Nose, Mouth, and Throat By Orest Kornetsky

Nose anatomy Bridge is the superior part (nasal bone) Tip is the anterior part of nose (cartilage) Hair – Filter coarse matter from entering nasal cavity Ciliated mucous membrane filters dust and bacteria. The rich blood supply warms and humidifies the air Turbinates (conchae) increase the surface are of the nasal cavity so that more air is filtered, warmed, and humidified Particles not filtered in the nares are trapped in the mucous layer of the turbinates. These particles are moved by cilia (hairlike projections) to the oropharynx, where they are either swalowed or expectorated. Inspired air is humidified by contact with the mucous membrane and is warmed by exposure to heat from the vascular network.

Nose - Sinuses Only the ethmoid and maxillary sinuses are present at birth. Frontal develop between 7 and 8 years. Sphenoid develop after puberty. Which sinuses can we examine? Frontal and maxillary

Mouth – A & P Hard palate – made out of bone (whitish color) Soft palate – made out of muscle (more pink in color) Uvula – hangs from middle of soft palate Tongue – striated muscle assist with mastication and swallowing. Papillae on dorsal surface of tongue hold neurons responsible for taste

Mouth – Salivary Glands Parotid gland Located superior of mandibular angle Submandibular gland Lies beneath the mandible Sublingual gland Lies posterior to the tongue at the floor of the mouth Function of the glands is to secrete saliva

Throat (Pharynx) Nasopharynx Oropharynx Laryngopharynx Located behind the nose, above the soft palate Contains adenoids (pharyngeal tonsils) Eustachian tube opens during swallowing to equalize pressure within the middle ear Oropharynx Located behind the mouth, below the nasopharynx Shared passageway for breathing and swallowing Contains palatine tonsils, which guard the body against microorganisms Laryngopharynx Extends from base of tongue to the esophagus Critical dividing point where solids are separated from air Divides larynx from esophagus (adenoids) Named according to location

Developmental Considerations – Infants and Children Children have 20 deciduous (temporary) teeth (compared to the adults’ 32). Deciduous teeth are lost beginning at 6 years until about 12

Developmental Considerations - Aging Nasal hair grow coarser and stiffer and may not filter air as well. Decreased sensation of smell. Loss of taste due to soft tissue atrophy Decrease in salivary secretion Tooth surface is abraded. Gums begin to recede and erode. Poor oral hygiene may cause tooth loss, which increase the difficulty of mastication Use of medications may have anticholinergic effects, which further decrease salivation

Health History Nasal discharge? (rhinorrhea) – Cold, allergies, sinus infection, trauma Frequent colds? – immunosuppression Epistaxis (nosebleeds)? – may occur with trauma, irritants Allergies? Sores or lesions in mouth or oral cavity? – may be malignant Sore throat? – Determine if bacterial or viral cause. Strep throat may lead to rheumatic fever. Are tonsils still in place? Bleeding gums or toothache? – may indicate poor oral hygiene Any voice changes? Dysphagia (difficulty swallowing)? – may be caused by GERD, pharyngitis, neurologic diseases, cancer.

Assessing the Nose External nose Nasal cavity Normal – nose is symmetric, midline, proportional Test for obstruction of by blocking each nare and asking the person to inhale with the open nare. Nasal cavity Insert otoscope into the nasal vestibule, lifting the tip of the nose Normal – nasal mucosa pink, smooth, and moist Abnormal – note any bleeding, swelling, redness, discharge, foreign body Rhinitis – mucosa swollen, red, and often includes discharge (watery, thick, purulent, green) in upper resp infection Observe for deviated septum, which is only significant if airflow is obstructed Observe turbinates for polyps (benign growths) – smooth, gray, avascular, mobile, nontender

Assessing the Sinuses Palpation Transillumination Using thumbs, palpate the frontal and maxillary sinuses Tenderness in persons with sinusitis or allergies Transillumination Using a pen light in a darkened room, place light under the superior orbital ridge, inferior to the frontal sinuses Clear sinuses should transilluminate

