Chapter 6 - Mouth, Throat, and Nose Assessment

Mouth, Throat, Nose, and Sinus
Assessment
The mouth and throat make up the first part of the digestive system and are responsible for receiving food.
Cranial nerves V"trigeminal", VII"facial", IX "glosopharyngeal", and IIX"hypoglossal" assist with some
of the digestive functions. The nose and paranasal sinuses constitute the first part of the respiratory system
and are responsible for receiving, filtering, warming, and moistening air to be transported to the lungs.
Receptors of cranial nerve I "olfactory" are also located in the nose.
Mouth
The roof of the oral cavity is formed by the anterior hard palate and the posterior hard palate. An extension
of the soft palate is the uvula.
Contained within the mouth are the tongue, teeth, gums, and the opening of the salivary glands "parotid,
submandibular, sublingual". The three pairs of salivary glands secrete saliva "watery, serous fluid contains
salts, mucous, and salivary amylase" into the mouth. The parotid glands, located below, and in front of
the ears, empty through Stensen's ducts, which are located inside the check across from the second upper
molar.
The submandibular glands, located in the lower jaw, open under the tongue on either side of the frenulum
through opening called Wharton's ducts. The sublingual glands, located under the tongue, open through
several ducts located on the floor of the mouth.
Mouth and throat
Lips
Cheeks
Buccal mucosa
Hard palate
Soft palate
Tonsils
Oropharynx and nasopharynx
Uvula
Tongue taste (CN VII)
Salivary glands
Parotid
Submandibular
Sublingual
Teeth
Crown
Neck
Root
Throat
The throat "pharynx", located behind the mouth and nose, serves as a muscular passage for food
and air. The upper part is called the nasopharynx. Below it lays laryngopharynx.
The soft palate, anterior and posterior pillars, and uvula connect behind the tongue to form
arches.
The lingual tonsils lie at the base of the tongue. Pharyngeal tonsils "adenoid" are found high in
the nasopharynx.
External Nose and Mouth
Nose
It composed of bone and cartilage and is lined with mucous membrane. The nasal cavity is located.
External nose
Internal nose
Nasal cavity
Paranasal Sinuses
Frontal
Maxillary
Sphenoid
Ethmoid
Turbinates
Projections in nasal cavity that increase surface area
Superior, middle and inferior turbinates

Nasal mucosa
Olfactory receptor cells (CN I)
Functions of Nose
Identify odors (upper 1/3 of septum) CN I
Air passageway (obligate in newborns)
Air conditioning
Humidify
Warms/cools air
Cleans and filters air of dust and bacteria
Voice resonance
Common Chief Complaints
Nasal blockage or congestion
Halitosis breath odor
Fruity (acetone) diabetic ketoacidosis
Foul URI, sinus, tonsil or mouth infection
Ammonia renal problems (uremia)
Fecal GI obstruction
Oral lesions
Ear, Nose & Throat Assessment: History Review

Present Problem
dizziness or vertigo
earache
hearing loss
nasal discharge
snoring
3
nosebleed
dental problems
mouth lesions
sore throat
difficulty swallowing
Past Medial History
systemic diseases
Ear
- frequent problems in childhood
- surgery
- labrynthitis
- antibiotic use
Nose
- trauma
- surgery
- chronic nosebleeds
Sinuses
- chronic postnasal drip
- repeated sinusitis
- allergies
Throat
- frequent, documented strep infections
- tonsillectomy
- adenoidectomy
Assessment of the Nose

Inspection of internal nose
Otoscope with nasal speculum avoid septum d/t increased sensitivity
Color & integrity of nasal mucosa
Septum deviation, perforation, bleeding (epistaxis)
New/old bleeding anywhere
Turbinates (color, exudate, swelling, polyps) Note the middle and inferior turbinates
Normal dull red
Allergies pale pink/gray, swollen (polyps & a clear, watery discharge are also common)
Acute rhionitis infection bright red & swollen
Normal findings
Located in midline of face
No swelling, bleeding, lesions, or masses
Both nostrils patent
Septum midline
Nasal mucosa is pink or dull red
Abnormal findings
4
Broken, misshapen, swollen nose

