Immersion: Nose, mouth & throat

Landmarks and structures

Structures of the oral cavity include the lips, the inside lining of the lips and cheeks (buccal mucosa), the teeth and gums, the front 2/3 of the tongue, the floor of the mouth below the tongue, and the bony roof of the mouth (the hard palate). The oropharynx refers to the structures behind the oral cavity: the side and back walls of the throat, tonsils, and posterior tongue.

Exam steps

Step 1. Observe the external nose for symmetry and discharge

Step 2. Inspect the oral cavity and posterior pharynx

With a penlight and the mouth opened as widely as comfortable, examine:

• Teeth, tongue, and hard palate
• Buccal mucosa and lateral teeth. Ask your patient to pull their own cheek out slightly, or with permission, gently use a tongue blade.
• Floor of the mouth.  Ask your patient to place the tip of the tongue on the roof of the mouth.
• Posterior pharynx. If the clinical situation requires a careful exam, ask your patient to say “aaah” to raise the soft palate.  If necessary, you can also use a tongue depressor held gently on the tongue.

Step 3. Palpate the parotid and submandibular salivary glands

The parotid glands are anterior to the angle of the jaw and the ear.  The submandibular glands are on the underside of the lower jaw, midway between the angle of the jaw and the chin. They may feel slightly lumpy, but there should be no dominant masses

Step 4. Palpate the temporomandibular joint (TMJ)

With your fingers placed just anterior to the ear, palpate as your patient opens and closes the jaw, feeling for crepitus (crackling) or tenderness.

Sample documentation

Nose, Mouth and Throat Exam Video