The nose.

The paranasal
sinuses .The oral cavity ,
the tongue, the gullet,
the lips, the oral mucosa.
The palate, the tongue
and the oral cavity base.
The nose and paranasal sinuses
ANATOMY AND PHYSIOLOGY.
Approximately the upper third of the nose is
supported by bone, the lower two thirds by
cartilage. Air enters the nasal cavity by way of the
anterior naris on either side, then passes into a
vestibule and the narrow nasal passage to the
nasopharynx.
ANATOMY AND PHYSIOLOGY
 The medial wall of each nasal cavity is formed by the
nasal septum, which, is supported by both bone and
cartilage. It is covered by a mucous membrane well
supplied with blood. The vestibule, is lined with hair-
bearing skin.

 Laterally, Curving bony structures, the turbinates ,

covered by a highly vascular mucous membrane
,protrude into the nasal cavity. Below each turbinate is a
groove, or meatus, each named according to the
turbinate above it. The nasolacrimal duct drains into the
inferior meatus; most of the paranasal sinuses drain into
the middle meatus.

 The additional surface area provided by the turbinates

and the mucosa covering them aids the nasal cavities in
their principal functions: cleansing, humidification, and
temperature control of inspired air.
 The Paranasal Sinuses
The paranasal sinuses are air-filled cavities within
the bones of the skull. They are lined with mucous
membrane. Only the frontal and maxillary sinuses
are readily accessible to clinical examination
Techniques of Examination
Inspect the anterior and inferior surfaces of the nose. Gentle
pressure on the tip of the nose with your thumb usually widens the
nostrils and, with the aid of otoscope light, you can get a partial
view of each nasal vestibule.
Note any asymmetry or deformity of the nose.

Test for nasal obstruction, by pressing on each nasi in turn and

asking the patient to breathe in.
Techniques of Examination
 Inspect the inside of the nose with an otoscope .Tilt the patient’s
head back a bit and insert the speculum gently into the vestibule of
each nostril. By directing the speculum posteriorly, then upward in
small steps, try to see the inferior and middle turbinates, the nasal
septum, and the narrow nasal passage between them.
Observe the nasal mucosa, the nasal septum, and any
abnormalities. Inspect :
 The nasal mucosa covers the septum and turbinates. Note its
color and any swelling, bleeding, or exudate. If exudate is
present, note its character: clear, mucopurulent, or purulent. The
nasal mucosa is normally redder than the oral mucosa.

 The nasal septum. Note any deviation, inflammation, or

perforation of the septum.

 Any abnormalities such as ulcers or polyps.

Examination of sinuses
Palpate for sinus tenderness. Press up on the
frontal sinuses from under the bony brows. Then
press up on the maxillary sinuses.
MOUTH AND PHARYNX
The lips are muscular folds that surround
the entrance to the mouth. When
opened, the gums (gingiva) and teeth
are visible. Note the scalloped shape of
the gingival margins and the pointed
interdental papillae.

The gingiva is firmly attached to the teeth

and to the maxilla or mandible in which
they are seated. A midline mucosal fold,
called a labial frenulum, connects each
lip with the gingiva.
Adjacent to the gingiva is the alveolar
mucosa, which merges with the labial
mucosa of the lip
The dorsum of the tongue is covered with papillae, giving it a rough
surface. Some of these papillae look like red dots, which contrast
with the thin white coat that often covers the tongue.

The undersurface of the tongue has no papillae. Note the midline

lingual frenulum that connects the tongue to the floor of the
mouth. At the base of the tongue, the ducts of the submandibular
gland (Wharton’s ducts) pass forward and medially. They open on
papillae that lie on each side of the lingual frenulum.
Above and behind the tongue rises an arch formed by the
anterior and posterior pillars, the soft palate, and the uvula.
The pharynx is visible in the recess behind the soft palate and
tongue.

In the adjacent photograph, note the right tonsil protruding

from the hollowed tonsillar fossa, or cavity, between the
anterior and posterior pillars.
Buccal mucosa
The buccal mucosa lines the cheeks . Each
parotid duct opens onto the buccal mucosa
near the upper second molar. Its location is
frequently marked by its own small papilla.
Techniques of Examination
Inspect the following:

The Lips. Observe their color and moisture, and note any lumps,
ulcers, cracking, or scaliness.

The Oral Mucosa. Look into the patient’s mouth and, with a good
light and the help of a tongue blade, inspect the oral mucosa for
color, ulcers, white patches, and nodules.
The Gums. The Roof of The Mouth.

The Gums. Note the color of the gums, normally pink.

Inspect the gum margins and the interdental papillae for swelling or
ulceration.
Inspect the teeth. Are any of them missing, discolored, misshapen,
or abnormally positioned . Check for looseness with your gloved
thumb and index finger.

The Roof of the Mouth. Inspect the color and architecture of the
hard palate.
The Tongue and the Floor of the
Mouth.

Ask the patient to put out his or her tongue. Inspect it for
symmetry
test of the hypoglossal nerve (CN XII).

Note the color and texture of the dorsum of the tongue.

Inspect the sides and undersurface of the tongue and the floor of
the mouth, areas where cancer often develops. Note any white or
reddened areas, nodules, or ulcerations.

Palpate any lesions. Ask the patient to protrude the tongue. With
your right hand, grasp the tip of the tongue with a square of gauze
and gently pull it to the patient’s left. Inspect the side of the
tongue, and then palpate it with your gloved left hand, feeling for
any induration. Reverse the procedure for the other side.