Extraoral examination

Extraoral examination presentation

1. •EXTRA ORAL
EXAMINATION
•STUDENT NAME : FATEMAH IBRAHIM

2. INTRODUCTION :
Clinical examination should begin
with an evaluation of extra oral
structure for abnormalities . The
patient head and neck region
should be examined for any
pathological condition , as well as
the lip , lymph node , salivary
gland , and the articulatory system
which are the TMJ & muscle of
mastication .

3. 1- HEAD , FACE AND NECK
Visually examine the face and neck from the front .
Look for obvious lumps , defects, skin blemishes , moles , gross facial
asymmetry .
To visually examine the neck , ask the patient to tilt the head back slightly to
extend the neck. Any swelling or other abnormalities is clearly seen in this
position
Watch the patient swallow : thyroid swellings move on swallowing .
The patient should be then turn the head , still with the neck extended , first to
the left and the to the right , to allow visual examination of the submandibular
region on each side . Swellings of the sublingual glands , the lymph node and
submandibular gland will be seen .
The neck should then be relaxed to allow bilateral examination of the region to
the parotid gland
Note ; unilateral , bilateral swelling suggest :

4. FACE PROFILE
It is anteroposterior relationship between maxilla and mandible
It is examined by viewing the patient from the side and by adjoining of two reference lines
A- line joining forehead and soft tissue ( upper lip )
B- line joining lip to most anterior part pf chin
Examination of Facal profile is very important because it determines the jaw relation and
occlusion and help in diagnosis gross deviation in maxillao-mandibular relationship .
TYPE OF FACE PROFILE :
I. Normal ( straight profile )
II.Retrognathic ( convex profile )
III.Prognathic (concave profile )

5. FACE SYMMETRY
Facial symmetry determine
about the distortion of the face
in transverse and vertical plane
Type of facial symmetry
( asymmetry and symmetry )
Asymmetry that are gross and
detected easily it should be
recorded
Facial asymmetry cause both
functional as well as esthetic
problem

6. FRONTAL FACIAL ANALYSIS
(i) Vertical proportion (II)Transverse proportion
The ‘rule of fifths’ describes the
ideal transverse proportions of the
face to comprise equal fifths, each
roughly equal to one eye width.
The vertical facial thirds should be
approximately equal, although the
lower facial third may be slightly greater
than the middle third in males

7. 2- LIPS
Visual examination : note muscle tone , any changes in color or texture ,
ulceration , patches , herpetic lesions , angular chelitits .
Note also the competency / incompetency .
Bimanual palpation : palpate for lumps , using thumb and index finger

8. 3- LYMPH NODE
Most lumps nodes should be examined by extra oral , bimanual , palpation from behind the
patient :
Do not extend the neck since sternomastoid must be relaxed . Use the pulp of the finger tips
and try to roll the gland against adjacent harder structures .
If node is palpable , record the :
Site
Size
Texture
Tenderness to palpation
Fixation to sounding tissues
Coalescence
Number of nodes

9. Submental L.N. - tip the head
forward and try to roll the node
against the inner aspect of the
mandible .
Submandibular L.N. - same as
submental , but with the patients
head tipped to the side being
examined
Jugulodigastric L.N. - move the
anterior border of stereo mastoid
back .
Jugulo-omomhyoid L.N - move
the posterior border of
sternomastoid forward .

10. 4-SALIVARY GLAND
A.PAROTID SALIVARY GLAND
View from the front .
The lower part of the ear lobe may be turned
outward if the gland is swollen . Palpate the
glands for enlargement or tenderness .
The gland located mainly distal to the
ascending ramus of the mandible .
B.SUBMANDIBULR SALIVARY GLAND
Bimanual palpation : use index and middle
finger of one hand intra orally and the same
fingers of the other hand extra orally .
Palpate the gland above and below the
mylohyoid.

11. 5- EXAMINATION OF ARTICULATORY SYSTEM
I.Tempromandibualr joints ( TMJ )
Investigate the following :
a.Range of movement
b.Tenderness
c.Sounds
d.Locking
e.Dislocation
II.Muscle of mastication

12. I.RANGE OF MOVEMENT
Measure the maximum pain-free jaw opening ,
then measure the maximum opening possible , at
the central incisor tips .
Identify whether limitation is caused by pain or
physical obstruction .
Observe any lateral deviation .
MANDIBULAR MOVEMENT MAY BE LIMITED BY :
Third molar surgery , local anesthetic injection , fracture of mandible , middle third of face or
zygomatic arch .
Infection , e.g. pericoronitis , pterygomandibular , paraphrngeal space infections , tonsillitis ,
mumps , osteomylaytis .
Tempromandibular joint disorder
Central nervous system disorder , eg. Tetanus , meningitis .
Medication , eg. Phonethiazine group of drugs.
Neoplasm , eg. Nasopharngeal carcinoma.

13. II.TMJ SOUNDS
Clicks are caused by sudden movement of the disc relative to the condyle
50% of the population experience clicking during their life . It is usually of limited duration and if not
causing problems should remains untreated !
Crepitus is a prolonged , continues , grating or crackling noise . It occurs with degenerative disease and
arthritis affecting TMJ .
III.TMJ TENDERNESS
Use bimanual palpation by gently pressing over the lateral aspect of the joint
Follow this by intra- auricular palpation by placing the little fingers into the external auditory meatus and gently
pressing forward

14. IV.TMJ LOCKING
Locking is due to malposition and distortion of the disc , which allows the
condyle to rotate but not to translate . The jaw may open up to 20 mm and the
“ stick “. Rarely , the jaw may open but fail to close easily .
V.DISLOCATION
The condyle is displaced over the articular eminence . This may be caused by
trauma or very rarely on yawning .

15. B.MUSCLE OF MASTICATION
Examine for tenderness :
Muscle should be tested where they attach to bone . The body of a muscle is
not usually tender .
MUSCLE OF MASTICATION :
(i)Masseter :
(ii)Temporalis
(iii)Lateral pterygoid :
(iv)Medial pterygoig :
(v)Occasionally , a more extensive examination may include the sternomastoid ,
trapezius , and digastric muscles .

16. MASSETER MUSCLE
Palpate multiple areas of
the masseter muscle .
It can be located when
patient’s jaw forcibly closed
. The body of masseter can
be palpated with thumb
and index finger .

17. TEMPORALIS MUSCLE
It can be see and readily palpated throughout entire length and breadth when
the patient’s teeth are firmly clenched .

18. LATERAL PTERYGOID
MUSCLE
It is inaccessible to palpation .
Attempt to palpate behind the
maxillary tuberosity are unreliable .
Resistance provided by the
operator’s hand may elicit lateral
pteyrgoid pain .
MEDIAL PTERYGOID
MUSCLE
It is not accessible to comfort
palpation
Occasionally , a more extensive examination may include the sternomastoid ,
trapezius , and digastric muscles .

19. VIDEO :

20. REFERENCES :

21. Thank you !