Nose, Mouth, and Throat

Nose, Mouth, andThroatNose, Mouth, andThroat

By Orest KornetskyBy Orest Kornetsky

Nose anatomy

Bridge is the superior part (nasal bone)

Tip is the anterior part of nose (cartilage)

Hair – Filter coarse matter from entering nasal cavity

Ciliated mucous membrane filters dust and bacteria. The rich bloodsupply warms and humidifies the air

Turbinates (conchae) increase the surface are of the nasal cavity so thatmore air is filtered, warmed, and humidified

Nose - SinusesNose - Sinuses

Frontal andmaxillary

Which sinuses can

we examine?

Only the ethmoid andmaxillary sinuses arepresent at birth. Frontaldevelop between 7 and 8years. Sphenoid developafter puberty.

Mouth – A & PMouth – A & P

Hard palate – made out of bone (whitish color)Hard palate – made out of bone (whitish color)

Soft palate – made out of muscle (more pink in color)Soft palate – made out of muscle (more pink in color)

Uvula – hangs from middle of soft palateUvula – hangs from middle of soft palate

Tongue – striated muscle assist with mastication and swallowing.Papillae on dorsal surface of tongue hold neurons responsiblefor tasteTongue – striated muscle assist with mastication and swallowing.Papillae on dorsal surface of tongue hold neurons responsiblefor taste

Mouth – SalivaryGlandsMouth – SalivaryGlands

Parotid glandParotid gland

Located superior ofmandibular angleLocated superior ofmandibular angle

Submandibular glandSubmandibular gland

Lies beneath themandibleLies beneath themandible

Sublingual glandSublingual gland

Lies posterior to thetongue at the floor ofthe mouthLies posterior to thetongue at the floor ofthe mouth

Function of the glands is

to secrete saliva

Throat (Pharynx)Throat (Pharynx)

NasopharynxNasopharynx

Located behind the nose, above the softpalateLocated behind the nose, above the softpalate

Contains adenoids (pharyngeal tonsils)Contains adenoids (pharyngeal tonsils)

Eustachian tube opens duringswallowing to equalize pressure withinthe middle earEustachian tube opens duringswallowing to equalize pressure withinthe middle ear

OropharynxOropharynx

Located behind the mouth, below thenasopharynxLocated behind the mouth, below thenasopharynx

Shared passageway for breathing andswallowingShared passageway for breathing andswallowing

Contains palatine tonsils, which guardthe body against microorganismsContains palatine tonsils, which guardthe body against microorganisms

LaryngopharynxLaryngopharynx

Extends from base of tongue to theesophagusExtends from base of tongue to theesophagus

Critical dividing point where solids areseparated from airCritical dividing point where solids areseparated from air

Divides larynx from esophagusDivides larynx from esophagus

(adenoids)

Named according to

location

Developmental Considerations –Infants and ChildrenDevelopmental Considerations –Infants and Children

Children have 20 deciduous (temporary) teeth (compared to theadults’ 32).Children have 20 deciduous (temporary) teeth (compared to theadults’ 32).

Deciduous teeth are lost beginning at 6 years until about 12Deciduous teeth are lost beginning at 6 years until about 12

Developmental Considerations -AgingDevelopmental Considerations -Aging

Nasal hair grow coarser and stiffer and may not filterair as well. Decreased sensation of smell.Nasal hair grow coarser and stiffer and may not filterair as well. Decreased sensation of smell.

Loss of taste due to soft tissue atrophyLoss of taste due to soft tissue atrophy

Decrease in salivary secretionDecrease in salivary secretion

Tooth surface is abraded. Gums begin to recede anderode.Tooth surface is abraded. Gums begin to recede anderode.

Poor oral hygiene may cause tooth loss, which increasethe difficulty of masticationPoor oral hygiene may cause tooth loss, which increasethe difficulty of mastication

Use of medications may have anticholinergic effects,which further decrease salivationUse of medications may have anticholinergic effects,which further decrease salivation

Health HistoryHealth History

Nasal discharge? (rhinorrhea)– Cold, allergies, sinusinfection, traumaNasal discharge? (rhinorrhea)– Cold, allergies, sinusinfection, trauma

Frequent colds? –immunosuppressionFrequent colds? –immunosuppression

Epistaxis (nosebleeds)? –may occur with trauma,irritantsEpistaxis (nosebleeds)? –may occur with trauma,irritants

Allergies?Allergies?

