Mouth AND Oropharynx - HEALTH ASSESSMENT RLE PDF

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Summary

MOUTH AND OROPHARYNX The mouth and oropharynx are composed of a number of structures: lips, oralmucosa, the tongue, and floor of the mouth, teeth, gums, hard and soft palate, uvula, salivary glands, tonsillar pillars, and tonsils The mouth is the beginning of the digestive tract and serves as an a...

Description

MOUTH AND OROPHARYNX  The mouth and oropharynx are composed of a number of structures: lips, oral mucosa, the tongue, and floor of the mouth, teeth, gums, hard and soft palate, uvula, salivary glands, tonsillar pillars, and tonsils 

The mouth is the beginning of the digestive tract and serves as an airway for the respiratory tract. The upper and lower lips forms entrance to the mouth, serving as a protective gateway to the digestive and respiratory tracts. The roof of the oral cavity is formed by an anterior hard palate and the posterior soft palate. An extension of the soft palate is the uvula, which hangs in the posterior midline of the oropharynx. The cheeks form the lateral walls of the mouth, whereas the tongue and its muscles form the floor of the mouth. The mandible provides structural support for the floor of the mouth.

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The throat (pharynx), located behind the mouth and nose, serves as muscular passage for food and air. The upper part of the throat is the nasopharynx. Below the nasopharynx lies the oropharynx, and below the oropharynx lies the laryngopharynx. The soft palate, anterior and posterior pillar, and uvula connect behind the tongue to form arches.

NASOPHARYNX This portion of the pharynx begins at the back of the nasal cavity, situated behind the nose and above the soft palate. Unlike the other two portions of the pharynx, the nasopharynx remains open all the time. On each lateral wall is the pharyngeal opening of the Eustachian (auditory) tube. The nasopharynx functions as an airway in the respiratory system. Also contained within the nasopharynx are the adenoids, or pharyngeal tonsils. OROPHARYNX The oropharynx is the middle portion of the pharynx, working with both the respiratory and digestive systems. It opens anteriorly in the mouth and extends from the soft palate to the hyoid. In each lateral wall is a palatine tonsil; also in this region are the sublingual tonsils, which are under the tongue. The oropharynx functions as an airway and as part of the alimentary canal. LARYNGOPHARYNX The laryngopharynx is where both food and air pass. It can be found between the hyoid bone and the larynx and esophagus, which helps guide food and air where to go. It is a part of the pharynx.

Humans are born with four types of tonsils: the pharyngeal tonsil, two tubal tonsils, two palatine tonsils and the lingual tonsils.

1. Inspect the outer lips for symmetry of contour, color and texture. Ask the client to purse the lips as if to whistle. NORMAL FINDINGS:  

Lips are smooth and moist without lesions or swelling. Pink lips are normal in light skinned clients, as are bluish or freckled lips in some darkskinned patients, especially those of Mediterranean descents.

ABNORMAL FINDINGS: 

Pallor around lips (circumoral pallor) is seen in anemia and shock. Bluish (cyanotic) lips may result from cold or hypoxia. Reddish lips are seen in clients with ketoacidosis, carbon monoxide poisoning, and chronic obstructive pulmonary disease (COPD) with polycythemia. Swelling in the lips (edema) is common in local or systemic allergic or anaphylactic reactions. Inability to purse lips may indicate facial nerve paralysis.

Diabetic ketoacidosis is a serious complication of diabetes that occurs when your body produces high levels of blood acids called ketones. The condition develops when your body can't produce enough insulin. ABNORMALITIES Angular cheilitis, 

also known as angular stomatitis and perlèche, causes swollen, red patches in the corners on the outside of your lips. Angular cheilitis can occur on one or both sides of your mouth. It’s an inflammatory condition that can either last a few days or be a chronic problem. It can affect people of all ages, including infants.

LIP CANCER 

Lip cancer is a form of head and neck cancer that starts in the squamous cells of the lips and mouth. Early signs can include a sore or lump that does not heal on the lips or in the mouth.

2. Inspect and palpate the inner lips and buccal mucosa for color, moisture, texture and the presence of lesions. BUCCAL MUCOSA  is the lining of the cheeks and the back of the lips, inside where they touch the teeth .

