Head & Neck Examination - Mouth, Throat & Neck

Question 1

How should the patient be sitting for a head & neck exam?

Answer 1

Sitting in a chair

Question 2

What is required for an examination of the mouth, throat and neck?

Answer 2

A glass of water

Expose the neck down to the clavicles - undo top buttons of their shirt

Ask patient to remove any jewellery

Question 3

How is the mouth examined?

Answer 3

With a tongue depressor and torch

Question 4

What are you looking for during the examination of the mouth?

Answer 4

Lips - cyanosis, angular stomatitis, BCC

Open mouth - inspect dentition, floor of mouth, hard & soft palate, inside cheeks, parotid duct opening (opposite 2nd uper molar)

Oropharynx, uvula, tonsillar folds + tonsils (stick tongue out and move side to side)

Tongue - dorsal surface, both lateral borders for dryness or fasciculation/wasting

• Ask patient to touch roof of mouth with the tongue to inspect underside of tongue and floor of mouth, submandibular duct and opening

Question 5

What else should the patient do with their teeth?

Answer 5

Bite them together

Question 6

What needs to be inspected in the neck area?

Answer 6

1) Scars, swellings
2) Lumps - site, size, skin changes
3) Movement with tongue protrusion (please stick your tongue out) and swallowing (take a sip, hold in mouth, then swallow)

Question 7

How is the neck area palpated?

Answer 7

1) Check tracheal position
2) Move behind patient to examine further and explain to the patient what you are going to be doing?
3) Palpate lateral aspects of neck and whole of front of neck - looking for any swellings, including lymph nodes (follow a Z)
4) For all swellings, note if it is midline or lateral
5) If lateral, is it anterior or posterior triangle
6) If midline, is it thyroid swelling or thyroglossal cyst (swallow some water whilst palpating)?
7) If a swollen node, then describe the clinical level I-V

Question 8

If a swelling is detected, how should it be described?

Answer 8

1) Mobile
2) Compressible
3) Hard
4) Pulsatile

Question 9

How is the mouth palpated?

Answer 9

1) Wear gloves and explain the examination to the patient

Examine the following 4 areas, checking for cystic swellings, irregular rough areas, or stones in parotid duct:

1 - Floor of mouth under the tongue

2 - Inside of cheeks

3 - Parotid & submandibular gland

4 - Substance of tongue (warning - may trigger gag reflex)

Question 10

How is the neck area auscultated?

Answer 10

1) Listen over carotid artery - listen for a bruit by using diaphragm and asking patient to hold their breath
2) Listen over an elarged Thyroid - Use diaphragm and ask patient to hold their breath, listen over both lobes for a bruit