Nose, Mouth, and

Throat
By Orest Kornetsky

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

Nose Sinuses

Only the ethmoid and

maxillary sinuses are
present at birth.
Frontal develop
between 7 and 8
years. Sphenoid
develop after
puberty.
Which sinuses can
we examine?

Frontal
and
maxillary

Mouth A & P

Hard palate made out of bone (whitish color)

Soft palate made out of muscle (more pink in color)
Uvula hangs from middle of soft palate
Tongue striated muscle assist with mastication and
swallowing. Papillae on dorsal surface of tongue hold
neurons responsible for taste

Mouth
Salivary Glands

Parotid gland

Submandibular
gland

Located superior of
mandibular angle

Lies beneath the

mandible

Sublingual gland

Lies posterior to
the tongue at the
floor of the mouth

Function of the glands is

to secrete saliva

Nasopharynx

(adenoi
ds)

Oropharynx

Located behind the nose, above

the soft palate
Contains adenoids (pharyngeal
tonsils)
Eustachian tube opens during
swallowing to equalize pressure
within the middle ear

Throat
(Pharynx)

Located behind the mouth,

below the nasopharynx
Shared passageway for
breathing and swallowing
Contains palatine tonsils, which
guard the body against
microorganisms

Laryngopharynx

Extends from base of tongue to

the esophagus
Critical dividing point where
solids are separated from air
Divides larynx from esophagus

Named according to
location

Developmental
Considerations Infants
and
Children
Children have
20 deciduous
(temporary) teeth

(compared to the adults 32).

Deciduous teeth are lost beginning at 6 years until
about 12

Developmental
Considerations - Aging

Nasal hair grow coarser and stiffer and may

not filter air as well. Decreased sensation of
smell.
Loss of taste due to soft tissue atrophy
Decrease in salivary secretion
Tooth surface is abraded. Gums begin to
recede and erode.
Poor oral hygiene may cause tooth loss,
which increase the difficulty of mastication
Use of medications may have anticholinergic
effects, which further decrease salivation

Health History

Nasal discharge?
(rhinorrhea) Cold,
allergies, sinus
infection, trauma
Frequent colds?
immunosuppression
Epistaxis
(nosebleeds)? may
occur with trauma,
irritants
Allergies?
Sores or lesions in
mouth or oral cavity?
may be malignant

Sore throat? Determine

if bacterial or viral
cause. Strep throat may
lead to rheumatic fever.
Are tonsils still in place?
Bleeding gums or
toothache? may
indicate poor oral
hygiene
Any voice changes?
Dysphagia (difficulty
swallowing)? may be
caused by GERD,
pharyngitis, neurologic
diseases, cancer.

Assessing the
External nose Nose

Normal nose is symmetric, midline,

proportional
Test for obstruction of by blocking
each nare and asking the person to
inhale with the open nare.

Nasal cavity

Insert otoscope into the nasal

vestibule, lifting the tip of the nose
Normal nasal mucosa pink, smooth,
and moist
Abnormal note any bleeding,
swelling, redness, discharge, foreign
body

Rhinitis mucosa swollen, red, and

often includes discharge (watery, thick,
purulent, green) in upper resp
infection

Observe for deviated septum, which is

only significant if airflow is obstructed
Observe turbinates for polyps (benign
growths) smooth, gray, avascular,
mobile, nontender

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

Assessing the Lips

Black people normally have bluish lips

What do bluish lips signify in light
skinned people?

Pallor on lips?

Painful fissures at corners of mouth caused

by Candida infection

Herpes simplex virus

CO poisoning, acidosis

Angular cheilitis (inflammation of lips)

Anemia, shock

Cherry red lips?

Hypoxemia or hypothermia

Mostly HSV-1 virus, possibly HSV-2

Vesicles or pustules, highly contagious

Carcinoma

Mostly crusted or ulcerated

Assessing Teeth

Teeth normally look white,

straight, and free of decay.
In the back, the upper
molars should directly rest
on the lower molars. In the
front, upper incisors should
overlap lower incisors

Yellowing as result of tobacco

use
Malocclusion misalignment of
upper and lower teeth
Dental carries tooth decay as
result of acids produced by
bacteria eating
carbohydrates and sugars,
destroying enamel.

