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Accelerate dz. Indicate Dz - Severity. Reveal asymptomatic dz’s. SIGNIFICANCE OF HISTORY AND EXAM. RISK FACTORS. SYMPTOMS. SIGNS. Symptoms. PAIN. FUNCTION. ASYMTOMATIC PROBLEMS. HISTORY. EXAM. Risk Factors . Cardiac arrhythmia Hypertension Oral cancer. Signs.

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slide1

Accelerate dz

Indicate Dz - Severity

Reveal asymptomatic dz’s

SIGNIFICANCE OF HISTORY AND EXAM

RISK FACTORS

SYMPTOMS

SIGNS

slide2

Symptoms

PAIN

FUNCTION

ASYMTOMATIC PROBLEMS

HISTORY

EXAM

Risk Factors

Cardiac arrhythmia

Hypertension

Oral cancer

Signs

standard patient assessment

Ass/Dx (Assessment / Diagnosis)

Plan

Reassessment

EXAM

VS (Vital Signs)

E/O (Extraoral)

I/O (Intraoral)

Tests (Vitality/Mobility)

RADIOLOGY

HISTORY

CC (Chief Complaint)

HPI (History of present Illness)

PDHx (Past Dental History)

PMHx (Past Medical History)

ROS (Review of System)

SHx (Social History)

FHx (Family History)

Meds (Medications)

All (Allergies)

STANDARD PATIENT ASSESSMENT

slide4

COMPETENCY EXAM

  • PHYSICAL EXAMINATION
  • You are required to demonstrate the following diagnostic procedures:
      • - Take vital signs and document findings in the proper write-up
      • Palpate regional lymph nodes and landmarks of the neck (hyoid bone, stylohyoid process, thyroid and cricoid cartilage, thyroid gland, mastoid process, vertebral processes, carotids).
      • Perform a neurologic exam of cranial nerves
      • Perform regional muscle exam (know origins and insertions of muscles of mastication and major neck muscles)
      • Perform an intraoral exam, identifying intraoral anatomic landmarks (mucocutaneous junction; labial or lingual frenum; Stenson’s duct; Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; Fordyce granules, if present)
      • Perform examination of salivary gland function
      • Know the cardinal features of inflammation
      • Know how to describe a lesion or a node/lump/mass.
standard patient assessment5

Ass/Dx (Assessment / Diagnosis)

Plan

Reassessment

EXAM

VS (Vital Signs)

E/O (Extraoral)

I/O (Intraoral)

Tests (Vitality/Mobility)

RADIOLOGY

HISTORY

CC (Chief Complaint)

HPI (History of present Illness)

PDHx (Past Dental History)

PMHx (Past Medical History)

ROS (Review of System)

SHx (Social History)

FHx (Family History)

Meds (Medications)

All (Allergies)

STANDARD PATIENT ASSESSMENT

slide6

VITAL SIGNS:

Pulse: 68 reg.

BP: 130/85 RAS (right arm sitting)

standard patient assessment7

Ass/Dx (Assessment / Diagnosis)

Plan

Reassessment

EXAM

VS (Vital Signs)

E/O (Extraoral)

I/O (Intraoral)

Tests (Vitality/Mobility)

RADIOLOGY

HISTORY

CC (Chief Complaint)

HPI (History of present Illness)

PDHx (Past Dental History)

PMHx (Past Medical History)

ROS (Review of System)

SHx (Social History)

FHx (Family History)

Meds (Medications)

All (Allergies)

STANDARD PATIENT ASSESSMENT

slide8

COMPETENCY EXAM

  • PHYSICAL EXAMINATION
  • You are required to demonstrate the following diagnostic procedures:
      • - Take vital signs and document findings in the proper write-up
      • Palpate regional lymph nodes and landmarks of the neck (hyoid bone, stylohyoid process, thyroid and cricoid cartilage, thyroid gland, mastoid process, vertebral processes, carotids).
      • Perform a neurologic exam of cranial nerves
      • Perform regional muscle exam (know origins and insertions of muscles of mastication and major neck muscles)
      • Perform an intraoral exam, identifying intraoral anatomic landmarks (mucocutaneous junction; labial or lingual frenum; Stenson’s duct; Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; Fordyce granules, if present)
      • Perform examination of salivary gland function
      • Know the cardinal features of inflammation
      • Know how to describe a lesion or a node/lump/mass.
slide9

DISASTERS

CANCER

slide11

4 RF

Dz

3 RF

2 RF

1 RF

RISK FACTORS (RF)

infection

The concept of

T

local

regional

N

systemic

M

TUMOR

PAIN

local

INFECTION

slide13

INFECTION

NEOPLASM

OTHERS

  • leukemia
  • connective tissue diseases (e.g. lupus erythematosus)
  • sarcoidosis

CERVICAL LYMPH NODE ENLARGEMENT

  • bacterial
  • viral (local / systemic)
  • fungal
  • postinfect. fibrosed node
  • < 40 yrs: lymphoma
  • > 40 yrs: metastatic SCC
diagnostic approach for head and neck tumors

Diagnostic approach for Head and Neck Tumors

1) Rule out lymphadenopathy caused by infection

bacterial (odontogenic, tonsils)

viral (respiratory epithelium)

2) Search for oral squamous cell carcinoma

3) Follow up in 2 weeks: if still present, refer to ENT specialist for evaluation

Asymmetric enlargement of one or more cervical lymph nodes in an adult over 40 is almost always cancerous and usually is due to metastasis from a primary lesion in the mouth or pharynx.

slide15

40%

stage I & II

60%

stage III & IV

80-90% cure

2/3 recurrence < 2 yrs

< 1/3 survive 3 yrs.

