Nose, Mouth & Throat
N1037
Nose A & P
•Review
structure and function of
External nose, nasal fossa, internal
nose (p 377)
Nose A & P
Nasal Cavity
 Extends
over the roof of the mouth
 Lined with coarse nasal hairs
 Mucous blanket filters out dust and
bacteria
 Divided by the septum
 3 parallel bony projections:
superior, middle and inferior
turbinates.
 Olfactory receptors lie at the roof of
the nasal cavity
Nose – Sinuses
4 pairs of Sinuses: air-filled within the
cranium, serve as resonators for sound
production, lighten the weight of skull
bone, provide mucous and drain into the
nasal cavity.
Ethmoid: between the orbits (smaller
and deeper)
Sphenoid: deep within the skull in the
sphenoid bone (post. to nasal cavity).
These are non-palpable
Nose - Sinuses
These are Palpable
1.
Frontal: in frontal bone, above
and medial to the orbits.
2.
Maxillary: in the maxilla
(cheekbone) along the side walls
of the nasal cavity.
Mouth
Structure and Function
Exterior and Interior
 Exterior
structures
Head-Salivary Glands
3
pairs of Salivary glands:
– parotid, submandibular and sublingual

Parotid:

Submandibular:

Sublingual:
ant. and below the ear in cheeks, normally
not palpable, secret amylase-rich fluid through
Stensen’s Ducts located near upper 2nd molars
beneath the mandible, size of
walnuts, opens at either side of the tongue frenulum
lie in the floor of the mouth, has many
small openings along the sublingual fold under the
tongue.*
Throat
Structure and Function
Throat (Pharynx)
Area behind the mouth and the nose
Oropharynx
Tonsils: mass of lymphoid tissue, deep crypts
Nasopharynx:
 above and continuous with oropharynx,
behind the nasal cavity
 Pharyngeal tonsils (adenoids) and
eustachian tube openings here
Nose Mouth & Throat
Health History - Subjective
Data
Nose Mouth & Throat
Health Hx
Nose
 Discharge
 Frequent colds (Upper Resp
Infection)
 Sinus pain
 Trauma (cause a deviated septum)
 Epistaxis (nosebleeds)
 Allergies
 Altered smell
Nose Mouth & Throat
Health Hx
Mouth & Throat
 Sores or lesions
 Sore throat
 Bleeding gums
 Toothaches
 Hoarseness
 Dysphagia
 Altered taste
 Smoking, alcohol consumption
 Self-care behaviours (dental care,
dentures or appliances
Nose Mouth & Throat
Objective Data
Preparation and
Equipment Needed
Nose, Mouth & Throat
Preparation
o
o
o
Client sitting up
straight
Head at your eye
level
Remove dentures
Equipment




Otoscope (nasal
speculum with
light)
Tongue blade
Cotton gauze pad
(4x4)
gloves
Nose, Mouth & Throat
Objective Data
Inspection and Palpation
Assessment of Nose
External Inspection
 Symmetric
 Midline
 Proportionate to other facial features
 Deformity, asymmetry
 Inflammation
 Skin lesions
Assessment of Nose

Inspect and palpate external nose
– Inspect external nose for symmetry
– Palpate external nose noting any tenderness - may
indicate inflammation

Patency
– Occlude one nostril at a time with a finger and ask pt to
breath in & out through the nose.

