1. Nose, Mouth & Throat
N1037

2. Nose A & P
Review structure and function of External nose, nasal fossa, internal nose (p 377)

3. Nose A & P

4. Nasal Cavity Extends over the roof of the mouth
Lined with coarse nasal hairs
Mucous blanket filters out dust and bacteria
Divided by the septum
3 parallel bony projections: superior, middle and inferior turbinates.
Olfactory receptors lie at the roof of the nasal cavity

6. Nose – Sinuses
4 pairs of Sinuses: air-filled within the cranium, serve as resonators for sound production, lighten the weight of skull bone, provide mucous and drain into the nasal cavity.
Ethmoid: between the orbits (smaller and deeper)
Sphenoid: deep within the skull in the sphenoid bone (post. to nasal cavity).
These are non-palpable

7. Nose - Sinuses These are Palpable
Frontal: in frontal bone, above and medial to the orbits.
Maxillary: in the maxilla (cheekbone) along the side walls of the nasal cavity.

10. Structure and Function Exterior and Interior
Mouth
Structure and Function
Exterior and Interior

11. Exterior structures

14. Head-Salivary Glands 3 pairs of Salivary glands:
parotid, submandibular and sublingual
Parotid: ant. and below the ear in cheeks, normally not palpable, secret amylase-rich fluid through Stensen’s Ducts located near upper 2nd molars
Submandibular: beneath the mandible, size of walnuts, opens at either side of the tongue frenulum
Sublingual: lie in the floor of the mouth, has many small openings along the sublingual fold under the tongue.*

16. Structure and Function
Throat
Structure and Function

17. Throat (Pharynx) Area behind the mouth and the nose Oropharynx
Tonsils: mass of lymphoid tissue, deep crypts
Nasopharynx:
above and continuous with oropharynx, behind the nasal cavity
Pharyngeal tonsils (adenoids) and eustachian tube openings here

19. Health History - Subjective Data
Nose Mouth & Throat
Health History - Subjective Data

20. Nose Mouth & Throat Health Hx
Discharge
Frequent colds (Upper Resp Infection)
Sinus pain
Trauma (cause a deviated septum)
Epistaxis (nosebleeds)
Allergies
Altered smell

21. Nose Mouth & Throat Health Hx
Sores or lesions
Sore throat
Bleeding gums
Toothaches
Hoarseness
Dysphagia
Altered taste
Smoking, alcohol consumption
Self-care behaviours (dental care, dentures or appliances

22. Objective Data Preparation and Equipment Needed
Nose Mouth & Throat
Objective Data
Preparation and Equipment Needed

23. Nose, Mouth & Throat Preparation Client sitting up straight
Head at your eye level
Remove dentures
Equipment
Otoscope (nasal speculum with light)
Tongue blade
Cotton gauze pad (4x4)
gloves

24. Objective Data Inspection and Palpation
Nose, Mouth & Throat
Objective Data
Inspection and Palpation

25. Assessment of Nose External Inspection Symmetric Midline
Proportionate to other facial features
Deformity, asymmetry
Inflammation
Skin lesions

26. Assessment of Nose Inspect and palpate external nose Patency
Inspect external nose for symmetry
Palpate external nose noting any tenderness - may indicate inflammation
Patency
Occlude one nostril at a time with a finger and ask pt to breath in & out through the nose.
Internal Inspection
Extend pt’s head, place non dominant hand on pts head and use thumb to lift the tip of the nose , insert nasal speculum or otoscope and inspect nasal septum, turbinates

28. Nasal Cavity – Inspection
(short, wide tipped speculum to otoscope)
N- nasal mucosa should be pink or dull red colour, smooth, moist surface with small amount of clear watery discharge.
Nasal septum: *deviations, perforations or bleeding (airflow must not be obstructed)
Note *polyps, (benign growths that sometimes accompany chronic allergy)
Note swelling, *discharge (watery, copious to thick, purulent, green-yellow)
Bleeding or foreign body

29. Assessment of Sinuses Inspection
Observe patients face for any swelling around nose and eyes
N= no evidence of swelling

30. Sinuses – Palpation Client feels pressure but no pain
Press frontal sinuses (below eyebrows)
Press maxillary sinuses ( below cheekbones)
Chronic allergies and acute infections (sinusitus) = tenderness to sinuses

32. Perscussion of Sinuses
Gently percuss frontal and maxillary sinuses using direct percussion technique
N = elicits a resonant sound indicating air filled cavity
If a dull sound is heard = fluid in cavity
note any signs of tenderness or pain which may indicate sinusitis due to infection, allergies

33. Transillumination of the Sinuses
Turn lights off in room
Place strong light under bony ridge of upper orbits
Observe red glow
Place strong light under each eye just above the infraorbital ridge
Ask pt to open mouth
Observe red glow on hard palate
N= glow on each side is equal indicating air filled frontal and maxillary sinuses

35. Mouth Inspection Breath Should smell fresh Lips
Teeth, Buccal mucosa & Gums
White, straight, evenly spaced, clean and free of debris or decay
Note absent, loose, abnormally positioned
Gums are pink with margins tight and well defined.
Note swelling, retractions, spongy or bleeding gingivae.
Breath
Should smell fresh
Lips
Observe colour, moisture, swelling cracking or lesions
Inner surface pinkish-red.

36. Mouth – Inspection Mucous membranes Pink, smooth and moist Tongue
Palate – hard (anterior) and soft (posterior)
Anterior: white with irregular transverse rugae
Posterior: pink, smooth and movable
“Say ahhh,”: soft palate and uvula rise (may be split in two)
Tongue
Pink and even, roughened
White coating may be present
Ventral suface smooth, shows veins
Saliva present
Note *induration on palpation

37. Mouth - Palpation Don gloves
LIPS = Pull pts lower lip with thumb and index finger
N= lips should be flaccid and without lesions
Tongue = ask pt to stick out tongue (CNXII)
Move tongue from side to side, and up and down
Press tongue against cheek on each side
Using gauze and gloves hold tongue and inspect ventral surface for Whartons’ ducts, frenulum, color, hydration, lesions, inflammation and vasculature
N= tongue is midline, dorsum is pink, moist with taste buds (rough) and without lesions. Tongue strength is equal. Ventral surface has visible vasculature. Lateral aspect is pink, moist and free of lesions

39. Salivary and Parotid Gland Inspect and palpate
Note for enlargement of salivary gland as the client moves their head back and forth
Note swollen parotid gland with head extended ( below the angle of the jaw)

40. Throat - Inspection Ask pt to stick tongue out
Place tongue depressor on middle third of tongue
Shine light at back of pt throat
Ask pt to say “ah” & observe uvula
Observe tonsillar pillars
Touch posterior third of tongue & observe for gag reflex
N= soft palate, uvula is midline and rises symmetrically (CN IX & X), gag reflex is present, tonsils are not enlarged

41. Throat - Inspection Tonsils Tonsil - Grade
pink, peppered with indentations or crypts.
No exudate present
Graded
Tonsil - Grade
1+ visible
2+ halfway pillars/uvula
3+ touching uvula
4+ touching each other

44. Developmental Considerations
Infant and children
Drool before they swallow
Milia on nose
No nasal flaring present
Note # of teeth 20 temporary (by 2 ½)
Lost between 6 and 12
Pregnant
Gingivitis
Stuffiness and epistaxis
Aging Adult
Mouth and lips fold in
Changes to appearance of teeth, gums recede
Mucosa is shinier, thinner, less vascular
Tongue is smoother (atrophy)
Sense of smell diminishes