Assessing Gums

Normally the gums look pink,

with well defined margins
between teeth and gums

Gingival hyperplasia
enlargement of gums. Possible
SA of Dilantin
Gingivitis redness, swelling,
or bleeding of gum margins
caused by anaerobic bacteria as
a result of poor dental hygiene
or vitamin C deficiency . If
disease is untreated and
spreads to bone, the result is
periodontitis (absorption of
bone)

Assessing the Tongue

Normally the tongue is pink with a

roughened dorsal surface and
moist underneath
Inspect tongue by holding it with
cotton gauze pad and moving to
each side

Tongue
Abnormalities

Enlarged tongue
(macroglossia)

Fissured tongue

occurs in Down
syndrome, acromegaly,
cretinism, myxedema
congenital, benign.
Mild form may be
caused by dehydration

Candidiasis

White, cheesy, patch on

buccal mucosa or
tongue
Occurs after use of
antibiotics, steroids,
and immunosuppression
(AIDS)

Tongue
Abnormalities
Atrophic Glossitis (glossy
tongue)

Black hairy tongue

surface of tongue is smooth and

shiny, burning. Occurs with
pernicious anemia (vit B 12
deficiency), folic acid deficiency,
and iron deficiency anemia
fungal infection usually due to
prolonged antibiotic use

Carcinoma

common underneath the tongue

Assessing the
Buccal
Mucosa

Normal mucosa looks

pink, smooth, and moist
Inspect by using light and
a tongue blade
Note presence of
Stensens ducts (openings
of parotid gland) which
are inflamed and red with
mumps

Kopliks spots prodromal

sign of measles

Also notice breath. Fruity

odor might indicate
ketoacidosis.

Assessing the Palate

The anterior hard palate is normally filled with

irregular transverse rugae

Might appear yellow with jaundice in whites and

yellow-brown in blacks

The posterior soft palate is pinker, smooth, and

upward movable. Contains the uvula

To check for CN X (vagus nerve) reflex, ask person

to open mouth and say ahhhh. Uvula should move
up.

Palate Abnormalities

Cleft palate is a congenital defect where the

maxillary process fails to fuse. This causes a
gap in the hard palate and possibly the upper
lip. Surgery required.

Assessing the
Tonsils

Normal are pink at the

sides of mouth, barely
visible
Inspect by depressing the
tongue blade on the tongue
During an upper
respiratory infection, the
tonsils become bright red,
swollen, and might contain
exudate and/or white spots

1+ tonsils visible
2+ tonsils inflamed
3+ tonsils touching uvula
4+ tonsils touching each
other

Question 1

A 70-year-old woman complains of

dry mouth. The most frequent
cause of this problem is:
1.
2.

3.
4.

The aging process

Related to medications she may be
taking
The use of dentures
Related to a diminished sense of smell

Question 2

Because of history of headache, the

examiner uses transillumination to
assess for an inflamed sinus. The
findings in a healthy individual would
be:
1.
2.
3.
4.

A diffuse red glow

No transillumination
Findings vary with ethnicity of the person
Light visible in the nares through a
speculum

Question 3

The nurse observes blackish lesions on

the top of the tongue of an adult client.
The client indicates that his tongue is
painful. Which question by the nurse
would be helpful in explaining this
finding?
1.
2.
3.
4.

Have you been taking antibiotics lately?

Have you injured your tongue?
Have you been diagnosed with a mouth
cancer before?
When was the last time you brushed your
teeth?

Question 4

Which of the following statements

made by a 72-year-old client is
considered a normal process or aging?
1.
2.
3.

4.

My tongue feels swollen.

My tonsils are large and sore.
I have white and black spots under my
tongue.
Food does not taste the same as it used
to.