Internal Inspection
– Extend pt’s head, place non dominant hand on pts head
and use thumb to lift the tip of the nose , insert nasal
speculum or otoscope and inspect nasal septum,
turbinates
Nasal Cavity – Inspection
(short, wide tipped speculum to otoscope)





N- nasal mucosa should be pink or dull red colour,
smooth, moist surface with small amount of clear
watery discharge.
Nasal septum: *deviations, perforations or bleeding
(airflow must not be obstructed)
Note *polyps, (benign growths that sometimes
accompany chronic allergy)
Note swelling, *discharge (watery, copious to thick,
purulent, green-yellow)
Bleeding or foreign body
Assessment of Sinuses
 Inspection
– Observe patients face for any swelling
around nose and eyes
– N= no evidence of swelling
Sinuses – Palpation
Client feels pressure but no pain
 Press
frontal sinuses (below
eyebrows)
 Press maxillary sinuses ( below
cheekbones)

Chronic allergies and acute infections
(sinusitus) = tenderness to sinuses
Perscussion of Sinuses
Gently percuss frontal and maxillary
sinuses using direct percussion technique
 N = elicits a resonant sound indicating air
filled cavity

– If a dull sound is heard = fluid in cavity
– note any signs of tenderness or pain which
may indicate sinusitis due to infection,
allergies
Transillumination of the Sinuses







Turn lights off in room
Place strong light under bony ridge of upper
orbits
Observe red glow
Place strong light under each eye just above the
infraorbital ridge
Ask pt to open mouth
Observe red glow on hard palate
N= glow on each side is equal indicating air filled
frontal and maxillary sinuses
Mouth Inspection
Breath
 Should smell fresh
Lips
 Observe colour,
moisture, swelling
cracking or lesions
 Inner surface
pinkish-red.
Teeth, Buccal mucosa
& Gums
 White, straight, evenly
spaced, clean and free
of debris or decay
 Note absent, loose,
abnormally positioned
 Gums are pink with
margins tight and well
defined.
 Note swelling,
retractions, spongy or
bleeding gingivae.
Mouth – Inspection
Tongue
 Pink and even,
roughened
 White coating may be
present
 Ventral suface
smooth, shows veins
 Saliva present
 Note *induration on
palpation
Mucous membranes
 Pink, smooth and
moist
Palate – hard
(anterior) and soft
(posterior)
 Anterior: white with
irregular transverse
rugae
 Posterior: pink,
smooth and movable

“Say ahhh,”: soft
palate and uvula rise
(may be split in two)
Mouth - Palpation
Don gloves
 LIPS = Pull pts lower lip with thumb and index finger
N= lips should be flaccid and without lesions


Tongue = ask pt to stick out tongue (CNXII)
– Move tongue from side to side, and up and down
– Press tongue against cheek on each side
– Using gauze and gloves hold tongue and inspect
ventral surface for Whartons’ ducts, frenulum,
color, hydration, lesions, inflammation and
vasculature
N= tongue is midline, dorsum is pink, moist with
taste buds (rough) and without lesions. Tongue
strength is equal. Ventral surface has visible
vasculature. Lateral aspect is pink, moist and
free of lesions
Salivary and Parotid Gland
Inspect and palpate
Note for enlargement of salivary
gland as the client moves their head
back and forth
 Note swollen parotid gland with head
extended ( below the angle of the
jaw)

Throat - Inspection
Ask pt to stick tongue out
 Place tongue depressor on middle third of
tongue
 Shine light at back of pt throat
 Ask pt to say “ah” & observe uvula
 Observe tonsillar pillars
 Touch posterior third of tongue & observe
for gag reflex

N= soft palate, uvula is midline and rises
symmetrically (CN IX & X), gag reflex is
present, tonsils are not enlarged
Throat - Inspection
Tonsils



pink, peppered
with indentations
or crypts.
No exudate
present
Graded
Tonsil - Grade
1+
2+
3+
4+
visible
halfway pillars/uvula
touching uvula
touching each other
Developmental Considerations
Infant and children
 Drool before they swallow
 Milia on nose
 No nasal flaring present
 Note # of teeth 20 temporary (by 2 ½)
 Lost between 6 and 12
Pregnant
 Gingivitis
 Stuffiness and epistaxis
Aging Adult
 Mouth and lips fold in
 Changes to appearance of teeth, gums recede
 Mucosa is shinier, thinner, less vascular
 Tongue is smoother (atrophy)
 Sense of smell diminishes