General Concepts
These are the four modalities of examination
What is inspection, palpation, percussion, and auscultation?
What is observe the patient's general appearance, gait / mobility / speech?
A continuous grating sound made by the TMJ upon opening
What is crepitus?
This cranial nerve (number and name) carries facial sensation and motor supply to the muscles of mastication, making it central to dentistry
What is cranial nerve V (the trigeminal nerve)?
A 58-year-old smoker has a firm, non-tender left upper-neck node just below the angle of the mandible that has been present for 6 weeks and does not move with swallowing. This is the single most appropriate next step
What is refer for evaluation / obtain fine-needle aspiration and imaging (treat as suspicious for malignancy)? A firm, fixed node >1.5 cm persisting ≥2 weeks warrants workup, not empiric antibiotics.
Two common presenting symptoms of head and neck cancer
The ABCDEs of skin lesions
Normal range of maximum mandibular opening
What is 35 -55mm?
Asking the patient to raise the eyebrows, close the eyes tightly, and smile tests this cranial nerve.
What is cranial nerve VII, the facial nerve?
A 17-year-old presents with jaw pain. Upon exam, they are able to open their mandible a maximum distance of 29mm. Describe this TMJ range of motion.
What is limited opening?
These are the two modalities of examination used in a dentist's extraoral head and neck exam
What are visual inspection and palpation?
Major salivary gland anterior to the ear
What is the parotid?
Normal range of mandibular lateral range of motion
What is >/= 7mm?
When the tongue is protruded, it deviates toward the side of a lesion of this cranial nerve
What is the hypoglossal nerve (CNXII)?
A 50-year-old with no dental pathology reports several weeks of numbness of the lower lip and chin on one side; a panoramic radiograph shows no local cause. This is the red-flag process that must be excluded.
What is malignancy / numb chin syndrome (metastatic disease of V3/mental nerve, classically breast cancer or lymphoma)?
A red flag is any abnormality lasting longer than this amount of time
What is 2 weeks?
The most commonly enlarged node in dental infections
What is the submandibular node?
The TMJ is roughly 2mm anterior to this orifice
What is the external auditory meatus (ear canal)?
When differentiating between a neck mass and a thyroid mass, you test this cranial nerve
What is the glossopharyngeal nerve (CN IX?)
A 40-year-old reports a lower anterior neck fullness. On inspection a diffuse swelling is visible below the thyroid cartilage; when the patient sips water and swallows, the mass rises and then descends. This is the most likely structure enlarged.
What is the thyroid?
Next step considerations when finding a red flag
What is re-evaluate and/or refer?
The upper jugular nodes just below the angle of the mandible, at high risk for metastases from oral cavity and oropharyngeal cancers, belong to this level
What is level II?
Mandibular opening pathway where the midline is shifted laterally to one side at maximum opening
What is deflection?
In a patient with no dental cause, an isolated numb chin is a red flag for this general disease process, most commonly breast cancer or lymphoma
What is metastasis?
A 62-year-old presents with a firm mass in front of and below the right ear; on exam the right corner of the mouth droops and the eye will not fully close. This is the worrisome diagnosis suggested by the combination.
What is a malignant parotid tumor? A parotid mass with facial nerve (CN VII) weakness is malignant until proven otherwise.