Midterm I: Head & Neck Anatomy

Question 1

what are the 4 steps to the ODTP process

Answer 1

1. history gathering and assessment (CC, medical, dental, social, vital signs, etc.), CLINICAL EXAM OF HEAD AND NECK REGIONS: EOE- extraoral exam, and IOE (intraoral exam) includes oral cancer screening exam
   - also lab tests/radiographs
2. Soft Tissue assessment (periodontal disease status)- diagnosis, etiology, prognosis
3. hard tissue assessment (caries and occlusal disease status)-diagnosis, etiology, prognosis
4. Treatment planning- ideal treatment plan and options/alternatives

Question 2

what are the (skeletal) reference points for the extraoral exam?

Answer 2

forehead; frontal eminence, superciliary arches, glabella, nasion

• orbit
• zygomatic (malar) eminences
• maxilla: pririform aperture, alveolar process, zygomatic process
• ramus: condyle/neck, coronoid provess, mandibular notch, coronoid notch
• angle of mandible (gonial angle)
• alveolar process
• inferior border , antigonal notch

Question 3

what is sclera, iris

Answer 3

sclera-the white part of the eye, iris= color part (brown eyes, blue eyes, that part only)

Question 4

what is cilia in reference to the face

Answer 4

eye lashes

Question 5

what are the upper and lower eyelids called

Answer 5

super and inferior palpebra

Question 6

what is canthus

Answer 6

medial and lateral palpebral commissures (where eyelids meet, corners of eye on both sides)

Question 7

what is the word for eyeball

Answer 7

bulbar

Question 8

what is conjunctiva

Answer 8

bulbar (eyeball) and palpebral (eyelid) mucosa

-conjunctival sac is when you reflect eyelids, sac

Question 9

what is the gland for tear fluid

Answer 9

lacrimal gland- in superior lateral area of orbit

Question 10

whats another word for auricle

Answer 10

(external ear) also pinna

Question 11

what is the depression in the line above the upper lip

Answer 11

philtrum

Question 12

which lymph nodes should you check in a head and neck exam

Answer 12

• parotid (preauricular, buccal)
• mastoid (post auricular)
• submandibular/submental
• sternocleidomastoid muscle- anterior border, deep and superficial
• supraclavicular

Question 13

what are the 8 major anatomical areas intraoral

Answer 13

1. labia
2. buccal mucosa
3. gingiva
4. vestibules
5. Palates (roof of mouth)
6. Pharynx (throat)
7. Tongue (lingua)
8. Sublingual (floor of mouth)

Question 14

what are normal “abnormalities” of buccal mucosa

Answer 14

fordyce granules (yellow bumps - sebaceous glands) in posterior cheek region
linea alba: white line on buccal mucosa, from occlusion (biting cheeks?)

Question 15

what is the dip area behind last molar

Answer 15

retromolar pad (only mandibular) soft tissue

Question 16

what is the line along the palate?

Answer 16

palatine raphe

Question 17

what are the folds on the palate called?

Answer 17

palatal rugae

Question 18

what is the ridge behind the last molars on the maxilla

Answer 18

maxillary tuberosity

Question 19

what is the deepening behind the maxillary tuberosity?

Answer 19

hamular notch

Question 20

what is the purpose of head and neck exam

Answer 20

• to examine visually and manually (feel) soft tissues of head and neck extra and intraoral
• to identify/characterize and document all areas of normality /pathology
• to make decisions about patient case based on the findings

Question 21

what is the name of the exam we do for head and neck

Answer 21

head and neck exam (head and neck “soft tissue” exam)- which includes oral cancer exam or oral cancer screening exam

Question 22

when should you do head and neck exam

Answer 22

while asking about health history

Question 23

how has oral cancer survival changed and why? how common is metastasization? what is the survival if it is still localized?

Answer 23

from 50 to 57%, but due to an increase of hpv-16 caused oral cancer, which ahs a better survival rate. over 60% have already metastasized when detected
greater than 80% survival if localized. if cervical lymph nnodes are involved it drops

Question 24

what are oral cancer risk factors

Answer 24

• age
• use of tobaco
• heavy alcohol use
• immunosuppression
• radiation therapy (second primary cancers)
• iron deficiency anemia (plummer vinson syndrome)
• diets low in fruits and veggies
• candida (fungus)
• hPV 16
• • 27% of cases do not have risk factors

Question 25

whats the basic armamentarium for head and neck exam

-advanced?

Answer 25

• light source
• mirror
• periodontal probe
• gauze
• air/water syringe

advanced:
-radiographs
-diascopy 
-dyes and optic illuminators
-biopsy kit/cytology
-stethescope
(others for ent slide 47

Question 26

what is diascopy

Answer 26

clear glass or anasthetic cartirage used to examine vascular lesions. compress lesion and look for blanching- loss of red/putple color
-intravascular lesions blanch (change color) extravascular lesions dont

Question 27

what are macules/plaques

Answer 27

types of pigmented lesions

macules are small and flat, plaques are large and raised

Question 28

what is the sequence of intraoral ex

Answer 28

• upper and lower lips and labial mucosa/gingiva
• right and left buccal mucosa and gingiva (parotid salivary flow)
• hard and soft palate areas and palatal gingiva
• oropharynx and tonsillar areas
• tongue; dorsal,lateral and ventral surfaces
• floor of mouth and lingual vestibule and gingiva (submandibular salivary flow

Question 29

extraoral sequence

Answer 29

• visual inspection of hair/scalp and all H&N, skin
• inspection of external eyes, ears, nose and lips
• palpation of auricular, parotid, submandibular, submental, mid-line neck, lateral neck and supraclavicular areas
• salivary gland and lymph node eval
• evaluation of tmj

Question 30

what always must be examined

Answer 30

lips
labial and buccal mucosa
palates and oral pharynx
-tongue of floor of mouth
-skin of face and neck
-parotid regions and glands
-regional lymph nodes of neck and face

Question 31

whats are teh steps of head and neck exam

Answer 31

intraoral:
1.
visual exam and bidigital palpation of perioral region. vermillion part of lips, commisure of lips, palpate lips/labial mucosa. palpate labial gingiva
2.examine buccal mucosa. bidigital palpation. (milking parotid gland-dry, compress against ramus, observe for flow of saliva- if issue w patient saliva flow)
3. palpate and inspect hard palate visually
4. visually inspect soft palate and oropharynx
5. visually inspect then palpate tongue (grab, 1 side then the other)
6. palpate and visually inspect floor of mouth

extraoral:
7. visual inspection of face, ears, head and neck
8.palpate face and neck
(parotid-pre and post auricular areas, buccal and labial skin, temperomandibular joints, temples, submandibular and submental, anterior and posterior triangles of neck)

Question 32

whats another term for pharyngeal tonsels and where is it

Answer 32

adenoids,its up above at the posterior of throat area, near concha, not visible i think

Question 33

whats leukoplakia

Answer 33

premalignant white lesion-biopsy needed

Question 34

how long should you wait to see if a lesion heals after a biopsy?

Answer 34

14 days