CLINICAL EXAMINATION Pharynx and larynx

CLINICAL EXAMINATION Pharynx and larynx

Before examination of the pharynx, the oral cavity should be examined with the aid of a good light and tongue depressors. Historically , a reflecting mirror on the head was used as a source of examination light. However, a headband-mounted fibreoptic light source is widely available and more commonly used. Either option permits the use of both hands to hold instruments. Inspection should include the buccal mucosa and lips, the palate, the tongue and floor of the mouth, all surfaces of the teeth and gums, the salivary ductal orifices, opening and closing of the mouth and dental occlusion. Patients should be asked to elevate the tongue to the roof of the mouth - and protrude the tongue towards both the right and the left. Grasping the protruded tongue with a gauze aids the exam - ination. Intraoral palpation may be required gently using one Level II Level III Level IV Level V Level VI I

Stell & Maran’s textbook of head and neck

combined with extraoral bimanual palpation of the submental and submandibular lymph nodes and salivary glands to aid the characterisation and/or localisation of any swelling detected. Following examination of the oral cavity , the oropharynx is then inspected with the tongue depressor placed firmly onto the tongue base to depress it inferiorly . Care must be taken to, if possible, avoid pr ovoking a gag reflex. The anterior and pos terior faucial pillars, the tonsil, retromolar trigone and poste rior pharyngeal wall should all be inspected for colour changes, ulceration, mass lesions, mucopus, foreign bodies and swell ings. Pain and trismus as a consequence of pharyngolaryngeal or neck pathology may add to the di ffi culty of the examination but are significant clinical findings in their own right. While angled mirrors and a headlight may be used in expert hands, moder n flexible fibreoptic endoscopes passed through the nose, with or without topical anaesthesia, allow high- quality examination of the entire nasopharynx, oropharynx, larynx and often the hypopharynx in almost every patient. Moreover, a camera attached to the endoscope permits the taking of high-quality photographs to record and present pertinent clinical findings. A rigid 0° fibreoptic endoscope (Hopkins’ rod) is often used in preference to inspect the nasal cavities and nasopharynx. CLINICAL EXAMINATION Pharynx and larynx

Before examination of the pharynx, the oral cavity should be examined with the aid of a good light and tongue depressors. Historically , a reflecting mirror on the head was used as a source of examination light. However, a headband-mounted fibreoptic light source is widely available and more commonly used. Either option permits the use of both hands to hold instruments. Inspection should include the buccal mucosa and lips, the palate, the tongue and floor of the mouth, all surfaces of the teeth and gums, the salivary ductal orifices, opening and closing of the mouth and dental occlusion. Patients should be asked to elevate the tongue to the roof of the mouth - and protrude the tongue towards both the right and the left. Grasping the protruded tongue with a gauze aids the exam - ination. Intraoral palpation may be required gently using one Level II Level III Level IV Level V Level VI I

Stell & Maran’s textbook of head and neck

combined with extraoral bimanual palpation of the submental and submandibular lymph nodes and salivary glands to aid the characterisation and/or localisation of any swelling detected. Following examination of the oral cavity , the oropharynx is then inspected with the tongue depressor placed firmly onto the tongue base to depress it inferiorly . Care must be taken to, if possible, avoid pr ovoking a gag reflex. The anterior and pos terior faucial pillars, the tonsil, retromolar trigone and poste rior pharyngeal wall should all be inspected for colour changes, ulceration, mass lesions, mucopus, foreign bodies and swell ings. Pain and trismus as a consequence of pharyngolaryngeal or neck pathology may add to the di ffi culty of the examination but are significant clinical findings in their own right. While angled mirrors and a headlight may be used in expert hands, moder n flexible fibreoptic endoscopes passed through the nose, with or without topical anaesthesia, allow high- quality examination of the entire nasopharynx, oropharynx, larynx and often the hypopharynx in almost every patient. Moreover, a camera attached to the endoscope permits the taking of high-quality photographs to record and present pertinent clinical findings. A rigid 0° fibreoptic endoscope (Hopkins’ rod) is often used in preference to inspect the nasal cavities and nasopharynx.