Occluded nasal passages
Septum is deviated
Nasal mucosa is red and swollen
Nasal Polyp;
Smooth, pale gray nodule
Overgrowths of mucosa
Chronic allergic rhinitis
Mobile, nontender
Decrease/absence of smell
Assessment of the Sinuses
Inspection
Palpation, percussion & transillumination (very dark room)
Normal findings
No evidence of swelling
Resonance heard on direct percussion
Will feel firm pressure with palpation, but no pain normally
Healthy sinuses contain air and may light up symmetrically
Assessment of the Mouth

Inspection (use good light source)
Lips (color, moisture, cracking, lesions) smile for symmetry (CNVII)
Tongue (color, surface fissures, moisture) stick out for deviation (CN VII)
Gums, buccal mucosa (check for pink color, bleeding, swelling)
Teeth (#, molars, color, cavities, dental repair) 32 adult 20 children (3rd molars may be
missing wisdom teeth)
Hard palate & soft palate

5
Floor of mouth (Whartons duct/Submandibular gland, Sublingual gland)
Parotid gland (in cheek in front of ear) and Stensens duct (opposite 2nd molar)
Tongue (Lingual frenulum, lingual veins)
Palpate
Roof of mouth in infants
Lips, cheek, tongue, floor of mouth
Use gauze to hold tongue
Find Stensens duct (parotid salivary gland) opposite upper second molar
Check temporomandibular joint (TMJ) depression in front of tragus felt with fingers
(slight pop can be normal; crepitus and masses are abnormal)
Normal findings
Pink, moist lips
Tongue midline, adequate movement
No lesions
Tongue, gums, buccal mucosa are pink, moist, smooth
No bleeding
Smooth, white teeth, no dental caries
Abnormal findings
Lesions, growths
Dry, cracked lips
Vesicles or blisters
Red, tender, inflamed tongue, gums, buccal mucosa
Thrush
Coating on tongue
Bleeding gums
Thrush Candidiasis
Scrapes off easily
Leaves red, raw surface that may bleed
Can occur after antibiotics, corticosteroids, and with immunosupression
Gum Hyperplasia
Painless enlargement
Occurs with puberty, pregnancy, leukemia, and extensive use of phenytoin (Dilantin)
Gingivitis
Gum margins red, swollen, bleed easily
Gums will recede and produce purulent drainage with chronicity
Poor dental hygiene, vitamin C deficiency
More common in pregnancy & puberty
Inspection of the Throat
Gag reflex (CN IX & X)
Posterior pharynx and oropharynx
Presence of swelling, exudate or lesions. Note color.
Inspect tonsils
6
Grade tonsils (+1 +4)

Normal findings
Soft palate and uvula rise when patient says, ahhh (CN IX & X)
Uvula is midline
No swelling, exudate, or lesions
Gag reflex is present (CN IX & X)
Abnormal findings
Posterior pharynx is red with white patches
Tonsils and uvula are red and swollen
Hoarse voice
Grayish membrane covering tonsils, uvula, soft palate
Tonsil Exudate
Streptococcal pharyngitis and acute tonsillitis
Bright red pharynx with red, swollen tonsils, pillar and uvula
Patches of white/yellow exudate
Family History
hearing problems/loss
Menieres disease
allergies
hereditary renal disease
Personal & Social History
employmenthazards
nutrition
oral care pattern
tobacco use
alcohol use
intranasal cocaine use
OTC nasal spray use
Infants and Children
prenatal history
prematurity
infection
- meningitis/encephalitis
- recurrent otitis media
congenital defects
playing with small objects
behaviors indicating hearing loss
dental care
Pregnant Women
weeks gestation/postpartum
symptoms before pregnancy
pattern of dental care
Older Adults
7
hearing loss
physical disability
deterioration of teeth
dry mouth
medications
salivation
NOSE & NASOPHARYNX

Warm/humidify/moisten air and resonate sound
Floor is hard and soft palate
Roof is sphenoid and frontal bone
Mucous membrane caries debris
Turbinates increase surface area
Sinuses
-
maxillary and frontal accessible to exam
ethmoid and sphenoid behind frontal
mucous and cilia move mucous
Check patency of nares