NORMAL FINDINGS  Uniform pink color (freckled brown pigmentation in dark-skinned clients)  Moist, soft, and soft, glistening, and elastic texture (drier oral mucosa in older clients due to decreased salivation)  The buccal mucosa should appear pink in light-skinned clients: tissue pigmentation typically increases in dark skinned clients, which may include freckling or dark pigmentation on ventral surface of tongue and floor of mouth; hard and soft alate may also be darkly pigmented.  In all clients, tissue is smooth and moist without lesions. ABNORMAL FINDINGS:  Leukoplakia (chalky white raised patches) may be seen in chronic irritation, heavy smoking, and alcohol use. These are precancerous lesions and should be referred to the client’s primary health care provider for further assessment.  Whitish, curd-like patches that scrape off over reddened mucosa and bleed easily indicate “thrush” (Candida albicans) infections. Thrush is a fungal (yeast) infection that can grow in your mouth, throat and other parts of your body.  Koplik spots (tiny whitish spots that lie over reddened mucosa) are an early sign of the measles.  Canker sores may be seen  Brown patches inside the cheeks of clients with Adison disease (chronic adrenocorticortical insufficiency) Addison's disease, also called adrenal insufficiency, is an uncommon disorder that occurs when your body doesn't produce enough of certain hormones. 3. Inspect the teeth and gums while examining the inner lips and buccal mucosa. NORMAL FINDINGS: 

32 pearly whitish teeth with smooth surfaces and edges. Upper molars should rest directly on the lower molars and the front upper incisors should slightly override the

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lower incisors. Some clients normally have only 28 teeth if the four wisdom teeth do not erupt. No decayed areas; no missing teeth Client may have appliances on the teeth (e.g., braces). Client may have evidence of repair work done on teeth (fillings, crowns, or cosmetics such as veneers. Jaws are aligned with no deviation seen with biting down Colors and consistency of tissues along cheeks and gums are even.

ABNORMAL FINDINGS: 

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Clients who smoke, drink large quantities of coffee or tea, or have an excessive intake of fluoride may have yellow or brownish teeth. Tooth decay (caries)may appear as brown dots or cover more extensive areas of chewing as surfaces. Missing teeth can affect chewing as well as self-image. A chalky white area in the tooth surface is a cavity that will turn darker with time. Malocclusion of teeth is seen when upper or lower incisors protrude. A malocclusion is a misalignment or incorrect relation between the teeth of the upper and lower dental arches when they approach each other as the jaws close Poor occlusion of teeth can affect chewing, wearing down of teeth, speech, and selfimage. Brown or yellow stains or white spots on teeth may result from antibiotic therapy or tooth trauma. Receding Gums, receding gums are a condition in which your gums pull back from the tooth surface, exposing the root surfaces of your teeth.

ABNORMALITIES: GINGIVITIS  Gingivitis means inflammation of the gums, or gingiva. It commonly occurs because a film of plaque, or bacteria, accumulates on the teeth. Gingivitis is a non-destructive type of periodontal disease, but untreated gingivitis can progress to periodontitis. Periodontitis is a severe gum infection that can lead to tooth loss and other serious health complications. This is more serious and can eventually lead to loss of teeth. 4. Inspect the dentures. Ask the client to remove complete or partial dentures. Inspect their condition, noting in particular broken or worn areas. NORMAL FINDINGS:  Smooth, intact dentures ABNORAML FINDINGS:

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Ill-fitting dentures; irritated and excoriated area under dentures.

ABNORAMALITIES: DENTURE-INDUCE HYPERPLASIA 

Denture-induced fibrous hyperplasia (DIFH) is a persistent lesion caused mostly by the prolonged wear of an ill-fitting, over-extended denture.

5. Inspect the surface of the tongue for position, color, and texture. Ask the client to protrude the tongue and to move it from side to side. NORMAL FINDINGS:    

Central positions Pink color (some brown pigmentation on tongue borders in dark-skinned clients); moist: slightly rough: thin whitish coating Smooth, lateral margins; no lesions Raised papillae (taste buds)

ABNORMAL FINDINGS: 

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Deviated from center (may indicate damage to hypoglossal {12 th cranial nerve}; because 12th cranial nerve is responsible for the movement of most of the muscles in your tongue. excessive trembling Smooth red tongue (may indicate iron, vitamin B 12, or vitamin B3 deficiency) Dry, furry tongue (associated with fluid deficit), white coating may be oral yeast infection) Nodes, ulcerations, discolorations, (white or red areas); areas of tenderness Deep longitudinal fissures are seen in dehydration: black hairy tongue seen in conditions causing hyposalivation, heavy smoking, alcohol intake, use of antibiotics that inhibit normal bacteria leading to fungus, use of mouthwashes; also seen with bismuth intake. Raised whitish feathery areas on sides of tongue that cannot be scraped off suggest hairy leucoplakias seen in HIV infection and AIDS.

ABNORMALITIES: Macroglossia 

Macroglossia is a disorder in which the tongue is larger than normal.

CAUSES: 

Macroglossia is most often caused by an increase in the amount of tissue on the tongue, rather than by a growth, such as a tumor.