Sores or lesions in mouth ororal cavity? – may bemalignantSores or lesions in mouth ororal cavity? – may bemalignant

Sore throat? – Determine ifbacterial or viral cause. Strepthroat may lead to rheumaticfever. Are tonsils still inplace?

Bleeding gums or toothache?– may indicate poor oralhygiene

Any voice changes?

Dysphagia (difficultyswallowing)? – may becaused by GERD,pharyngitis, neurologicdiseases, cancer.

Assessing the NoseAssessing the Nose

External noseExternal nose

Normal – nose is symmetric, midline,proportionalNormal – nose is symmetric, midline,proportional

Test for obstruction of by blocking each nareand asking the person to inhale with the opennare.Test for obstruction of by blocking each nareand asking the person to inhale with the opennare.

Nasal cavityNasal cavity

Insert otoscope into the nasal vestibule, liftingthe tip of the noseInsert otoscope into the nasal vestibule, liftingthe tip of the nose

Normal – nasal mucosa pink, smooth, andmoistNormal – nasal mucosa pink, smooth, andmoist

Abnormal – note any bleeding, swelling,redness, discharge, foreign bodyAbnormal – note any bleeding, swelling,redness, discharge, foreign body

Rhinitis – mucosa swollen, red, and oftenincludes discharge (watery, thick, purulent,green) in upper resp infectionRhinitis – mucosa swollen, red, and oftenincludes discharge (watery, thick, purulent,green) in upper resp infection

Observe for deviated septum, which is onlysignificant if airflow is obstructedObserve for deviated septum, which is onlysignificant if airflow is obstructed

Observe turbinates for polyps (benigngrowths) – smooth, gray, avascular, mobile,nontenderObserve turbinates for polyps (benigngrowths) – smooth, gray, avascular, mobile,nontender

Assessing the SinusesAssessing the Sinuses

PalpationPalpation

Using thumbs, palpatethe frontal andmaxillary sinusesUsing thumbs, palpatethe frontal andmaxillary sinuses

Tenderness in personswith sinusitis or allergiesTenderness in personswith sinusitis or allergies

TransilluminationTransillumination

Using a pen light in adarkened room, placelight under the superiororbital ridge, inferior tothe frontal sinusesUsing a pen light in adarkened room, placelight under the superiororbital ridge, inferior tothe frontal sinuses

Clear sinuses shouldtransilluminateClear sinuses shouldtransilluminate

Assessing the LipsAssessing the Lips

Black people normally have bluish lipsBlack people normally have bluish lips

What do bluish lips signify in light skinnedpeople?What do bluish lips signify in light skinnedpeople?

Hypoxemia or hypothermiaHypoxemia or hypothermia

Pallor on lips?Pallor on lips?

Anemia, shockAnemia, shock

Cherry red lips?Cherry red lips?

CO poisoning, acidosisCO poisoning, acidosis

Angular cheilitis (inflammation of lips)Angular cheilitis (inflammation of lips)

Painful fissures at corners of mouth caused byCandida infectionPainful fissures at corners of mouth caused byCandida infection

Herpes simplex virusHerpes simplex virus

Mostly HSV-1 virus, possibly HSV-2Mostly HSV-1 virus, possibly HSV-2

Vesicles or pustules, highly contagiousVesicles or pustules, highly contagious

CarcinomaCarcinoma

Mostly crusted or ulceratedMostly crusted or ulcerated

Assessing TeethAssessing Teeth

Teeth normally look white,straight, and free of decay. Inthe back, the upper molarsshould directly rest on the lowermolars. In the front, upperincisors should overlap lowerincisorsTeeth normally look white,straight, and free of decay. Inthe back, the upper molarsshould directly rest on the lowermolars. In the front, upperincisors should overlap lowerincisors

Yellowing as result of tobacco useYellowing as result of tobacco use

Malocclusion – misalignment ofupper and lower teethMalocclusion – misalignment ofupper and lower teeth

Dental carries – tooth decay asresult of acids produced by bacteria“eating” carbohydrates and sugars,destroying enamel.Dental carries – tooth decay asresult of acids produced by bacteria“eating” carbohydrates and sugars,destroying enamel.

