Head & Neck Examination

 
criteria procedure observe example
Extraoral Examination

1. Inspection of the head, observing size and symmetry.

 patient should be facing forward size and symmetry - deviation from normal size or prominent asymmetry noted  

2. Inspection of the exposed skin of the head and neck.

 move hair back if necessary - use unit light patches of color change - elevated or depressed lesions  

3. Inspection of the eyes and conjunctival mucosa.

 retract the lower lid redness, paleness, evidence of lesions

4. Inspection and palpation of the temporomandibular joint.

 place index finger tips over the TMJ lightly and ask the patient to open and close several times (do not wear gloves) inter-incisal distance - deviation or deflection - clicking or crepitus

5. Inspection and external palpation of the parotid and submandibular salivary glands.

 palpate the parotid and submandibular areas bilaterally masses, enlargement, tenderness
6. Inspection of the neck observe the neck symmetry and suppleness

7. Palpation of the cervical lymph nodes.

 palpate the anterior and posterior lymph node chains masses, enlargement, tenderness
8. Inspection of the vermilion zone of the lips. observe color changes - elevated or depressed lesions
Intraoral examination - all wearing gloves

1. Retraction, inspection, and palpation of the labial mucosa.

 retract, inspect and palpate upper and lower lip color changes - elevated or depressed lesions, masses

2. Retraction, inspection and palpation of the buccal mucosa.

 retract, inspect, palpate both sides color changes - elevated or depressed lesions, masses

3. Inspection and palpation of the palate.

 inspect hard & soft palate and run finger over hard palate color changes - elevated or depressed lesions, masses

4. Inspection of the oropharynx and tonsillar region.

 depress tongue with mouth mirror and have patient say "Ahh" and then inspect area color changes - elevated or depressed lesions, masses
5. Retraction, inspection and palpation of the tongue. have patient stick out tongue - inspect dorsal surface - use gauze to grasp the tip of the tongue - inspect and palpate lateral borders - have patient touch tip of tongue to palate to inspect ventral tongue color changes - elevated or depressed lesions, masses


6. Inspection and bimanual palpation of the floor of the mouth.

 use mouth mirror to retract tongue and inspect floor of mouth - use two fingers (one intraorally and one extraorally) to palpate the contents of the floor of the mouth color changes - elevated or depressed lesions, masses

7. Inspection and palpation of the alveolar process.

 inspect the upper and lower alveolar process  - use two fingers to palpate (one buccally and one lingually) color changes - elevated or depressed lesions, masses

8. Inspection of the gingivae.

 inspect the gingivae color changes - elevated or depressed lesions, masses
9. Inspection of the teeth. count the number

inspect teeth

access caries activity, oral hygiene - look for dental abnormalities