Module 5 Oral Cancer Examination Oral Cancer Exam

Oral Cancer Exam § To properly perform an oral cancer examination, you will need:

Extraoral exam: Visually assess the § § § head face eyes ears neck

Second Step: Palpate Lymph Nodes Look for changes in: § Size § Mobility §

Lymph nodes to palpate include the: § § Preauricular Postauricular Submandibular Anterior & posterior

Intraoral Exam Visually and digitally assess the: § § § § Lips Labial mucosa

Changes to observe include: § absence of symmetry § enlargements § swellings § dry

Lips Assess: §Color §Texture §Presence of lesions on the upper and lower vermilion borders

Lips § Bidigitally palpate the lower lip from one commissure to the other for

Labial Mucosa Assess by pulling the upper and lower lip away from the teeth

Buccal mucosa Retract with a finger, mirror or tongue depressor. Look for changes in:

Buccal Mucosa - Bidigital Palpation Repeat procedure on the other side of the mouth.

§Begin with facial gingiva and alveolar ridges in the maxillary right posterior gingiva. §Follow

Tongue Observe the dorsum of the tongue for: §swelling §ulceration §coating §changes in papillae

Tongue Grasp the tip of the tongue with a piece of gauze and gently

Examine the ventral surface § Ask the patient to place the tip of the

Floor of the mouth §With the tongue still raised: §Inspect the floor of the

Floor of the mouth Look for changes in: §color §texture §swellings §ulcerations

Floor of the mouth § Bimanually palpate the sublingual area § Place the index

Palate With the patient’s head tilted back: observe the hard and soft palate

Oropharynx Visually assess the oropharynx

Anatomical Landmarks § The next several slides will show normal anatomical features present in

Features that represent deviations from normal that are observed on the tongue include: §Scalloped

Fissured tongue Used with permission from John L. Giunta, BS, DMD, MS http: //www.

Median rhomboid glossitis Used with permission from John L. Giunta, BS, DMD, MS http:

Geographic tongue Used with permission from John L. Giunta, BS, DMD, MS http: //www.

Hairy tongue Used with permission from John L. Giunta, BS, DMD, MS http: //www.

Mandibular Tori & Palatal Torus Used with permission from John L. Giunta, BS, DMD,

Summary § Performing an oral cancer examination involves a visual and tactile assessment of

The intraoral examination includes inspecting and palpating the: § § § § Lips Labial

If you find a lesion. . . • If oral cancer is strongly suspected,

The most important takehome message is: § Perform an oral cancer examination on all

Slides: 54

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Module 5 Oral Cancer Examination

Oral Cancer Exam § To properly perform an oral cancer examination, you will need: – a good light source – mouth mirror – gloves – gauze – tongue depressor

Extraoral exam: Visually assess the § § § head face eyes ears neck

Second Step: Palpate Lymph Nodes Look for changes in: § Size § Mobility § Consistency

Lymph nodes to palpate include the: § § Preauricular Postauricular Submandibular Anterior & posterior cervical § Occipital § Supraclavicular § Parotid salivary gland

Preauricular & Parotid Gland

Postauricular

Submandibular & Submental

Anterior Cervical

Posterior Cervical

Occipital

Supraclavicular

Intraoral Exam Visually and digitally assess the: § § § § Lips Labial mucosa Buccal mucosa Gingiva Tongue Floor of the mouth Palate

Changes to observe include: § absence of symmetry § enlargements § swellings § dry or crusty areas § lesions § color changes

Lips Assess: §Color §Texture §Presence of lesions on the upper and lower vermilion borders

Lips § Bidigitally palpate the lower lip from one commissure to the other for any changes in texture or swellings. Use the same technique for the upper lip.

Labial Mucosa Assess by pulling the upper and lower lip away from the teeth to observe the labial mucosa and frena for changes in: §color §texture §swelling

Maxillary Labial Mucosa

Mandibular Labial Mucosa

Buccal mucosa Retract with a finger, mirror or tongue depressor. Look for changes in: § color § texture § mobility § swelling § lesions

Buccal Mucosa - Bidigital Palpation Repeat procedure on the other side of the mouth.

§Begin with facial gingiva and alveolar ridges in the maxillary right posterior gingiva. §Follow the arch around to the left side. §Drop to the lower left and follow around to the lower right Gingiva

Tongue Observe the dorsum of the tongue for: §swelling §ulceration §coating §changes in papillae pattern §variations in size color texture

Tongue Grasp the tip of the tongue with a piece of gauze and gently pull out and to the side to allow complete observation Repeat on the other side.

Examine the ventral surface § Ask the patient to place the tip of the tongue on the palate to observe the ventral surface. § Palpate the tongue to feel for any growths.

Floor of the mouth §With the tongue still raised: §Inspect the floor of the mouth

Floor of the mouth Look for changes in: §color §texture §swellings §ulcerations

Floor of the mouth § Bimanually palpate the sublingual area § Place the index finger of one hand inside the mouth § Place the fingertips of the other hand extraorally under the chin

Palate With the patient’s head tilted back: observe the hard and soft palate

Oropharynx Visually assess the oropharynx

Anatomical Landmarks § The next several slides will show normal anatomical features present in the oral cavity, as well as some common features that are innocuous or self limiting.

Gingiva

Vestibule

Buccal Mucosa

Oropharynx

Dorsum of the tongue

Floor of the mouth

Palate

Features that represent deviations from normal that are observed on the tongue include: §Scalloped edges §Fissured tongue §Median rhomboid glossitis §Geographic tongue (erythema migrans) §Hairy tongue

Fissured tongue Used with permission from John L. Giunta, BS, DMD, MS http: //www. forsyth. org/oralpathology/case_014. htm

Median rhomboid glossitis Used with permission from John L. Giunta, BS, DMD, MS http: //www. forsyth. org/oralpathology/case_051. htm

Geographic tongue Used with permission from John L. Giunta, BS, DMD, MS http: //www. forsyth. org/oralpathology/case_013. htm

Hairy tongue Used with permission from John L. Giunta, BS, DMD, MS http: //www. forsyth. org/oralpathology/case_057. htm

Mandibular Tori & Palatal Torus Used with permission from John L. Giunta, BS, DMD, MS http: //www. forsyth. org/oralpathology/case_044. htm

Lips Herpetic lesions

Lips Angular cheilitis

Lips Actinic cheilitis

Buccal mucosa Linea alba

Labial mucosa Aphthous ulcers

Buccal mucosa Fordyce granules

Summary § Performing an oral cancer examination involves a visual and tactile assessment of head and neck. § The extraoral examination includes the face, neck, head, eyes, and ears. § Lymph nodes are palpated for masses and consistency.

The intraoral examination includes inspecting and palpating the: § § § § Lips Labial mucosa Buccal mucosa Gingiva Tongue Floor of the mouth Palate

If you find a lesion. . . • If oral cancer is strongly suspected, refer immediately for biopsy. • Reevaluate lesion in 14 days. If the lesion has not resolved after that length of time, measures should be taken, including a referral to a specialist for biopsy. • Use of the screening aids that are currently available may also be performed to assist in evaluating lesions.

The most important takehome message is: § Perform an oral cancer examination on all of your patients! § It takes very little time and may save a life!