Extraoral Exam

Question 1

Extraoral Head and Neck Examination

What is is?
A physical examination technique consisting of:
A ___ ____ ____ of the skin of the head and neck
_____ of the lymph nodes, salivary glands, thyroid, and TMJ
Thorough and accurate _____ of findings.

Answer 1

systematic visual inspection
Palpation
documentation

Question 2

When do I preform a extra oral screening

Answer 2

Annually or more often if needed

Question 3

EXTRAORAL: Keys to Effective Examination

Answer 3

• Thorough Examination
• Consistent Sequence to include all structures
• Good Palpation technique
• Careful Documentation of all findings

Question 4

***Never palpate prior to __ ____

Answer 4

visual examination

Question 5

Document findings utilizing ____/_____

Answer 5

lesion/descriptors

Question 6

Correct Palpation Technique

Answer 6

Circular palpation. Light to firm pressure

Question 7

***What are Compression Techniques

Answer 7

To detect abnormalities such as swelling, tumors, enlarged lymph nodes, structure must be compressed :

• Against a firm structure
• or between the examiners fingers

Question 8

Compression between fingers of one hand

Answer 8

Bi-digital palpation

Question 9

Compression between fingers of both hands

Answer 9

Bi manual palpation

Question 10

Compression against underlying structure /compression over underlying structure

Answer 10

Digital palpation

Question 11

Descriptors of Head and Neck Findings Detected by Palpation

Answer 11

Surface: Smooth or rough/flat/raised knob/lump/swelling
Shape: Irregular/round/oval
Consistency:Firm/Hard/Spongy
Mobility: Mobile or Fixed
Tennderness: Amount of tenderness if any experienced by the patient whe the structure is palpated

Question 12

Four Subgroups of Head and Neck Exam

Answer 12

1. Overall appraisal of head, neck, face, skin
2. Lymph nodes of head and neck
3. Salivary and thyroid glands
4. TMJ

Question 13

Overall Appraisal of Head, Neck, Face, Ears, Skin

Position patient in upright position, supporting his or her own head
___ ___ and ____ for performing procedure to patient, answer any questions and secure consent

Remove eyeglasses, hat, visor, scarf, headphones, etc.

Patient napkin is placed ___ _____ of head and neck exam.

Unobtrusively inspect skin and symmetry of face and neck

Answer 13

Explain procedure and rationale

upon completion

Question 14

Normal Findings

• Face and neck appear ___
• Skin is ___ and ___ in color
• Even ____ of hair on scalp

Answer 14

symmetrical
intact and uniform
distribution

Question 15

Is documentation required for findings within normal limits for Extra oral

Answer 15

No

Question 16

Notable Findings

Answer 16

• Lesions or color changes of the skin
• Uneven patterns of hair loss
• Masses in the neck
• Wounds, bruises, scars
• Swelling of face or neck
• Asymmetry of face or neck

Question 17

How to document notable findings

Answer 17

Location
Discriptors( shape, borders,color,size)
Duration
follow up questions

Question 18

***Request the following information for follow up on findings

Answer 18

• Has it always looked like this or has it changed over time? Include size, shape, texture, color.

-Does it hurt or how do you know that it is there? If yes, when does it hurt? What makes it hurt?

Question 19

Lymphatic System

Answer 19

A network of lymph nodes connected by lymphatic vessels

-plays a role in defense against infection

Question 20

Bean Shaped structures that filter and trap bacteria, fungi, viruses, and waste

Answer 20

Lymph nodes

Question 21

400- ___ lymph nodes in the body

Answer 21

700

Question 22

170- ___ lymph nodes in neck

Answer 22

200

Question 23

Normal healthy lymph nodes can or can not be felt

Answer 23

can not

Question 24

Enlarged lymph nodes

Answer 24

Lymphadenopathy

Question 25

Infected lymph nodes will have 6 qualities

Answer 25

- Swollen, feels a bit like a grape - firm - tender - enlarged - bilateral swellin - freely moveable

Question 26

Malignant Lymph Nodes

Answer 26

- Enlarged - Firm - Non-tender-***Painless - Matted-stuck to each other-bundle of grapes - FIXED to underlying tissue - Unilateral (enlarged on only one side of head or neck)

Question 27

Correct Palpation Technique: Use the fingertips to ________________, using a circular motion. ALWAYS ____ PRIOR to _____

Answer 27

compress the structure against the underlying tissues Always look prior to palpating

Question 28

something to remember before palpating postauricular nodes

Answer 28

move ear and visual

Question 29

Occipital

Answer 29

- Always look prior to palpating - Visually inspect head, scalp, and ears from behind patient - Have patient lift hair so neck is visible - Begin at midline of neck and palpate along hairline - **Use CIRCULAR MOTION TO COMPRESS tissues against the underlying bone

Question 30

located on the surface of the masseter muscle between the ear and jaw

Answer 30

Parotid glands

Question 31

sit below the jaw toward the back of the mouth

Answer 31

Submandibular glands

Question 32

located under the tongue, beneath the mucous membrane of the floor of the mouth

Answer 32

Sublingual glands

Question 33

An enlarged thyroid gland

Answer 33

goiter

Question 34

Sits below the larynx (voice box) | Sits over the trachea and just above the clavicles

Answer 34

Thyroid

Question 35

Salivary glands: NOTABLE FINDINGS

Answer 35

- Palpable gland (healthy gland cannot be felt) - swollen or enlarged - Firm, hard consistency - Tender to palpation

Question 36

THYROID GLAND NOTEABLE FINDINGS

Answer 36

- Palpable gland (healthy gland cannot be felt) - Deviates from midline of neck - Asymmetrical lobes - Enlarged lobes nodules present hard, firm consitency - fixed to underylying sturcutres

Question 37

Crepitus means

Answer 37

clicking

Question 38

TMJ NOTable findings

Answer 38

- Abnormal sounds - Asymmetrical movements - Tenderness or pain - Limited opening adequte range of motion. patients fingers