1. Nose, Mouth, and Throat
By Orest Kornetsky

2. 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.

3. 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

4. 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

5. 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

6. 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

7. 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

8. 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

9. 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.

10. 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

11. 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

12. 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

13. 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.

14. 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)

15. 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

16. 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)

17. 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

18. 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.

19. 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.

20. 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.

21. 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

22. 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

23. 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

24. 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?”

25. 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.”