Symptoms involving the oral cavity or the oropharynx are not the only reason to examine these structures. Symptoms relating to the nose always require examination of the oropharynx. Symptoms in this area may involve inflammation as well as abnormal swellings (possibly bleeding), wounds or problems with production or drainage of saliva.
The presenting symptom and its location sometimes gives a clue as to where you should focus your examination. This also determines what you ask about during the history-taking.
What is your prediagnosis?
Prediagnosis
Congenital abnormalities
Inflammation
Tumours
Vascular problems
Trauma
Degenerative conditions involving the:
– lips
– mandibula
– maxilla
– floor of the mouth
– cheek mucosa + parotid gland
– tongue
– teeth
– palate
– uvula
– pharyngeal arches
– posterior pharyngeal wall
– tonsillar fossae and tonsils
– Waldeyer’s tonsillar ring
Obstruction of the:
– floor of mouth (salivary glands!)
– pharyngeal arches
Allergy
Questions that can be important in relation to disorders of the mouth and the oropharynx, include the following:
- What is the precise nature of the complaint?
- Ask if there is any pain, and if so, where and when exactly it hurts
- Fever and feeling unwell, and if so, since when
- Are there are any people in the patient’s social network who have the same symptoms?
- Are there any problems swallowing?
- Does the patient smoke?
- What is the patient’s alcohol consumption?
- Does the patient visit the dentist on a regular basis and do they brush their teeth?
- Is the saliva production normal?
- Can they drink fluids?
- Is there any weight loss?