6. Inspect tongue movement. Ask the client to roll the tongue upward and to move it from side to side.

NORMAL FINDINGS:  Moves freely; no tenderness ABNORMAL FINDINGS: 

Restricted mobility

ABNORMALITIES: Tardive dyskinesia  Tardive dyskinesia is characterized by involuntary and abnormal movements of the jaw, lips and tongue. CAUSE:  Tardive dyskinesia is caused by long-term use of a class of drugs known as neuroleptics. Neuroleptic drugs are often prescribed for management of certain mental, neurological, or gastrointestinal disorders 7. Inspect the base of the tongue, the mouth floor and the frenulum. Ask the client to place the tip of his/her tongue against the roof of the mouth. FRENULUM  The lingual frenulum is a fold of mucus membrane that's located under the center portion of your tongue. Mouth floor  The floor of mouth is a horseshoe-shaped area under the tongue, between the sides of

the lower jawbone (the mandible) NORMAL FINDINGS:  Smooth tongue base with prominent veins  The tongues ventral is smooth, shiny, pink, or slightly pale, with visible veins and no lesions.

ABNORMAL FINDINGS:  Swelling, ulcerations

ABNORMALITIES: Tongue-tie  Also known as ankyloglossia, is a congenital condition (the child is born with it) in which a child’s tongue remains attached to the bottom (floor) of his or her mouth. This happens when the thin strip of tissue (lingual frenulum) connecting the tongue and the floor of the mouth is shorter than normal. The short frenulum can restrict tongue mobility. Ankyloglossia has been associated with difficulties with breastfeeding and problems with speech. 8. Palpate the tongue and floor of the mouth for any nodules, lumps, or excoriated areas. Use a piece of gauze to grasp the tip of the tongue and with the index finger of your other hand, palpate the back of the tongue, its borders, and its base. NORMAL FINDINGS:  No nodules and lumps present  Tongue is pink, moist, a moderate size papilla present. ABNORMAL FINDINGS:  Leukoplakia, persistent lesions, ulcers, or nodules may indicate cancer and should be referred. Induration increases the like hood of cancer. ABNORMALITIES: 

Tongue cancer can occur on the front of the tongue, which is called “oral tongue cancer.” Or it may occur at the base of the tongue, near where it attaches to the bottom of your mouth. This is called “oropharyngeal cancer.” Squamous cell carcinoma is the most common type of tongue cancer.

Causes:  

Smoking and drinking alcohol. Smokers are five times more likely to develop tongue cancer than nonsmokers. Human papillomavirus (HPV), a sexually transmitted disease. ...b

9. Inspect salivary duct openings for any swelling or redness. (NAA KA SA LIKOD) The ducts of the salivary glands allow the passage of salivary juice from the glands to the oral cavity:

parotid duct (Stenson duct): connects the parotid gland to the buccal mucosa, adjacent to maxillary second molar submandibular duct (Wharton duct): connects the submandibular gland to the floor of the mouth NORMAL FINDINGS:  No redness, swelling, pain, or moistness in area. Fordyce spots or granules, yellowishwhitish raised spots, are normal ectopic sebaceous glands.  Fordyce spots are whitish-yellow bumps that can occur on the edge of your lips or inside your cheeks. ABNORMAL FINDINGS:  Lesions, ulcers, nodules, or hypertrophied duct openings on either side of frenulum ABNORMALITIES: Sialolithiasis  occurs when stones made of calcium form in the salivary glands. These stones can block the glands, and that can partially or completely stop the flow of saliva. Sialadenitis (or sialoadenitis)  is an infection involving a salivary gland. It often results from stones blocking the gland. Staph or strep bacteria can cause this infection. Older adults and infants are most likely to develop this condition. 10. Inspect the hard and soft palate for color, shape, texture, and presence of bony prominences. Ask the client to open mouth wide and tilt head backward. Then, depress tongue with tongue blade as necessary, and use a penlight for appropriate visualization. NORMAL FINDINGS:  Light pink, smooth, soft palate  Lighter pink hard palate, more irregular texture  The hard palate is pale or whitish with firm, transverse rugae (wrinkle-like folds) ABNORMAL FINDINGS:  A candida infection may appear as thick white plaques on the hard palate. Deep purple, raised or flat lesions may indicate a Kaposi Sarcoma Kaposi sarcoma (KS) is a cancer that causes patches of abnormal tissue to grow under the skin, in the lining of the mouth, nose, and throat, in lymph nodes, or in other organs. These

patches, or lesions, are usually red or purple. They are made of cancer cells, blood vessels, and blood cells  A yellow tint to the hard palate may indicate jaundice because bilirubin adheres to elastic tissue (collagen). An opening in the hard palate is known as a cleft palate  Bilirubin (bil-ih-ROO-bin) is a yellowish pigment that is made during the normal breakdown of red blood cells. 11. Test CN IX and CN X: assess tongue strength by asking client to press tongue against tongue blade. Cranial Nerves IX and X Glossopharyngeal & Vagus Nerves  Ask patient to open mouth and say “ah” while you depress the tongue with a tongue blade.  The motor division of CN 9 & 10 is tested by having the patient say "ah" or "kah". The palate should rise symmetrically and there should be little nasal air escape. With unilateral weakness the uvula will deviate toward the normal side because that side of the palate is pulled up higher. With bilateral weakness neither side of the palate will elevate and there will be marked nasal air escape. NORMAL FINDINGS: 

