Nose, Paranasal Sinuses,

Mouth, and Oropharynx

Chapter 14

Copyright © 2005, Mosby, Inc. All rights reserved.

 Health History: General History
• Present health status
– Chronic illnesses, medications?
– How often brush teeth, floss, toothpaste?
– Dentures or other appliances (how long, care, fit) last
dental visit?
– Bad breath (morning; continue after brushing)?
– Smoke, alcohol (how much)?
• Past medical history: nasal injury or surgery?
• Family history: seasonal allergies?
Copyright © 2005, Mosby, Inc. All rights reserved.
 Problem-Based History:
Nasal Discharge
• When begin, occasionally or constantly,
discharge (color, consistency, odor, side of
nose, other symptoms)?
• Clear drainage: allergies, to what, when
occurs, how long, other symptoms, what
makes worse?
• Anything lessen discharge, treat (drops or
spray), what kind and how often, effective?
Copyright © 2005, Mosby, Inc. All rights reserved.
 Problem-Based History
• Sinus congestion: when begin, constant or
occasionally, lasts how long, symptoms, pain
over sinus, what makes worse?
• What makes better, how treat, effective?
• Nosebleed: first one, how long experiencing,
frequency, last how long, blood thin or clotted,
one side or both, what makes worse, nose dry,
use cocaine?
• What makes better, how treated, effective?

Copyright © 2005, Mosby, Inc. All rights reserved.

 Problem-Based History
• Snoring: partner complain, wake up gasping or
choking, confused, headache when awaken, sleepy
during day?
• Mouth pain
– Location, intensity, how long, intermittent or constant,
interfere with eating, what starts, makes worse or relieves?
– Sores on mouth or lips, painful, had before, how long, how
treated, mouth odor?
– Sores elsewhere (vagina, penis, anus), had STD?
– Sores heal in 2 weeks, mouth areas bleed, swelling or lumps
in mouth, difficulty moving tongue or jaw, discomfort in
throat?
Copyright © 2005, Mosby, Inc. All rights reserved.
 Problem-Based History

• Difficulty swallowing: when noticed; when

occurs; with liquids, solids, tablets; sudden or
progressive onset; makes worse; throat
infections; choke while swallowing; drooling;
what do to relieve?

Copyright © 2005, Mosby, Inc. All rights reserved.

 Problem-Based History:
Sore Throat
• How long, feels like, hurt to swallow, worse
in morning, mouth breathing—difficulty
breathing through nose, associated with
other symptoms, get often, how often?
• Others ill, inhale dust or fumes, air dry,
hoarse?
• What makes better, how long treating,
effective?
Copyright © 2005, Mosby, Inc. All rights reserved.
 Examination Overview:
Nose and Paranasal Sinuses

• Inspect and palpate nose: appearance,

symmetry, discharge, tenderness
• Assess nose for patency
• Inspect internal nasal cavity (mucosa,,
septum)
• Palpate frontal and maxillary sinuses
(tenderness)
Copyright © 2005, Mosby, Inc. All rights reserved.
 Mouth and Oropharynx
• Inspect lips: color, symmetry, moisture,
texture
• Inspect and palpate teeth: condition, color,
surface characteristics, stability, alignment
• Inspect and palpate inner lips and gingiva:
integrity, tenderness, color, moisture
• Inspect buccal mucosa, anterior and
posterior pillars: color surface
characteristics
Copyright © 2005, Mosby, Inc. All rights reserved.
 Mouth and Oropharynx

• Inspect tongue: movement, color, surface

characteristics
• Palpate tongue: texture
• Inspect lateral surfaces of tongue: color,
surface characteristics
• Inspect palate and uvula: texture, color,
surface characteristics
Copyright © 2005, Mosby, Inc. All rights reserved.
 Mouth and Oropharynx

• Inspect soft palate: movement

• Inspect posterior wall of pharynx and
tonsils: color, surface characteristics

Copyright © 2005, Mosby, Inc. All rights reserved.

 Age-Related Variations:
Older Adults:
Anatomy and Physiology
• Tongue: fissured; altered motor function
increases swallowing difficulties
• Papillae: atrophy or decrease leads to
decreased taste
• Body heals slower: increased risk of
infection of oral cavity

Copyright © 2005, Mosby, Inc. All rights reserved.

Age-Related Variations: Older
Adults:
Health History
• Taking medications that make mouth
dry; nose dry; what doing about it?
• Teeth or dentures: interfere with eating
and chewing; able to chew desired food
• Problems swallowing, food stick in
throat?

Copyright © 2005, Mosby, Inc. All rights reserved.

 Age-Related Variations:
Older Adults
• Examination procedures and techniques
• If have dentures or appliances, examined
with and without
– May be sensitive to oral examination (especially
if removed)
– Reassure that assessment of proper fit and
gums necessary
• Exam same as for adult

Copyright © 2005, Mosby, Inc. All rights reserved.

 Age-Related Variations: Older
Adults Normal and Abnormal
Findings
• Lip surface: deep wrinkles or fissures (perleche)
over closure of mouth from vitamin deficiency
• Increased risk to squamous cell carcinoma of lip
• Gums: recede causing teeth to appear longer;
become friable, causing bleeding
• Teeth: darkened; edentulous or have
caps/bridges; occlusion surfaces worn down;
malocclusion secondary to teeth migration
Copyright © 2005, Mosby, Inc. All rights reserved.