Assessing the Lips Black people normally have bluish lips What do bluish lips signify in light skinned people? Hypoxemia or hypothermia Pallor on lips? Anemia, shock Cherry red lips? CO poisoning, acidosis Angular cheilitis (inflammation of lips) Painful fissures at corners of mouth caused by Candida infection Herpes simplex virus Mostly HSV-1 virus, possibly HSV-2 Vesicles or pustules, highly contagious Carcinoma Mostly crusted or ulcerated

Assessing Teeth Teeth normally look white, straight, and free of decay. In the back, the upper molars should directly rest on the lower molars. In the front, upper incisors should overlap lower incisors Yellowing as result of tobacco use Malocclusion – misalignment of upper and lower teeth Dental carries – tooth decay as result of acids produced by bacteria “eating” carbohydrates and sugars, destroying enamel.

Assessing Gums Normally the gums look pink, with well defined margins between teeth and gums Gingival hyperplasia – enlargement of gums. Possible SA of Dilantin Gingivitis – redness, swelling, or bleeding of gum margins caused by anaerobic bacteria as a result of poor dental hygiene or vitamin C deficiency . If disease is untreated and spreads to bone, the result is periodontitis (absorption of bone)

Assessing the Tongue Normally the tongue is pink with a roughened dorsal surface and moist underneath Inspect tongue by holding it with cotton gauze pad and moving to each side

Tongue Abnormalities Enlarged tongue (macroglossia) Fissured tongue occurs in Down syndrome, acromegaly, cretinism, myxedema Fissured tongue congenital, benign. Mild form may be caused by dehydration Candidiasis White, cheesy, patch on buccal mucosa or tongue Occurs after use of antibiotics, steroids, and immunosuppression (AIDS)

Tongue Abnormalities Atrophic Glossitis (glossy tongue) surface of tongue is smooth and shiny, burning. Occurs with pernicious anemia (vit B 12 deficiency), folic acid deficiency, and iron deficiency anemia Black hairy tongue fungal infection usually due to prolonged antibiotic use Carcinoma common underneath the tongue

Assessing the Buccal Mucosa Normal mucosa looks pink, smooth, and moist Inspect by using light and a tongue blade Note presence of Stensen’s ducts (openings of parotid gland) which are inflamed and red with mumps Koplik’s spots – prodromal sign of measles Also notice breath. Fruity odor might indicate ketoacidosis.

Assessing the Palate The anterior hard palate is normally filled with irregular transverse rugae Might appear yellow with jaundice in whites and yellow-brown in blacks The posterior soft palate is pinker, smooth, and upward movable. Contains the uvula To check for CN X (vagus nerve) reflex, ask person to open mouth and say “ahhhh.” Uvula should move up.

Palate Abnormalities Cleft palate is a congenital defect where the maxillary process fails to fuse. This causes a gap in the hard palate and possibly the upper lip. Surgery required.

Assessing the Tonsils Normal are pink at the sides of mouth, barely visible Inspect by depressing the tongue blade on the tongue During an upper respiratory infection, the tonsils become bright red, swollen, and might contain exudate and/or white spots 1+ tonsils visible 2+ tonsils inflamed 3+ tonsils touching uvula 4+ tonsils touching each other

Question 1 A 70-year-old woman complains of dry mouth. The most frequent cause of this problem is: The aging process Related to medications she may be taking The use of dentures Related to a diminished sense of smell

Question 2 Because of history of headache, the examiner uses transillumination to assess for an inflamed sinus. The findings in a healthy individual would be: A diffuse red glow No transillumination Findings vary with ethnicity of the person Light visible in the nares through a speculum

Question 3 The nurse observes blackish lesions on the top of the tongue of an adult client. The client indicates that his tongue is painful. Which question by the nurse would be helpful in explaining this finding? “Have you been taking antibiotics lately?” “Have you injured your tongue?” “Have you been diagnosed with a mouth cancer before?” “When was the last time you brushed your teeth?”

Question 4 Which of the following statements made by a 72-year-old client is considered a normal process or aging? “My tongue feels swollen.” “My tonsils are large and sore.” “I have white and black spots under my tongue.” “Food does not taste the same as it used to.”