Assessment of Mouth, Throat, Nose and Sinuses (Return Demonstration)

The video begins by identifying the patient and outlining the assessment process for the mouth, throat, nose, and sinuses. The first step involves inspecting the external nose for symmetry, color, and any discharge. The clinician then palpates the external nose for tenderness, masses, or displacement, ensuring the patient's comfort and noting any abnormalities. Next, the patency of each nasal cavity is assessed by having the patient sniff while one nostril is occluded. Finally, the internal nasal cavities are inspected using a flashlight or speculum to check for redness, swelling, growths, or discharge, noting the dark pink, moist, and exudate-free appearance of healthy mucosa.

The assessment continues with palpation and percussion of the maxillary and frontal sinuses. The frontal sinuses are palpated by pressing upwards on the brow, and the maxillary sinuses are palpated by pressing upwards with the thumbs. Percussion is performed by lightly tapping over these areas to check for tenderness. Normal findings indicate no tenderness on palpation and percussion.

The assessment then moves to the mouth, starting with inspection of the outer lips for symmetry, color, and texture. Healthy lips are uniformly pink, moist, symmetric, and smooth. The patient is asked to purse their lips to check muscle function. The clinician then puts on gloves and inspects and palpates the inner lips and buccal mucosa for color, moisture, texture, and lesions, using a penlight and tongue depressor. The buccal mucosa should appear uniformly pink, moist, soft, glistening, and elastic.

The assessment proceeds to the gums and dentures, checking for color and consistency with retractable lips. Gums should be pinkish, with no discolorations or retractions. The tongue is then inspected for position, color, and texture, ensuring it is centrally positioned, pink, moist, and slightly rough. Tongue movement is assessed by having the patient press their tongue against the inside of their cheek to resist pressure. The base of the tongue, mouth floor, and frenulum are inspected with a penlight to check for Wharton's ducts and a short frenulum that might limit tongue movement. Finally, the tongue and floor of the mouth are palpated for nodules, lumps, or excoriated areas, looking for a smooth absence of lesions or ulcers.

The hard and soft palates are inspected for color, shape, texture, and bony prominences. The soft palate should be light pink and smooth, while the hard palate has a more irregular texture. The uvula is then inspected for position and mobility; the patient is asked to say 'ah' to observe the uvula and soft palate move, noting any unusual odors. The oropharynx is inspected for color and texture, which should be pink without exudate. Lastly, the tonsils are inspected for color, discharge, and size, and graded from 1 (tonsil behind the pillar) to 4 (in the midline). The gag reflex is elicited by touching the posterior third of the tongue to confirm it is intact.