The tongue offers strong resistance

ABNORMAL FINDINGS: 

Decreases tongue strength may occur with a defect of the 12 th cranial nervehypoglossal- or with a shortened frenulum that limits motion.

12. Inspect the uvula for position and mobility while examining the palates. To observe the uvula, ask the client to say, “ahh” so that the soft palate rises. UVULA  a fleshy extension at the back of the soft palate which hangs above the throat.  It stops food and liquid from entering your nasal cavity as it and the soft palate move upward when you swallow  It helps in your ability to speak  It stops you from choking as it triggers your gag reflex should a large piece of food or foreign object get to the back of your throat NORMAL FINDINGS:  Positioned in midline of soft palate, rises during vocalization.  The uvula is a flesh, solid structure that hangs freely in the midline. No redness of or exudate from uvula or soft palate. Midline elevation of uvula and symmetric elevation of the soft palate.

ABNORMAL FINDINGS:  Deviation to one side from tumor or trauma; immobility (may indicate damage to trigeminal [5th cranial nerve] nerve or vagus [10th cranial nerve])  Asymmetrical movement or loss of movement may occur after a cerebrovascular accident (stroke). Palate fails to rise and uvula deviates to normal side with cranial nerve 10 (vagus) paralysis. 13. Inspect the oropharynx for color and texture. Inspect one side at time to avoid eliciting the gag reflex. To expose one side of the oropharynx, press a tongue blade against the tongue on the same side about halfway back while the client tilts head back and opens mouth wide. Use a penlight for illumination, if needed. NORMAL FINDINGS:  Pink and smooth posterior wall.

ABNORMAL FINDINGS:  Reddened or edematous; presence of lesions, plaques, or drainage 14. Inspect the tonsils for color, discharge, and size. Humans are born with four types of tonsils: the pharyngeal tonsil, two tubal tonsils, two palatine tonsils and the lingual tonsils. NORMAL FINDINGS:    

Tonsils may be present or absent. Pink and smooth No discharge Of normal size or not visible Grade 1 (normal): The tonsils are behind the tonsillar pillars (the soft structures supporting the soft palate) ABNORMAL FINDINGS:  Tonsils are red, enlarged (to 2+, 3+, or 4+) and covered with exudate in tonsilitis. They also maybe indurated with patches of white or yellow exudate Grade 2; the tonsils are between the pillars and the uvula Grade 3: The tonsils touch the uvula Grade 4: One or both tonsils extend to the midline of the oropharynx ABNORMALITIES:  Acute tonsillitis: A bacteria or virus infects the tonsils, causing swelling and a sore throat. The tonsil may develop a gray or white coating (exudate).  Tonsilloliths (tonsil stones): Tonsil stones, or tonsilloliths, are formed when trapped debris hardens, or calcifies

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Peritonsillar abscess: An infection creates a pocket of pus next to the tonsil, pushing it toward the opposite side. Peritonsillar abscesses must be drained urgently.

15. Test CN X: Elicit the gag reflex by pressing the posterior tongue with a tongue blade. The gag reflex, also known as the pharyngeal reflex, is a reflex contraction of the muscles of the posterior pharynx after stimulation of the posterior pharyngeal wall, tonsillar area, or base of the tongue. The gag reflex is believed to be an evolutionary reflex that developed as a method to prevent the aspiration of solid food particles. It is an essential component of evaluating the medullary brainstem and plays a role in the declaration of brain death. The gag reflex tests both the sensory and motor components of CN 9 & 10. This involuntary reflex is obtained by touching the back of the pharynx with the tongue depressor and watching the elevation of the palate. NORMAL FINDINGS: • Gag reflex present ABNORMAL FINDINGS:  • Absent gag reflex - may indicate problems with glossopharyngeal (ninth cranial) or vagus (tenth cranial) nerve

16. Assess CN VII and CN IX: have the client close her eyes. Check taste by placing salt, sugar, and lemon on tongue. NORMAL FINDINGS: 

The client can distinguish between sweet and salty

ABNORMAL FINDINGS: 

Loss of taste discrimination occurs with trauma, viral infections, sinusitis and polyposis, increasin...