Figure 3 Throat Scope examination by medical practitioner.
Figure 4 Oral Self-examination with Throat Scope
A review and assessment of the systemic health, risk factors, and pharmacological status of the patient is always done
prior to the extraoral and intraoral examination. Following
the accumulation of this data, a systematic examination of the
head, face, and neck should be conducted, including the tem-poromandibular joint, masseter muscle, parotid gland, frontal
and maxillary sinuses, and palpation of the thyroid gland.
There are a number of areas that are considered high risk and
more vulnerable to oral and oropharyngeal cancer. A thorough
and effective examination of the lymph nodes is critical in the
early identification of an abnormal lesion or growth. The lymph
nodes are examined with the clinician positioned behind the
patient with the patient sitting upright in the dental chair. It is
important to employ a systematic approach to the examination.
A suggested order would be to commence with palpation of the
submental and submandibular glands followed by the cervical
nodes (deep and superficial), supraclavicular, occipital, post-and preauricular nodes.
Palpation of the lymph nodes is accomplished with fingertips
exerting firm pressure. When examining the submental nodes, instruct the patient to bite together lightly and place the tongue into
the palatal vault. This results in tensing of the mylohyoid muscle,
facilitating easier palpation of submental glands. (Figure 5)
Figure 5. Bilateral palpation of the submental lymph nodes
The submandibular glands are again a critical area with afferent
and efferent drainage pathways linked to upper respiratory infections, mononucleosis, mycobacterial infections, oral disease, as well
as squamous cell carcinomas of the head and neck. They are best
examined with firm, unilateral palpation following a cursory bilateral palpation. Once fingers are in position, instruct the patient to
place their chin down and ear over to the shoulder of the side being
palpated. This facilitates deep palpation of the nodes. (Figure 6)
Figure 6. Unilateral palpation of the submandibular lymph nodes