1. Patient’s Evaluation 1& 11 ( OMFS/ SYS ) Introduction : History, clinical exam.,then diagnosis &treatment plan. You need written record: to assess progress of treatment, for medico- legal importance, and for other practitioners to see the patient. - In hospitals & specialist clinics this is a routine work. - History at the first visit is important, then, less in straightforward dental conditions. - With experience, only important facts need be noted. History : - establish a relationship with the patient, attitude. Seat comfortably, addressed by his name & proper title. Records in details. - anxious or relaxed. Some will verbose, reticent. - avoid leading question. - arrange the facts in inverse chronological order( recent events first). History recorded under the following headings :

2. a- patient referred by. b- complains of (CO)---- his own words ----symptoms he wants to cure ---not his views on the diagnosis. c- history of the present complaint (HPC): pain, swelling,discharge,remissions treatment received d- previous dental history (PDH) : regular patient, pay attention to his teeth, difficulty in extractions or anaesthesia, bleeding-----. e- relevant medical history (RMH) : the conditions that affect the diagnosis or treatment. f- family history (FH) : mainly in O.S., haemophilia---anodontia. g- social history (SH) : - occupation - social habits -----smoking,drinking,exercise. - home relation---alone,travel,or has somebody to look after him.

3. Principles of examination Medical or dental is the same ( inspection—palpation- percussion— auscultation). Inspection :- observe signs of or psychological disease (in the gait). - eyes first then hands. -locate the anatomical landmarks by tips of hands & notice any asymmetry ----swelling (fluctuation, bimanual palpation) & record positive or negative findings.

4. Systematic procedure for exam. of the mouth :- extra-oral exam. : inspection & palpation of the face (asymmetry, facial paralysis, eyes movement, pupils reaction, and difficulty in breathing. a- T.M.J. : open & closed---range of opening ---tenderness---clicking & crepitus. b- maxillary sinus : swelling, tenderness, redness, nasal discharge, O.A.F- c- lymph nodes : tenderness, cosistency & degree of mobility. d- the lips : fissure at the angle of the mouth or ulceration. intra-oral exam. : a- m.m. : colour, texture, swelling or ulceration. Compare both sides by palpation. b- the tongue : movements, intrinsic & extrinsic (limitation is an important clinical sign in inflammation & early neoplasia). Check dorsum ----pull the tongue using dental napkin---for fissure, ulcers,etc. c- the tonsils : depress the tongue with a spatula & ask the patient to say AH.

5. Cont. intra-oral exam. : d- The pharynx :depress the tongue & pass the uvula, mirror to show the oro-and naso-pharynx. e- the salivary glands f- the periodontal tissues : standard of oral hygiene& calculus, plaque, & color, texture of the gingivae, hyperplasia & mobility of the teeth. g- the teeth : caries, fillings, loose teeth before G.A. h- edentulous ridges : form, R.Rs., bony & soft tissues abnormalities. check denture!!. i- the occlusion : occlusal function, bridges, crowns, dentures assessed.

6. Special lesions : This is the complaint of, the patient ( swelling, ulcer, fistulae ). Record down the site, size, shape, colour, margins, & multiple or single. Tenderness, fluctuant or solid. Solid swelling : hard ---- bone firm ---- muscle soft ---- relaxed muscle very soft ---- fat pulsatile swelling : check whether it is true or transmitted from an underlying artery.

7. Special investigation :- H istory & clinical exam. completed----consider your findings for provisional or differential diagnosis. Special investigation are not needed for every patient. local dental investigation :- a- performed in the surgery : - percussion to the teeth - vitality tests on the teeth ------- thermal or electrical. - radiography - diagnostic injection of local anesthesia– facial pain. - study models for occlusion. - photography as a comparative record. b- requiring special facilities: - bacteriological ------- C. & S. - aspiration of cystic cavities - biopsy of tissue

8. General investigation : a- performed in the surgery: - temperature, pulse rate blood pressure, respiration rate b- requiring special facilities : - urinalysis - blood examination - chest radiographs - electrocardiograph - tests for allergy The surgeon must understand the clinical significance of the results.

9. Diagnosis : after completing the investigation, the surgeon should be able to make the final diagnosis which is like a computer exercise in which all the information are sorted & analyzed in the surgeon mind. sometimes it is difficult to reach a diagnosis due to lack of information or knowledge. It is wise to seek another opinion, or consult textbooks or papers. Treatment plan : - Is divided into : - pre-operative - operative - post-operative care Bear in mind that the ultimate aim is to cure the patient with the least risk & minimal inconvenience to him.