Extraoral Examination

From the topic of oral examination, I was described a bit of what the extraoral examination is and what it includes. In this topic I want to go more in deep and explain more in detail how that extraoral examination is perform and which parts of the body is included. But first, I am going to copy paste some texts from the topic oral examination in order to refresh our mind what the extraoral examination was: 

So, the extraoral examination involves the examination of the head and neck which is the main part of oral examination to provide more information about the overall assessment of possible oral diseases. 

It is very important that you as a dentist should examine the cervical lymph glands. The cervical lymph glands is examined by firstly, standing behind the individual. Secondly, you can slightly flex and bend the neck to the side, in order to relax the sternocleidomastoid muscle. Thirdly, you will perform some kid of palpation and identification of any enlarged nodes. 
Other cervical lymph nodes can also be examined, such as submandibular, submental and upper deep nodes. 

The extraoral examination involves the following sequence: 
-- General overview of the skin areas (like in head, neck, limbs)
-- Perioral skin areas like in nose, cheeks and lips, by checking if there is any change of color, if there is a crest or fissures. 
-- Lymph nodes in head and neck. The size is till 1 cm and they should be constancy and movable. 
-- The cutaneous (skin) parts of the upper and lower lips. 
-- Temporomandibular joint (TMJ) and parotid gland region.

Now, I would like to explain more in detail how to perform the examination of each sequence of the extraoral examination. so, to start with, is the general overview of the skin areas. The general overview includes that you make an inspection of face, head and neck. Here it is very important to notice if there is an asymmetry or changes on the skin such as crusts, fissuring, growths, and/or color change in the face, ears, and neck.

The areas of lymph nodes in head and neck, are palpated bilaterally because here we want to detect any enlargements. In case of enlargement, the examiner should determine the mobility and consistency of the nodes. Also, it is very necessary for the examiner to go through a recommended order of examination, like:
1. Preauricular nodes
2. Submandibular nodes
3. Anterior  cervical region
4. Posterior auricular node
5.  Posterior cervical regions

For the examination of the lips, it is necessary to start the examination by observing the lips with the patient's mouth both closed and open. It is a good idea to note if there is any changes of color, texture and if there are any surfaces abnormalities of the upper and lower vermilion borders.

The last sequence of the extraoral examination is the assessment of temporomandibular joint (TMJ). Here, as an examiner, you might look after if there is any dysfunction like popping and/or clicking of the joints. This can be detected by placing the tip of the little finger in the external auditory canal and ask then ask the patient to open and close the mouth and by moving the mandible laterally from side to side. In case of clicking, it will be evaluated by a sharp sound or by palpation of temporomandibular joint. In case of palpation or tenderness, it can be detected by unilateral palpation by making a pressure of two fingers, exerted twice on the most voluminous part of the muscle. 

It is always a very important thing to do such type of examinations even before doing any type of work, because it will let you know what patient has for problems, and it will be more easier for you to make any procedure. 

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