnormalities)
- Infection
- Pus discharge, tinnitus, and hearing impairment
lesions that might be observed in the lips
- Clefts
- Ulcerative and nonulcerative growths
- Angular chelitis, and herpes infections
How palpation conducted
- Gentle to avoid distressing the patient
- Helps the clinician establish a primary diagnosis
How the temporomandibular joints (TMJ) examined
- 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
Palpation indicators of a fracture in trauma patients
- Abnormal mobility of fragments, tenderness, and reduced TMJ movements
Distinguishes a facial swelling that is infective from one that is neoplastic or cystic
- Infective swelling is soft, fluctuant, warm, and tender
- Neoplastic or cystic swelling=> firm to bony hard=>
- w/ cortical plate expansion and variable tenderness
Presence of eggshell crackling sound on palpation indicates
- Thinning of the buccal cortex
- Often seen in certain conditions affecting the jaw
How salivary gland disorders examined
- 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
What is evaluated when palpating the lymph nodes
- Preauricular
- Submandibular, submental, and cervical lymph nodes=>
- for enlargement, tenderness, mobility, and consistency
Main uses of auscultation in the orofacial region
- Detect bruits in vascular lesions
- Hear movements and pathological processes of the temporomandibular joint (TMJ).
Structures examined during an intraoral examination
- 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
Specific aspects of the mucosa inspected
- Color, texture
- Presence of ulceration, growth, or draining sinuses
How the tongue examined
- Size, mobility, and surface of the tongue inspected
- Tongue then depressed to visualize the uvula, soft palate, and the lateral and posterior pharyngeal walls
Findings in the floor of the mouth that are significant
- Examined for inflammation, masses, and hematomas
- A raised floor of the mouth in a patient with an abscess suggests Ludwig’s angina
What is looked for at salivary gland orifices
Signs of inflammation or pus discharge
