NOSE, MOUTH, AND THROAT .

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NOSE, MOUTH, AND THROAT.
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NOSE, SINUSES, MOUTH, OROPHARYNX

• Nasal appearance patency
• Inspection palpation of frontal maxillary
  sinuses
• Lips
• Teeth Inner gums

• Buccal mucosa
• Tongue
• Palate, uvula
• Posterior pharynx
• Tonsils

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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

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NASAL CAVITY

• Nasal cavity divided medially by the septum into
  2 slit like air passages
• Anterior part of septum holds rich vascular
  network, kiesselbachs 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

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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

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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

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• Structures of the Nasal Cavity

Figure 16-2. p. 373
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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

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SINUSES

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

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• Paranasal Sinuses, Adult and Child

Figure 16-3. p. 373
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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

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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

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• Oral Cavity Structures

Figure 16-4 p. 374
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Salivary Glands

• Parotid Gland- the largest that lies within the
  cheeks in front of the ear Its duct, Stensons
  duct opens opposite the 2nd upper molar teeth
• Submandibular-size of a walnut that lies beneath
  the mandible Whartons 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

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Figure 16-5 p. 375
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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

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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

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Pharynx

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

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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

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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

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Middle turbinate Inferior turbinate
Figure 16-7 p. 380
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Choanal Atresia
Perforated Septum
Epistaxis
p. 396
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Acute Rhinitis
Allergic Rhinitis
Polyps
Sinusitis Rhinitis

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Carcinoma
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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

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Figure 16-12 p.383
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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.

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Buccal Mucosa

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

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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

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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

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Figure 16-18 p. 387
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ORAL LANDMARKS

• Uvula
• Frenulum
• Hard palate
• tonsils