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NOSE, MOUTH, AND THROAT . Nasal appearance & patency Inspection & palpation of frontal & maxillary sinuses Lips Teeth & Inner gums. Buccal mucosa Tongue Palate, uvula Posterior pharynx Tonsils. NOSE, SINUSES, MOUTH, & OROPHARYNX. NOSE. 1 ST segment of the respiratory system

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  2. Nasal appearance & patency Inspection & palpation of frontal & maxillary sinuses Lips Teeth & Inner gums Buccal mucosa Tongue Palate, uvula Posterior pharynx Tonsils NOSE, SINUSES, MOUTH, & OROPHARYNX

  3. NOSE • 1ST segment of the respiratory system • Sensory organ for smell • Nasal cavity-much larger than external nose would indicate-Extends back over the roof of the mouth • Anterior edge-lined with coarse nasal hairs to filter coarsest matter from inhaled air; rest of cavity lined with ciliated mucous membrane to filter out dust and bacteria

  4. NASAL CAVITY • Nasal cavity divided medially by the septum into 2 slit like air passages • Anterior part of septum holds rich vascular network, kiesselbach’s plexus, most common site of nosebleeds • Nasal Septum may not be absolutely straight in many people-may deviate toward one passage • Nasal mucosa appear more red in color than oral mucosa because of rich blood supply present

  5. NASAL CAVITY • Lateral walls of each nasal cavity contain 3 parallel bony projectons- superior, middle,and inferior turbinates • Increase surface area so more blood vessels and mucous membranes are available to warm, humidify, and filter the inhaled air. • Underlying each turbinate is a cleft, the meatus • The sinuses drain into the middle meatus, and tears from the nasolacrimal duct drain into the inferior meatus

  6. NASAL CAVITY The olfactory receptors (hair cells) lie at the roof of the nasal cavity and in the upper 1/3 of the septum Receptors for smell merge into the olfactory nerve, cranial nerve I, which transmit to the temporal lobe of the brain

  7. Structures of the Nasal Cavity Figure 16-2. p. 373

  8. PARANASAL SINUSES • Air-filled pockets within the cranium • Communicate with the nasal cavity & lined with the same type of ciliated mucous membrane • Functions: lighten wt of skull bones, serve as resonators for sound production, and provide mucus, which drains into nasal cavity • Sinus openings –narrow & easily occluded

  9. SINUSES • Accessible to examination- frontal andmaxillary sinuses • Smaller and deeper are the ethmoid and the sphenoid sinuses • Only the maxillary and ethmoid sinuses present at birth

  10. Paranasal Sinuses, Adult and Child Figure 16-3. p. 373

  11. Mouth • 1st segment of digestion system • Airway for the respiratory system • Oral cavity-short passage that contains teeth, gums, tongue, and salivary glands • Palate-arching roof of the mouth divided into 2 parts • Hard palate-anterior made up of bone and is a whitish color • Soft palate-posterior arch of muscle that is pinker in color and mobile

  12. Mouth • Uvula-free projection hanging down from the middle of the soft palate • Floor of mouth-consists of mandible bone, the tongue, and underlying muscles • Tongue- mass of striated muscle that can change shape and position; papillae are the rough bumpy elevations on its dorsal surface; microscopic taste buds are in the papillae • Frenulum- midline fold of tissue that connects the tongue to the floor of the mouth

  13. Oral Cavity Structures Figure 16-4 p. 374

  14. Salivary Glands • Parotid Gland- the largest that lies within the cheeks in front of the ear; It’s duct, Stenson’s duct opens opposite the 2nd upper molar teeth • Submandibular-size of a walnut that lies beneath the mandible; Wharton’s duct runs up to the floor of the mouth and opens at either side of the frenulum • Sublingual- smallest almond-shaped lies under the tongue; has many small openings along sublingual fold under the tongue • The glands secrete saliva-moistens and lubricates food, starts digestion, cleans & protects mucosa

  15. Figure 16-5 p. 375

  16. Teeth • Adults have 32 permanent teeth-16 upper arch & 16 lower arch • Tooth consests of -crown, neck & root • Gums (gingivae) collar the teeth-thick fibrous tissue covered with mucous membrane

  17. Pharynx (throat) • Behind the mouth and nose • Oropharynx-separated from mouth by a fold of tissue on each side-anterior tonsillar pillar • Tonsils- behind folds-each is a mass of lymphoid tissue that is same color as surrounding mucous membrane; Tonsillar tissue enlarges during childhood until puberty, then involutes

  18. Pharynx • Nasopharynx-has Eustachian tube and pharyngeal tonsils (adenoids) openings here • Laryngopharynx-goes from hyoid bone to lower border of the cricoid cartilage

  19. Subjective Data • Epistaxis-nosebleeds • Headache or toothache • Dysphagia-difficulty swallowing • Prolonged use of bottle ( infants) during day or when going to sleep-risk for both tooth decay or otitis media

  20. Inspection • Nose-symmetric, in the midline, and in proportion to other facial features • Nasal cavity-normal red color, smooth and moist surface • Nasal septum-observe for deviation, note any bleeding or perforation • Middle and inferior turbinates-light red color • Note any polyps-smooth, pale gray, avascular, and nontender

  21. Middle turbinate Inferior turbinate Figure 16-7 p. 380

  22. Foreign Body Choanal Atresia Epistaxis Perforated Septum p. 396

  23. Acute Rhinitis Allergic Rhinitis Polyps Sinusitis Rhinitis

  24. Furuncle Carcinoma

  25. Palpation: • Using thumbs, press over frontal sinuses below eyebrow, and over maxillary sinuses below cheekbone Inspection of mouth: • Mouth-Use tongue blade to restrict structures and bright light for optimal visualization • Lips-color, moisture, cracking, or lesions • Teeth-Note any absent, loose, or abnormally positioned teeth • Gums- should be pink or coral with a stippled (dotted) surface

  26. Figure 16-12 p.383

  27. Tongue • Tongue-should be pink and even; dorsal surface roughened from the papillae; A thin white coating may be present; Ventral inspection-smooth, glistening, and shows veins • Inspect entire U-shaped area under tongue-oral malignancies are most likely to develop here. Note any lesions, nodules, ulcerations.

  28. Buccal Mucosa • Should be pink, smooth, and moist without nodules or lesions • Stensen’s duct-looks like a small dimple opposite the upper second molar • Fordyce’s granules-small, isolated white or yellow papules on the mucosa of cheek, tongue, and lips (small sebaceous cysts-not significant)

  29. Inspection • Palate-Shine light up to the roof of the mouth; anterior hard palate-white and posterior soft palate-pinker, smooth and upwardly moblie • Observe the uvula-ask person to say ahh and note the soft palate and uvula rise in the midline

  30. Inspect Throat • Using light, observe the oval, rough-surfaced tonsils; color pink with indentations • Graded: 1+ visible, 2+ halfway between tonsillar pillars and uvula, 3+ touching the uvula, 4+ touching each other • Depress tongue with tongue blade to enlarge your view or the posterior pharyngeal wall; push halfway back on tongue; push slightly off center to avoid eliciting the gag reflex

  31. Figure 16-18 p. 387

  32. ORAL LANDMARKS • Uvula • Frenulum • Hard palate • tonsils

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