Mariel Garza Rodríguez A01193056

OBSERVATION TECHNIQUE

SKIN • General appearance of Analyze the skin through

individual observation
• Rashes, sores or ulcerations
must not be present
• Change in color of the skin may
lead to anemia and jaundice
• Yellowness of skin is
carotenemia
• Check texture of skin (dry,
greasy or inelastic)
• Skin may get atrophied with age
or steroid medications
• Also note for eruptions,
erosions, pigmentations or
swelling or edema

HEAD • Check for head region for • Cephalic index: maximum skull
appearance and circumference width / maximum skull length
• Mesocephalic: Avg. shape of
head (76-80.9)
• Dolicocephalic: Long and
narrow head. (less than 75.9)
• Brachycephalic: Broad and
short head. (81-85.4)
• Hyperbrachycephalic: Extremely
wider head. (more than 85.5)

FACE -Straight profile Visualizing the patient from the

-Convex profile: Seen in a
prognathic maxilla or a
retrognathic mandible
-Concave profile: Associated with
a prognathic mandible or a
retrognathic maxilla
side.
-Straight profile: An imaginary line
is drawn from the forehead to the
upper lip and another line from
the upper lip to the anterior point
of chin. Both lines when joined
form a nearly straight line.
-Convex profile: The two
imaginary lines form an angle with
the concavity facing the tissue.
-Concave profile: The two
imaginary lines form an angle with
the convexity toward the tissue.

LIPS Examine the lips and the mucosa Labial mucosa: Gently turning the
inside the lips called labial lip out
mucosa.
Labial mucosa: wet and shiny
Note the lip color, texture and any
surface abnormalities as well as
angular or vertical fissures, sores,
ulcers, nodules, plaques, scars
and swellings. Also vermillion
border and presence of Fordyce´s
granules.
-Note lip posture (way in which an
individual maintains his/her
normal lip position in repose)
Mariel Garza Rodríguez A01193056
CHEEKS Note any changes in pigmentation Gently open patient´s mouth and
and linea alba, any hyperkeratotic with wood stick examine the
or any hyper pigmented patch,
swellings, nodules, scars or ulcers
LYMPH NODES • Location of nodes
• Number of nodes
• Size of nodes: (Abnormal
greater than 1.5 cm in jugulo-
digastric area and greater
than 1cm elsewhere
• Consistency (metastatic
nodes are hard; lymphoma
nodes are firm and rubbery;
hyperplastic nodes are soft,
also nodes of metastatic
melanoma are soft
• Discrete or matted nodes
• Tenderness = inflamed
• Fixity to overlying skin or
deeper structures.
• Mobility should be checked
both in the vertical and
horizontal planes
If node palpable, record:
• Site
• Size (vernier)
• Texture: Soft (infection),
rubbery hard (Hodgkins),
stony hard (secondary
carcinoma)
• Tenderness
• Fixation to surrounding
tissues —> metastatic cancer
• Number of nodes
Palpable characteristics : infection
-Acute infection: large, soft,
painful, mobile, discrete, rapid
onset
-Chronic: large, firm, less tender,
mobile
-Lymphoma: rubbery hard,
matted, painless, multiple
-Metastatic cancer: stony hard,
fixed to underlying tissues,
painless
inside of cheeks.
Ask patient to stand and slightly
flex neck.
• Submental nodes: Roll the
fingers below the chin with
patient´s head tilted forward.
• Submandibular nodes: Roll
fingers against inner surface
of mandible with patient´s
head gently tilted on one side
• Parotid Nodes: Roll the finger
in fornt of the ear, against the
maxilla
• Postauricular: Roll the fingers
behind the ear
• Internal Jugular chain:
Examine the upper, middle
and lower groups. Many of
them lie deep to
sternomastoid muscle.
• Transverse Cervical nodes
• Supraclavicular: Roll your
fingers gently behind the
clavicles —> instruct the
patient to cough (normal
lymph node cannot be felt, if a
node is palpable, it must be
abnormal
Mariel Garza Rodríguez A01193056
TMJ Lateral mandibular range of Lateral mandibular range of
movement = 8 - 10mm movement —> ask patient to
Maximum interincisal opening = occlude the teeth and then slide
width of two fingers (less than the jaw in both directions
30mm)
Palpation may be extra-auricular
Note any sounds or intra - auricular
• Clicks: single explosive noise
Disc displacement Crepitus —> listened with a
• Crepitus: Continuous “grating” stethoscope
noise
Caused by the articulatory
surfaces of the joint being worn

MUSCLES Palpation of Patient asked to clench their teeth

• Masseter muscles
• Bimanual palpation of the
master muscles
• Palpation of the lateral
pterygoid muscles
• Palpation of the medial
pterygoid muscle
• Palpation of the temporalis
muscles
• Palpation of the
sternocleidomastoid
• Palpation of the trapezius
muscles
and, using both hands, the
practitioner palpates the masseter
muscles on both sides. Palpate
the origin of the masseter along
the zygomatic arch and continue
to palpate down the body of the
mandible where masseter is
attached
Mariel Garza Rodríguez A01193056
SALIVARY GLANDS Parotitis —> pre auricular
swelling, may not be visible if
deep in the parotid tail or within
the substance of the gland.
Parotid gland:
Lies on the lateral surface of the
mandibular rams and posterior
border of the mandible.
usually soft and not usually
palpable. The secretions are
carried to the oral cavity by
Stensen´s duct, which enters the
oral cavity in the cheek just
opposite the upper second molar
tooth.
-Check swelling over the region.
Note
• Extent
• sise
• shape
• consistency
• Position
Examine the area for any fistula
and enlargement of lymph nodes.
Submandibular gland:
Resides under the inferior border
of the mandibular body
The gland is usually soft and
mobile and should not be tender
to palpation.
The submandibular duct (Wharton
´s) runs superiorly and anteriorly.
-Swelling, nodal swelling, skin
color and dissension of the
mucosa
-Pus when pushing
The sublingual glands lie beneath
the mucosa in the floor of the
mouth and empty directly into the
mouth or into the submandibular
duct.
Gland is not palpable
Initial inspection involves a careful
examination of the head and neck
regions, both intramurally and
extra orally.
Intraorally —> patient should
stand 3 to 4 feet away and directly
facing the examiner. The
examiner should inspect
• Symmetry
• Color
• Possible pulsation
• Discharging of sinuses on
both sides of the patient.
Extra oral palpation of face and
neck: patient´s head is inclined
forward to maximally expose the
parotid and submandibular gland
regions. The examiner may stand
in front of or behind the patient.
Bimanual palpation (extraoral with
one hand, intraoral with the
other). One or two gloved fingers
should be inserted within the oral
cavity to palpate the glands and
main excretory ducts internally,
while using the other hand to
externally support the head and
neck. By rolling the hands over
the glands both internally and
externally.
Parotid gland: retract the cheek
PHYSICAL EXAMINATION
The mayor salivary glands are
best examined by palpation and
by observation of the salivary
effluent during palpation (parotid
glans and submandibular glands)
Parotid gland: Ask patient to
clench his or her teeth together
The submandibular gland: best
palpated bimanually with one
hand in the lateral floor of the
mouth and the other on the
submandibular gland.
Fingers are pushed upward and
palpation is achieved
RX EXAMINATION
-Sialography: injection of contrast
medium into glandular ducts.
Presence of salivary calculus
-Computed tomography: For
parotid and submandibular
glands.
-Magnetic resonance imaging
-Sialendoscopy