Percuss and palpate sinuses
Observe mucosa color and discharge
allergy = white mucosa with clear discharge
virus = red mucosa with colorful discharge
?CSF = unilateral clear discharge
foreign body = unilateral colorful discharge
Assess polyps or ulcer
MOUTH & OROPHARYNX
Passage of food/fluid, emit air & speech, initiate digestion & identify taste
Gingivae cover neck and roots of teeth
Teeth - 32 permanent (4 incisors, 2 canines, 4 premolars and 6 molars)
Oropharynx separated from mouth by tonsilar pillars
Assess lips, buccal mucosa, teeth and gums
Observe occlusion of clenched teeth (CN VIII)
Inspect tongue color, texture, ulcerations and note movement (CN XII)
Assess soft palate and rise of posterior curtain with ahh (CN IX/X)
Inspect posterior pharynx noting tonsillar pillars
Lips
- cyanosis = hypoxia
- pallor = poor perfusion
8
- vesicles = HSV
Oral lesions
- Candida = white patches on red base
Pharynx
- viral vs bacterial pharyngitis
- Peritonsillar abcess = deviated uvula
Pediatric Variations
Essential to determine nasal patency of newborn (choanal atresia) Bilaterally will need
immediate intervention d/t obligate nose breathing
Only the maxillary and ethmoid sinuses are present at birth (easier to transilluminate)
Tonsils vary widely in size during childhood
3 month old begins salivation (drooling)
Teeth/tooth may be present at birth, most infants start between 6-10 months, will lose
teeth between 6-12 yrs
Gerontological Variations
Nose may appear more prominent d/t loss of SQ fat in face.
Diminished sense of smell and taste (decreased # of olfactory nerve fibers in nose and
papilla on tongue)
Periodontal disease
Gum lines recede
Oral alterations due to disease or side effects of medications
Tooth loss
Teeth will darken with age d/t exposed dentin
Lifestyle and Health Practices
Predisposing factors for oral cancer:

Cigarette smoking
Excessive use of alcohol
Age over 40
Male gender
Genetic predisposing
Vitamin A deficiency
Grinding the teeth is a sign of stress or slight malocclusion
Proper brushing, flossing, and oral hygiene can prevent dental caries and gum diseases
Cleaning the tongue is a way to prevent bad breath resulting from bacteria that
accumulates on the posterior tongue
Elderly and some disabled clients may have difficult caring properly for teeth or dentures
because of poor vision or impaired extremities
Collecting Objective Data

9
Examination of the mouth and throat can help the nurse detect abnormalities of the lips, gums,
teeth, oral mucosa, tonsils, and uvula.
It allows for early detection of oral cancer
Examination top detect oral problems, septum defects, patency of the nose and nasopharynx.
Early detection of impaired oral mucous membrane s or poor dental hygiene conditions may
require a change in client's diet. Early detection of septum deviation help the nurse determines
which nostrils to use to insert a NGT or suction tube.
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Chapter 6 - Mouth, Throat, and Nose Assessment

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What structures make up the oral cavity?

What structures make up the oral cavity?

What are the major salivary glands and where are they located?

What are the major salivary glands and where are they located?

Mouth, Throat, Nose, and Sinus

External Nose and Mouth

Superior, middle and inferior turbinates

Identify odors (upper 1/3 of septum) CN I

Air passageway (obligate in newborns)

Cleans and filters air of dust and bacteria

Common Chief Complaints

Nasal blockage or congestion

Halitosis breath odor

Fruity (acetone) diabetic ketoacidosis

Foul URI, sinus, tonsil or mouth infection

Ammonia renal problems (uremia)

Ear, Nose & Throat Assessment: History Review

Past Medial History

Assessment of the Nose

Located in midline of face

No swelling, bleeding, lesions, or masses

Both nostrils patent

Nasal mucosa is pink or dull red

Broken, misshapen, swollen nose

Resonance heard on direct percussion

Will feel firm pressure with palpation, but no pain normally

Healthy sinuses contain air and may light up symmetrically

Assessment of the Mouth

Lips (color, moisture, cracking, lesions) smile for symmetry (CNVII)

Gums, buccal mucosa (check for pink color, bleeding, swelling)

Hard palate & soft palate

Floor of mouth (Whartons duct/Submandibular gland, Sublingual gland)

Tongue (Lingual frenulum, lingual veins)

Grade tonsils (+1 +4)

NOSE & NASOPHARYNX

maxillary and frontal accessible to exam

ethmoid and sphenoid behind frontal

mucous and cilia move mucous

Check patency of nares

Predisposing factors for oral cancer:

Collecting Objective Data

It allows for early detection of oral cancer

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