Oral cancer physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]Associate Editor(s)-in-Chief: Simrat Sarai, M.D. [2]

Overview

Common physical examination findings of oral cancer include a lump or thickening in the oral soft tissues, soreness, difficulty chewing or swallowing, ear pain, difficulty moving the jaw or tongue, hoarseness, numbness of the tongue or swelling of the jaw that causes dentures to fit poorly.

Physical Examination

A thorough head and neck examination should be a routine part of each patient's dental visit and general medical examination.

Oral Cavity Examination

The extraoral and perioral tissues are examined first, followed by the intraoral tissues.

The Extraoral Examination

The extraoral assessment includes inspection of the face, head, and neck.

• The face, ears, and neck are observed for any asymmetry or changes on the skin such as crusts, fissuring, growths, or color change.
• Lymph node areas are bilaterally palpated to detect any enlarged nodes. If enlargement is detected, determine the mobility and consistency of the nodes.

Perioral and Intraoral Soft Tissue Examination

The perioral and intraoral examination procedure follows a seven-step systematic assessment of the lips, labial mucosa and sulcus, commissures, buccal mucosa, and sulcus; gingiva and alveolar ridge, tongue, floor of the mouth, and hard and soft palate.

• Observe the lips with the patient's mouth both closed and open. Note the color, texture and any surface abnormalities of the upper and lower vermilion borders.
• With the patient's mouth partially open, visually examine the labial mucosa and sulcus of the maxillary vestibule and frenum and the mandibular vestibule.
• Observe the color, texture, and any swelling or other abnormalities of the vestibular mucosa and gingiva.
• Retract the buccal mucosa. Observe any change in pigmentation, color, texture, mobility, and other abnormalities of the mucosa.
• Examine the buccal and labial aspects of the gingiva and alveolar ridges.
• Examine left mandibular posterior gingiva and alveolar ridge and move around the arch to the right posterior area.
• Examine the palatal and lingual aspects as had been done on the facial side, from right to left on the palatal (maxilla) and left to right on the lingual (mandible).
• Inspect the dorsum of the tongue for any swelling, ulceration, coating, or variation in size, color, or texture.
  • Note any change in the pattern of the papillae covering the surface of the tongue and examine the tip of the tongue.
  • Note any abnormality of mobility or positioning.
  • Inspect the right and left lateral margins of the tongue.
  • Examine the more posterior aspects of the tongue's lateral borders
  • Examine the ventral surface.
  • Palpate the tongue to detect growths.
  • Inspect the floor of the mouth for changes in color, texture, swellings, or other surface abnormalities.
  • First inspect the hard and then the soft palate.Examine all soft palate and oropharyngeal tissues.
  • Bimanually palpate the floor of the mouth for any abnormalities.
  • All mucosal or facial tissues that seem to be abnormal should be palpated.

Appearance of the Patient

The general appearance of the patient is ill appearing, cachectic.

Ears

• Ear pain may be present.

Throat

• Soreness of the throat may be present.

Oral Cavity

• Difficulty in moving tongue may be present.
• Numbness of the tongue may be present.
• Swelling of the jaw may be present.