Examination of throat

EXAMINATION OF HEAD & NECK

1. Examination of Throat Oral Cavity, Oropharynx, Laryngopharynx, Larynx

2. General Physical Examination Mental state Consciousness Built and nutrition Attitude and Gait Facies Pallor – palmar creases, mm lips cheeks, conjuctiva, nail beds Cyanosis – tongue (central), nail bed , tip of nose, palmar skin Jaundice – sclera, nail bed , ear lobule, tip of nose Skin eruptions – macules ( change in skin colour), papules , vesicles, pustules (solid projections) Neck nodes

3. Vitals Pulse – pulse rate, rhythm (regular, irregular) Respiratory rate – fast, slow Temperature – continous ( fluctuates less than 1 deg), remittent ( fluctuates more than 2 deg), intermittent Blood Pressure

4. Local Examination Examine the affected region Inspection Palpation Movements Measurements’ LYMPH NODES General Examination- Cranial Nerves, Respiratory CVS for surgery purpose

5. Oral Cavity Parts

6. Inspection Mouth opening – normal 2 to 5 cm between incisors Restricted – trismus , dislocation, arthritis Lips - ulcer, colour change, swelling, scar, thickening, cracked lips (cold) Tongue - Volume ( macroglossia ), colour, cracks or fissures, swelling , ulcer (dental – margins, malignant – margins ), lingual thyroid ( swelling at foramen caecum ), mobility (tongue tie, malignancy) Buccal mucosa – colour, ulcer, scars, opening of parotid duct (upper 2 nd molar) Hard Palate – perforation, swelling, ulcer, scar, cleft, bulge, high arched palate (mouth breathers)

7. Teeth – loose, caries, abscess Gums – colour , swelling, ulcer Floor of mouth – sweling , ranula , dermoid , submandibular duct opening

8. Palpation Cyst, swelling, thickening Malignant – hard, benign – firm Ulcer Abscess Lymph nodes Bimanual palpation – floor of mouth

9. Oropharynx

10. Base of tongue, vallecula – IDL, palpation( ulcer, swelling) Anterior pillar – congestion, oedema , ulcer Posterior pillar Tonsil – size, congestion, ulcer, abscess, membrane Palpation – hard ( tonsillolith , malignancy), on squeezing – pus (acute), cheesy material (chronic)

11. Post Pharyngeal wall – congestion, discharge, ulcer, bulge (Abscess) Soft Palate – congestion, ulcer, movement Gag reflex Bimanual palpation- styloid Pulsation – ICA anuerysm Uvula – bifid ( submucus cleft) X CN palsy – deviation of soft palate and uvula to healthy

12. Larynx and Laryngopharynx External examination (NECK) Inspection Broadening, thickening, redness, position, movement on deglutition and breathing Palpation Laryngeal crepitus ( move side to side), tenderness ( perichondritis ) Scars, Neck nodes Auscultation – vascular swelling, stridor Voice

13. Indirect Laryngoscopy

14. Post one third tongue Lingual tonsils Vallecula Glosso epiglottic folds Epiglottis True v.c False v.c Arytenoids Rings of trachea Redness , swelling, ulcer ,

15. Movement of vocal cords Ee , ah ( adduction), breathe quietly (abduction)

16. Laryngopharynx Pyriform Fossa – on either side of aryepiglottic folds Pooling of saliva – obstruction to swallowing at level of upper oesophagus Post cricoid malignancy Ulcer, swelling

17. Examination of Ulcer Ulcer – Break in the continuity of covering epithelium (skin, mucous memb ) Inspection Site – malignant ulcer in oral cavity, larynx Size and shape – tubercular (oval), malignant (irregular), size both horizontal and vertical Number Position and extent Edge – tubercular (undermined), carcinoma ( everted ), inflamed in spreading ulcer, bluish in healing ulcer Floor – exposed surface ( discharge, slough) Surrounding area – red and oedematous (inflammation )

18. Palpation Tenderness Margins ( between normal epithelium and ulcer) Edge (between margin and floor) Hardness ( induration ), thickening (chronic) Base (on which ulcer rests) Floor (exposed surface) Depth of ulcer Bleeding Relation with deeper structures (Fixed – malignancy)

19. Examination of Neck Swelling Reactive nodes (MC) Age – sternomastoid tumour (newborn), malignancy Duration Mode of onset – sudden, gradual Pain Progress Site at which started Associated symptoms – weight loss, appetite, voice change, dysphagia , resp distress Fever Recurrence Habits Family history

20. Examination - Inspection Site Number Size Extent – ant to post, med to lat, sup to inf Colour (blue- ranula ) Surface (irregular – malignancy, smooth – cyst) Skin over swelling – colour , ulcer, scar Edge – smooth(benign), irregular – malignancy) INSPECTION ALWAYS FROM FRONT

21. PALPATION ALWAYS FROM BEHIND. NECK FLEXED Surface – smooth, irregular Fixation of skin – malignancy, seb cyst Edge – irregular, smooth and well defined (benign) Pulsations – vascular tumours ( CB, aneurysms) Temperature Tenderness Consistency – soft, hard Reducibility – totally disappears ( meningocele ) Compressibility- haemangiomas Relation to Sternocleidomastoid - superficial, deep Translucency – any fluid ie lymph, water (cystic hygroma ) Mobility

22. Movements Impulse on coughing – if swelling in continuity with cranial or spinal cavity – meningocele Movement on deglutition – if fixed to larynx or trachea – thyroid Movement on protrusion of tongue – thyroglossal cyst MEASUREMENTS – size both vertical and horizontal diameter Percussion – Laeyngocele (tympanic note) Auscultation – bruits and murmurs (vascular swellings) EXAMINATION OF LYMPH NODES

23. EXAMINATION OF LYMPH NODES

24. Upper horizontal- submental , submandibular , parotid, occipital, pre and post auricular Lateral cervical – sup or deep to sternocleidomastoid Sup – ext jugular, deep – int jugular (upper, middle, lower) Supraclavicular Anterior cervical – pretracheal , prelaryngeal

25. Location Laterality Number Consistency – hard, rubbery, soft Discrete or matted Tender Fixation to skin, deeper structures Mobility (both transverse and vertical planes) Surface