Complete_Head_and_Neck_Examination_Expanded 2.pptx

Examination

1. Complete Head and Neck Examination Methods and techniques for a through examination of head and neck regions

2. Introduction Essential for early detection of oral and oropharyngeal cancers Dentists often first to identify suspicious lesions Performed in all patients, especially high-risk groups: tobacco, alcohol, HPV, betel nut Helps in detecting premalignant lesions, malignancies, and metastatic spread

3. General Principles Systematic approach: start extraoral → intraoral Good lighting, gloves, mirror, gauze Inspection, palpation, auscultation if needed Record findings: size, shape, color, surface texture, location Always compare both sides for symmetry

4. Patient History Chief complaint & history of present illness Systemic diseases: HIV, diabetes, immunosuppression Past medical/dental/family history (cancer, radiation therapy) Habits: tobacco (smoked/smokeless), alcohol, betel nut, marijuana Symptoms: non-healing ulcer, persistent sore throat, dysphagia, odynophagia , hoarseness Other red flag symptoms: unexplained weight loss, ear pain, numbne ss

5. Extraoral Examination General observation: facial symmetry, skin lesions, scars Head & scalp: masses, pigmented lesions, ulcerations Eyes: mobility, sclera changes, proptosis Nose & sinuses: obstruction, discharge, swelling Ears: nodules, lesions, parotid swelling TMJ: palpation, movement, tenderness

6. Neck Examination Inspection: asymmetry, swelling, scars, skin changes Palpation of lymph nodes systematically: Level I ( submental , submandibular): metastasis from tongue, lips, floor of mouth Level II (upper jugular): oropharynx, hypopharynx , posterior tongue Level III & IV (mid/lower jugular): larynx, hypopharynx Level V (posterior triangle): nasopharyngeal carcinoma spread Level VI (anterior compartment): thyroid, larynx, cervical trachea Note: size, consistency, mobility, tenderness, fixation

7. Intraoral Examination Lips & labial mucosa: ulcers, fissures, induration Buccal mucosa: leukoplakia, erythroplakia , fibrous bands Tongue: lateral border, ventral surface, dorsum (high-risk areas) Floor of mouth: frequent site for carcinoma Palate: pigmented or ulcerated lesions Gingiva & alveolar ridge: swellings, ulcerations Suspicious features: induration, rolled borders, fixation to deeper tissues

8. Techniques Inspection: mirror, tongue depressor, gauze to manipulate tongue Palpation: bimanual (floor of mouth, submandibular gland) Bidigital palpation: lips, cheeks Indirect mirror exam: oropharynx, tonsils, base of tongue Neck palpation: circular motion, from one side to the other

9. Red Flags in Oncology Non-healing ulcer >2 weeks Persistent white (leukoplakia) or red (erythroplakia) patch Hard indurated mass or rolled border lesion Fixation to deeper tissues Unexplained bleeding or paresthesia Persistent enlarged, non-tender lymph nodes

10. Adjunctive Diagnostic Aids Toluidine blue vital staining Brush biopsy / exfoliative cytology Incisional/ excisional biopsy – gold standard Imaging: CT, MRI, ultrasound, PET scan for staging Velscope /autofluorescence: highlights dysplastic tissues Salivary biomarkers: HPV DNA, p53, cytokines (emerging field)

11. Role of Dentist in Oncology Early detection and timely referral Documentation and structured follow-up Patient education: risk factors, self-examination Oral care during cancer therapy: manage mucositis , xerostomia , osteoradionecrosis prevention Long-term surveillance for recurrence or second primary tumors Collaboration with oncologists and maxillofacial surgeons

12. Conclusion Thorough head and neck exam is mandatory in oncology-focused dental practice Dentists play a crucial role in early detection of oral cancer Recognition of high-risk lesions improves prognosis Collaboration between dentist and oncology team ensures best patient outcomes