Assessing GumsAssessing Gums

Normally the gums look pink,with well defined marginsbetween teeth and gumsNormally the gums look pink,with well defined marginsbetween teeth and gums

Gingival hyperplasia – enlargementof gums. Possible SA of DilantinGingival hyperplasia – enlargementof gums. Possible SA of Dilantin

Gingivitis – redness, swelling, orbleeding of gum margins caused byanaerobic bacteria as a result ofpoor dental hygiene or vitamin Cdeficiency . If disease is untreatedand spreads to bone, the result isperiodontitis (absorption of bone)Gingivitis – redness, swelling, orbleeding of gum margins caused byanaerobic bacteria as a result ofpoor dental hygiene or vitamin Cdeficiency . If disease is untreatedand spreads to bone, the result isperiodontitis (absorption of bone)

Assessing the TongueAssessing the Tongue

Normally the tongue is pink with a rougheneddorsal surface and moist underneathNormally the tongue is pink with a rougheneddorsal surface and moist underneath

Inspect tongue by holding it with cotton gauzepad and moving to each sideInspect tongue by holding it with cotton gauzepad and moving to each side

Tongue AbnormalitiesTongue Abnormalities

Enlarged tongue(macroglossia)Enlarged tongue(macroglossia)

occurs in Down syndrome,acromegaly, cretinism,myxedemaoccurs in Down syndrome,acromegaly, cretinism,myxedema

Fissured tongueFissured tongue

congenital, benign. Mildform may be caused bydehydrationcongenital, benign. Mildform may be caused bydehydration

CandidiasisCandidiasis

White, cheesy, patch onbuccal mucosa or tongueWhite, cheesy, patch onbuccal mucosa or tongue

Occurs after use ofantibiotics, steroids, andimmunosuppression (AIDS)Occurs after use ofantibiotics, steroids, andimmunosuppression (AIDS)

Tongue AbnormalitiesTongue Abnormalities

Atrophic Glossitis (glossy tongue)Atrophic Glossitis (glossy tongue)

surface of tongue is smooth andshiny, burning. Occurs withpernicious anemia (vit B 12deficiency), folic acid deficiency, andiron deficiency anemiasurface of tongue is smooth andshiny, burning. Occurs withpernicious anemia (vit B 12deficiency), folic acid deficiency, andiron deficiency anemia

Black hairy tongueBlack hairy tongue

fungal infection usually due toprolonged antibiotic usefungal infection usually due toprolonged antibiotic use

CarcinomaCarcinoma

common underneath the tonguecommon underneath the tongue

Assessing theBuccal MucosaAssessing theBuccal Mucosa

Normal mucosa looks pink,smooth, and moistNormal mucosa looks pink,smooth, and moist

Inspect by using light and atongue bladeInspect by using light and atongue blade

Note presence of Stensen’sducts (openings of parotidgland) which are inflamedand red with mumpsNote presence of Stensen’sducts (openings of parotidgland) which are inflamedand red with mumps

Koplik’s spots – prodromalsign of measlesKoplik’s spots – prodromalsign of measles

Also notice breath. Fruityodor might indicateketoacidosis.Also notice breath. Fruityodor might indicateketoacidosis.

Assessing the PalateAssessing the Palate

The anterior hard palate is normally filled with irregulartransverse rugaeThe anterior hard palate is normally filled with irregulartransverse rugae

Might appear yellow with jaundice in whites and yellow-brown in blacksMight appear yellow with jaundice in whites and yellow-brown in blacks

The posterior soft palate is pinker, smooth, and upwardmovable. Contains the uvulaThe posterior soft palate is pinker, smooth, and upwardmovable. Contains the uvula

To check for CN X (vagus nerve) reflex, ask person to openmouth and say “ahhhh.” Uvula should move up.To check for CN X (vagus nerve) reflex, ask person to openmouth and say “ahhhh.” Uvula should move up.

Palate AbnormalitiesPalate Abnormalities

Cleft palate is a congenital defect where the maxillaryprocess fails to fuse. This causes a gap in the hardpalate and possibly the upper lip. Surgery required.Cleft palate is a congenital defect where the maxillaryprocess fails to fuse. This causes a gap in the hardpalate and possibly the upper lip. Surgery required.

Assessing the TonsilsAssessing the Tonsils

Normal are pink at the sidesof mouth, barely visibleNormal are pink at the sidesof mouth, barely visible

Inspect by depressing thetongue blade on the tongueInspect by depressing thetongue blade on the tongue

During an upper respiratoryinfection, the tonsils becomebright red, swollen, andmight contain exudateand/or white spotsDuring an upper respiratoryinfection, the tonsils becomebright red, swollen, andmight contain exudateand/or white spots

1+ tonsils visible1+ tonsils visible

2+ tonsils inflamed2+ tonsils inflamed

3+ tonsils touching uvula3+ tonsils touching uvula

4+ tonsils touching each other4+ tonsils touching each other

Question 1Question 1

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