In The Name of God

(A PROJECT OF NEW LIFE COLLEGE OF NURSING KARACHI)

UNIT-4
Assessment of Nose,
Mouth, & Pharynx.
Shahzad Bashir
RN, BScN, DCHN
Instructor
New Life College of Nursing
December 01, 2015
 Objectives
• By the end of this unit, learners will be able to:
• Review the anatomy & physiology
• Describe the component of health history that
should be elicited during the assessment of nose,
mouth & pharynx.
• Identify the structural landmarks of the nose,
mouth & pharynx.
• Describe specific assessment to be made during
the physical examination of the above systems.
• Practice assessment skills of nose, mouth &
pharynx.
• Documents findings.
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 Structure and function of Nose
• Nose and paranasal sinuses are first segment of
the respiratory system

• Responsible for receiving, filtering, warming, and

moistening inhaled air

• Sensory organ for smell, because cranial nerve I

(Olfactory) located in it.

• Nose consists of two portions.

– External and Internal

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 Structure and function of Nose

• Nose anatomy
– Bridge is the superior part (nasal bone)
– Tip is the anterior part of nose (cartilage)
– Hair – Filter coarse matter from entering nasal cavity
– Ciliated mucous membrane filters dust and bacteria. The rich blood
supply warms and humidifies the air
– Turbinates (conchae) increase the surface are of the nasal cavity so that
more air is filtered, warmed, and humidified
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 External parts
• Covered with Skin, and composed of bone and
cartilage & is lined with mucous membrane.
• Bridge
• Tip
• Nares
• Vestibule -nares widen in to vestibule
• Columella divides the nares
• Ala –lateral outside wing of the nose bilaterally
• Upper 1/3 nose is bone; rest is cartilage

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 Internal parts
• Nasal cavity, extends back over the roof of the
mouth

• Nasal hair, ciliated mucous membrane – red

due to ↑ bld. supply

• Septum-divides cavity into 2 passages

– Kiesselbach’s area, most common site of nasal
bleeding.
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 Internal
• Superior, middle, inferior turbinates - 3 parallel
bony projections on lateral walls of each cavity

• Meatus - cleft underlying each turbinate. The

sinuses drain into the middle, tears from the
nasolacrimal duct drain into the inferior

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 Sinuses
• Paranasal sinuses- air- filled pockets in the cranium
• Purpose
– ↓ wt. of the skull
– Serve as resonators for sound
– Provide mucous for the nasal cavity

• Primary site of infection because they can easily

become blocked & develop inflammation/sinusitis.
– Frontal Accessible during examination
– Maxillary
– Ethmoid
– Sphenoid

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 Paranasal Sinuses

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 Assessing the Sinuses
• Palpation
– Using thumbs, palpate
the frontal and maxillary
sinuses
• Tenderness in persons
with sinusitis or allergies

• Transillumination
– Using a pen light in a
darkened room, place
light under the superior
orbital ridge, inferior to
the frontal sinuses
• Clear sinuses should
transilluminate
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 Inspection of Nose
Internal (Nasal Cavity):
• Mucosa:
– Color
– Condition swelling, exudates, bleed
• Septum:
– Deviation, Perforation exudates.
• Turbinate:
– Color, Swelling, Discharge, Polyp.

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 Subjective data Nose
• Discharge
• Frequent colds
• Sinus pain
• Trauma
• Epistaxis
• Allergies
• Altered smell

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 Mouth
• Mouth and throat (pharynx), first segment of the
digestive system

• Responsible for receiving food (ingestion), taste,

preparing food for digestion, & aiding in speech.

