Extra-oral exam

Question 1

What is the best order to examine the head and neck?

Answer 1

• TMJ
• masseter
• temporalis
• salivary glands
  
  • parotid
  • submandibular
• lymph nodes
  
  • submandibular (same time as gland)
  • submental
  • cervical

Question 2

How do you examine the TMJ?

Answer 2

• place fingers on either side of the mandible at the TMJ
• ask patient to open and close
• ask patient to move mandible laterally
• ask patient to protrude and extrude

Question 3

What do you look out for in the examination of the TMJ?

Answer 3

• clicking (can be symptomatic or asymptomatic)

- discrepancies between sides

Question 4

How do you examine the masseter?

Answer 4

• move fingers anterior to the TMJ and work up and down the length of the masseter to the mandible
• ask patient to open and close
• ask patient to clench
• tenderness indicates bruxism

Question 5

How do you examine the temporalis?

Answer 5

• place fingers on the temples
• ask patient to clench
• tenderness indicates bruxism

Question 6

How do you examine the parotid salivary gland?

Answer 6

• the parotid is located just below and in front of the ear
• palpate to feel for irregularities such as salivary stones
• if unsure, compare to the opposite side

Question 7

How do you examine the submandibular gland?

Answer 7

• the submandibular is located below the body of the mandible and above the hyoid bone
• palpate to feel for irregularities such as salivary stones
• if unsure, compare to the opposite side

Question 8

How do you examine the cervical lymph nodes?

Answer 8

• ask the patient to turn away from you so that the sternocleidomastoid protrudes
• palpate fingers along the neck

Question 9

How do you examine the submandibular lymph nodes?

Answer 9

• they sit superficial to the submandibular salivary gland so palpate these together
• palpate under the mandible

Question 10

How do you examine the submental nodes?

Answer 10

• tip patients head forwards

- palpate the nodes by rolling you fingers over the lower border of the anterior mandible

Question 11

What is the best order for intra-oral examination?

Answer 11

• mucosa and gingiva working clockwise
• dorsal of the tongue
• lateral borders of the tongue
• ventral tongue
• floor of the mouth
• palate and tonsils