Examination of the Throat

The exam of the oral cavity includes inspection and palpation in patients at high risk for head and neck cancers. Remember to ask patients who wear dentures to remove them so you may see the mucosa underneath.

Lips, oral mucosa and gums:

Evaluate the lips, noting color and moisture level. Scaliness or cracking may be indicative of pathology. With a good light source, ask the patient to open his or her mouth. Evaluate the oral mucosa for ulcers, color changes or nodules. Note the color of the normally pink gums, recognizing that in people of color, brown patches may be normal. Evaluate the dentition and note the presence of gum erythema or edema suggestive of gingivitis.

Hard and soft palate:

Inspect the color and shape of the hard and soft palates. Normal mucosa is pink with a ridged hard palate. Torus palatinus may be present, and is a variation of normal.

Tongue:

Ask the patient to put out his or her tongue while you inspect for symmetry. The normal architecture of the tongue includes papillae that get bigger toward the rear of the tongue. Inspect the top, sides and undersurface of the tongue, noting any color variation, ulcerations or nodular lesions.

Pharynx:

With the patient's mouth open, ask the patient to say, "ahh." In a patient with an intact 10th cranial nerve, this action should raise the soft palate enabling full visualization of the pharynx. If this does not allow visualization, use a tongue blade to depress the tongue. Inspect the tonsilar pillars, tonsils if present, uvula and pharynx. Evaluate for color, symmetry, exudate and enlargement.

Click on the video icon to view a demonstration of throat exam techniques.