• Airway for the respiratory system

• ORAL CAVITY
– Lips, cheeks
– Palate
1. Hard
2. Soft
3. Uvula – hangs down from the soft palate

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 Mouth
• Cheeks- side walls of cavity

• Tongue
1. Papillae- rough, bumpy elevations on dorsal
2. Frenulum
3. Taste buds

• Teeth – 32 permanent
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 Mouth
• Salivary glands
1. Parotid- largest of the glands, located in the
cheeks, front of the ear. Stenson’s duct opens in
buccal mucosa
2. Submandibular - walnut size, beneath the
mandible at the angle of the jaw. Wharton’s duct
either side of the frenulum
3. Sublingual –smallest, almond shape, under
tongue

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 Mouth & Pharynx
• Use gloves, tongue depressor, light
• Position & Equipments:
• Inspection & Palpation:
• LIPS:
– Color
– Shape, Symmetry
– Condition, moist, cracks, edema.
– Lesions. Lumps, ulcers or fissures (Herpes,
Chancre, Cheilosis/ Angular stomatitis, Chelitis,
Mucocele, Carcinoma)
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 Conti….
• Throat
– Oropharynx
– Tonsils
– Nasopharynx

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 Equipment for examination of
Nose, Mouth and Throat
– Otoscope with short, wide-tipped
nasal speculum
– Pen light
– Two tongue blades
– Cotton gauze pad
– Gloves

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 Inspection and palpation of nose
• External nose
– Tenderness, discharge ,trauma, bleeding,
lesions, masses, swelling, asymmetry
– Test patency of nostril
• Inspection of internal nose
– Speculum or otoscope with nasal speculum
– Nasal cavity
Nasal septum
Turbinates
– Sinus Areas- Palpate
Frontal and maxillary sinuses
Transillumination
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 • Normal findings
–Located in midline of face
–No swelling, bleeding, lesions, or
masses
–Both nostrils patent
–Septum midline
–Nasal mucosa is pink or dull red

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 • Abnormal findings
–Broken, misshapen, swollen
nose
–Occluded nasal passages
–Septum is deviated
–Nasal mucosa is red and
swollen
–Purulent drainage

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 Assessment of the Sinuses

• Inspection (Sinus Transillumination)

• Palpation and percussion
• Normal findings
–No discomfort during palpation or
percussion
–Resonance heard on percussion

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 Assessment of the Mouth
Inspect Mouth
– Lips
– Teeth and gums
– Tongue
– U-shaped areas under the tongue
– Buccal mucosa
– Uvula
– Hard and soft palate

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 Mouth inspection and palpation
• LIPS inspect for color, moisture, cracking, or
lesions. Palpate lips, and face for mass and
tenderness

• TEETH/gums note any diseased absent, loose

teeth gums should be pink, check for swelling,
retraction of gum margins spongy, bleeding
discolored gums.

• TONGUE color pink and even dorsal side

roughened, ventral smooth, glistening, shows
veins Inspect under tongue for nodules,
lesions, ulcerations
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 Cont…
• Buccal mucosa looks pink, smooth, moist,
dark skinned people may have patchy
hyperpigmentation

• Uvula fleshy pendant midline uvula and soft

palate rise with “ahhh” sound. anterior hard
palate is white with irregular transverse
rugae the posterior soft palate is pinker
smooth, and upwardly movable.

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 • Normal findings of Mouth
– Breath is fresh
– Pink, moist lips
– Tongue midline, symmetrical, with
adequate movement
– No pockets between gums and teeth
– No bleeding
– Smooth, white teeth; proper alignment, no
dental caries

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• Abnormal findings of Mouth
– Lesions, growths
– Dry, cracked lips
– Vesicles or blisters
– Red, tender, inflamed tongue, gums, buccal
mucosa
– Thrush
– Coating on tongue
– Red, tender, swollen gingiva
– Bleeding gums
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 Inspection of the Throat
• Position, size, color,and general
appearance of tonsils and uvula
• Gag reflex
• Color of oropharynx
• Presence of swelling, exudate,
lesions

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 Assessment of tonsils

– Enlarged tonsils are graded

• Grade 1 – wnl
• Grade 2 – tonsils b/w pillars and
uvula
• Grade 3 – tonsils touching uvula
• Grade 4 – tonsils touching each other
(kissing tonsils)

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 References

1. Bickley, L. S., Szilagyi, P. G., & Bates, B.

(2007). Bates' guide to physical examination
and history taking (11th Edi). Philadelphia:
Lippincott Williams & Wilkins. Chapter
No.06 & 07 p.n 171-250

2. Weber, Kelley's. (2007). Health Assessment

in Nursing, 3rd Ed: North American Edition.
Lippincott Williams & Wilkins. Chapter
No.14 &15 p.n 239-294
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