Extraoral exam

Question 1

Explain how you would perform an EO exam

Answer 1

1. Introduce yourself and move to sit in front of the patient
2. Explain
   As part of the routine examination, I’m going to have a little look at your head and neck before we start to check that everything is normal, paying particular attention to your lymph nodes, muscles and jaw joint.
3. Mask, visor, wash hands, dry hands, gloves
4. Position patient
   I would sit the patient up for the extra-oral exam because it makes it easier to assess symmetry and gravity can act on lymph nodes
5. Start exam
   All the time I’ve been talking to the patient from in front I’ve been checking the following:
   * FACE - facial symmetry, swellings and general normality
   * EYES – any abnormalities like drooping, asymmetry, obvious scleral or conjunctiva abnormalities
   * SKIN – colour, texture, condition, lesions fixed to or arising from surrounding tissues
   * EARS – gross abnormalities are usually obvious
   * NECK – scarring, abnormalities, swellings, vessel pulsations, tracheal tugging as they breath, normal thyroid movement as they swallow
   * GAIT – mindful of the general way they move
   * DISABILITIES –
   Have you ever had any experience of pain or swelling of the head or neck area?

I am now feeling for the lymph nodes:
* beginning at the sub-mental (under chin)
* submandibular (under ramus)
* pre-auricular (in-front of ear)
* parotid (in front of the previous)
* post-auricular (behind ear)
* occipital (behind the head)
* down the cervical chain (either side of neck), the deep nodes of which can be better seen when the patient turns their head to the side to look over the shoulder
* Supra clavicular (above the clavicle, better seen on larger patients if they lift the shoulders) looking for any enlargement indicative of lymphadenopathy or tenderness.
I am palpating the muscles of mastication and would ask the patient if they could feel any tenderness there and looking for tenderness, hypertrophy or spasm. Temporalis origin is infratemporal fossa (can’t be palpated) and inserts into the coronoid process. Masseter origin is the zygoma and inserts into the angle of the mandible.
I am moving onto the TMJ, palpating and assessing for any clicks, crepitus, deviations, pain or limited movement when the patient opens, does lateral movements and closes.
I’d finish by looking at the lips and areas around the mouth, looking for anything unusual like ulcers or spots.