Chapter 17- Nose, Mouth, Throat

Describe the appearance and clinical significance of these findings on the tongue: ankyloglossia, fissured tongue, geographic tongue, black hairy tongue and macroglossia

- ankyloglossia: congenital defect, a short lingual frenulum, here fixing the tongue tip to the floor of the mouth and gums.-fissured tongue or scrotal: Deep furrows divide the papillae into small irregular rows, increase with age. The condition occurs in 5% of the general population and Down Syndrome.-geographic tongue: pattern of normal coating interspersed with bright red, shiny, circular bllad area with raised pearly borders. Pattern resembles a map and changes in a few days. Cause is unknown.-black hairy tongue: this is not hair, rather, the elongation of filiform papillae and painless overgrowth of mycelial threads of fungus infection on the tongue.-macroglossia: enlarged tongue- The tongue is enlarged and may protrude from the mouth. The condition is not painful but may impair speech development. Occurs with Down syndrome, cretinism, myxedema, acromegaly.

Contrast the appearance and clinical significance of these findings in the infant: sucking turbercle, epstein pearls and bednar aphthae

-Sucking tubercle: a normal finding in infants, a small pad in the middle of the upper lip from friction of breastfeeding or bottle-feeding. • Epstein's pearls: a normal finding in newborns and infants, small, white, glistening, pearly papules on the hard palate, and on the gums, where they look like teeth. They are small retention cysts and disappear in the first few weeks. See Fig. 17.22. • Bednar aphthae: traumatic areas or ulcers on the posterior hard palate on either side of the midline that result from abrasions while sucking.

List the 4 point grading scale for the size of tonsils

1+ Visible. 2+ Halfway between tonsillar palate and uvula. 3+ Touching the uvula. 4+ Touching each other.

Describe the appearance of a deviated nasal septum and a perforated septum

A deviated nasal septum looks like a hump or shelf in one nasal cavity. See Fig. 17.9. A perforated septum is seen as a spot or light from a penlight that is shining in the other naris. See Table 17.1, Nose Abnormalities.

After tooth loss in the middle or older adult, describe the consequences of chewing with the remaining maloccluded teeth.

If tooth loss occurs, the remaining teeth drift, causing malocclusion. The stress of chewing with maloccluding teeth causes the following problems: • Excessive bone resorption with further tooth loss. • Muscle imbalance resulting from a mandible and maxilla now out of alignment, which produces muscle spasms, tenderness of muscles of mastication, and chronic headaches. • The temporomandibular joint is stressed, leading to osteoarthritis, pain, and inability to fully open the mouth.

Contrast the physical appearance and clinical significance of the following: leukoedema; candidiasis, leukoplakia, fordyce granules

Leukoedema: a large, grayish opaque patch that may be present along the buccal mucosa. It is more common in blacks and East Indians. When it is mild, the patch disappears as you stretch the cheeks. The severity increases with age, and it looks grayish white and thickened. The cause is unknown. • Candidiasis: monilial infection, a white, cheesy, curdlike patch on the buccal mucosa and tongue. It scrapes off, leaving a raw, red surface that bleeds easily. See Table 17.4, Buccal Mucosa Abnormalities. • Leukoplakia: chalky, white, thick, raised patch with well-defined borders. The lesion is firm and does not scrape off and is due to chronic irritation. These lesions are precancerous. See Table 17.4, Buccal Mucosa Abnormalities. • Fordyce's granules: small, isolated white or yellow papules on the mucosa of the cheek, tongue, and lips. They are painless sebaceous cysts and not significant.

List the 3 pairs of salivary glands, including their location and the locations of their duct openings

Parotid salivary gland: the largest, lies within the cheeks, in front of the ear, and extends from the zygomatic arch down to the angle of the jaw. Its duct, Stensen's duct, runs forward to open on the buccal mucosa of the second molar. • Submandibular gland: the size of a walnut, lies beneath the mandible at the angle of the jaw. Its duct, Wharton's duct, runs up and forward to the floor of the mouth and opens at either side of the frenulum. • Sublingual gland: the smallest, is almond shaped and lies within the floor of the mouth under the tongue. It has many small openings along the sublingual fold under the tongue.

contrast the appearance of nasal turbinates versus nasal polyps

The inferior nasal turbinates should appear the same light red color as the nasal mucosa. Nasal polyps are smooth, pale gray, avascular, mobile, and nontender. See Table 17.1, Nose Abnormalities.

Describe the size and components of the nasal cavity

The nasal cavity is actually much larger than the external nose would indicate. The anterior edge is lined with numerous coarse nasal hairs. The rest of the cavity is lined with a blanket of ciliated mucous membrane. See Fig. 17.1.

Name the functions of the nose

The nose warms, moistens, and filters the inhaled air, and it is the sensory organ for smell.

List the 4 sets of paranasal sinuses, and describe their function

The paranasal sinuses are air-filled pockets within the cranium. They are connected to the nasal cavity and serve to lighten the weight of the skull bones, serve as resonators for sound production, and provide mucus, which drains into the nasal cavity. There are four sets of sinuses. The maxillary and frontal sinuses are accessible to examination. The ethmoid and sphenoid sinuses are smaller and deeper within the skull. See Fig. 17.3.

describe the appearance of a torus paltinus, and explain its significance

Torus palatinus: a normal variation, a nodular bony ridge down the middle of the hard palate. It is a benign growth that occurs after puberty and is a more common finding in Native Americans, Inuits, and Asians.