Second primary tumor in successfully treated patients within 5-7 years: up to 40% !!! Follow-up important!!!

Importance of early diagnosis of squamous cell carcinoma

therefore
therefore…….

...know the H&N anatomy!!!

...performing a H&N exam for EVERY dental check-up!!!

...following up on suspicious signs!!!

differential diagnosis of lateral tumors of the neck
Differential diagnosis of lateral tumors of the neck
  • Salivary gland (sublingual / submandibular / parotis)
  • Lymph node
  • Soft tissue tumor (Lipoma, Fibroma)
  • Neurofibroma
  • Esophageal diverticulum
  • Laryngocele
  • Branchial cyst
  • Carotid aneurysm
  • Hyoid bone
  • Transverse process of cervical spine
differential diagnosis of midline tumors of the neck
Differential diagnosis of midline tumors of the neck
  • Thyroid
  • Dermoid cyst
  • Sebaceous cyst
  • Thyroglossal duct
  • Lymphnode
slide19

COMPETENCY EXAM

  • PHYSICAL EXAMINATION
  • You are required to demonstrate the following diagnostic procedures:
      • - Take vital signs and document findings in the proper write-up
      • Palpate regional lymph nodes and landmarks of the neck (hyoid bone, stylohyoid process, thyroid and cricoid cartilage, thyroid gland, mastoid process, vertebral processes, carotids).
      • Perform a neurologic exam of cranial nerves
      • Perform regional muscle exam (know origins and insertions of muscles of mastication and major neck muscles)
      • Perform an intraoral exam, identifying intraoral anatomic landmarks (mucocutaneous junction; labial or lingual frenum; Stenson’s duct; Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; Fordyce granules, if present)
      • Perform examination of salivary gland function
      • Know the cardinal features of inflammation
      • Know how to describe a lesion or a node/lump/mass.
slide20

CARDINAL FEATURES OF INFLAMMATION

Redness

Heat

Swelling

Pain

Dysfunction

slide21

COMPETENCY EXAM

  • PHYSICAL EXAMINATION
  • You are required to demonstrate the following diagnostic procedures:
      • - Take vital signs and document findings in the proper write-up
      • Palpate regional lymph nodes and landmarks of the neck (hyoid bone, stylohyoid process, thyroid and cricoid cartilage, thyroid gland, mastoid process, vertebral processes, carotids).
      • Perform a neurologic exam of cranial nerves
      • Perform regional muscle exam (know origins and insertions of muscles of mastication and major neck muscles)
      • Perform an intraoral exam, identifying intraoral anatomic landmarks (mucocutaneous junction; labial or lingual frenum; Stenson’s duct; Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; Fordyce granules, if present)
      • Perform examination of salivary gland function
      • Know the cardinal features of inflammation
      • Know how to describe a lesion or a node/lump/mass.
slide22

DESCRIPTION OF MASSES / LYMPHNODES

  • Location
  • Size (< 1cm >)
  • Tenderness
  • Consistency
  • Mobility
slide23

COMPETENCY EXAM

  • PHYSICAL EXAMINATION
  • You are required to demonstrate the following diagnostic procedures:
      • - Take vital signs and document findings in the proper write-up
      • Palpate regional lymph nodes and landmarks of the neck (hyoid bone, stylohyoid process, thyroid and cricoid cartilage, thyroid gland, mastoid process, vertebral processes, carotids).
      • Perform a neurologic exam of cranial nerves
      • Perform regional muscle exam (know origins and insertions of muscles of mastication and major neck muscles)
      • Perform an intraoral exam, identifying intraoral anatomic landmarks (mucocutaneous junction; labial or lingual frenum; Stenson’s duct; Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; Fordyce granules, if present)
      • Perform examination of salivary gland function
      • Know the cardinal features of inflammation
      • Know how to describe a lesion or a node/lump/mass.
slide24

COMPETENCY EXAM

  • PHYSICAL EXAMINATION
  • You are required to demonstrate the following diagnostic procedures:
      • - Take vital signs and document findings in the proper write-up
      • Palpate regional lymph nodes and landmarks of the neck (hyoid bone, stylohyoid process, thyroid and cricoid cartilage, thyroid gland, mastoid process, vertebral processes, carotids).
      • Perform a neurologic exam of cranial nerves
      • Perform regional muscle exam (know origins and insertions of muscles of mastication and major neck muscles)
      • Perform an intraoral exam, identifying intraoral anatomic landmarks (mucocutaneous junction; labial or lingual frenum; Stenson’s duct; Wharton’s duct; Incisive papilla; Retromolar pad; Maxillary tuberosity; Foliate papillae; Circumvallate papillae; Linea alba; Fordyce granules, if present)
      • Perform examination of salivary gland function
      • Know the cardinal features of inflammation
      • Know how to describe a lesion or a node/lump/mass.