Good afternoon

Extraoral Examination

Under the guidance of: Dr. swati Dr. alankrita Dr. kuldeep Dr. prashant

Submitted by Neelam kumari

Table of contents

1. Abstract

2. Face profile

3. Face symmetry

4. TMJ examinationa) Clicking

b) Tenderness

c) Deviation

5.  Lip Seal

6. Lymph Nodesa) Tenderness

Introduction

The patient’s head and neck region should be examined for any pathological condition. Extra oral examination include facial examination, examination of lymph nodes, lip examination and TMJ examination .

Face profile It is anteroposterior relationship between maxilla and mandible .

Types of facial profile

Normal (straight profile)

Retrogenatic (convex profile)

Prognathic (concave profile)

Clinical examination of facial profileIt is examined by viewing the patient from the side and by

the joining of these two reference line.

Glabella to deepest point of curvature of upper lip

Lip to most anterior point of chin

Examination of facial profile is very important because it determines the jaw relation and occlusion and help in diagnosis gross deviation in maxilo mandibular relationship .

Face symmetryfacial symmetry determine about the disproportion of the face in transverse and in vertical planes.Types of facial symmetry

asymmetry symmetrical

Clinical examination of facial symmetry

visual inspection of the entire face

Asymmetry that are gross and are detected easily it should be recorded

facial asymmetry causes both functional as well as esthetic problems

TMJ examinationThe functional examination should be routinely include auscultation and palpation of the tempro – mandibular joint . Auscultation examination is done for checking

 crepitus or grinding and clicking or popping sounds during mandibular movement.

Extra-auricular intra-auricular

Before the exam it is always helpful to get a history from the patient concerning headaches and joint sounds or pain.   Palpatory examination is done for checking for

pain and tenderness. clinical examination into three portions: extra-oral (muscle and joint),    external auditory canal ( hearing changes in association with TMJ symptoms) intra-oral . (medial pterygoid muscle, dental, perio and soft tissue).

TMJ examination for deviation It determine deviation of jaw from the midline during the opening and closing of jaw. Mandible deviated toward the affected side during

opening of mouth

Examination of the musclesFunctional disorder of the masticatory muscles are probably the most common TMD complaint of the patient with pain and these complaint group under “masticatory muscles disorder” .As with any pathological state two major symptoms can be observed : Pain dysfunctionMost common complaint in patient with masticatory muscles disorder is pain ,which may range from slight tenderness to extreme discomfort Usually dysfunction is seen as decrease in range of mandibular movement

Palpation of masseter muscles The superficial muscles is palpated at three sites :-

The origin along the inferior border of the zygomatic arch .

The insertion along the lateral aspect of the ramus , The deep masseter is palpated extraorally at the

angles of mandible ,about one inch below the condyle .

Clinical examination of masseter

Palpation of temporalis Palpated at three site as it is a fan shaped muscles The anterior temporalis muscles is palpated posterior to

the orbit in an area that is slightly depressed . The mid or dip temporalis is palpated directly above the

zygomatic arch on a vertical line with the TMJ. The deep temporalis is palpated directly over the tops of ears

Clinical examination of temporalis

Lip seal Upper and lower lip contact when musculature is relaxed. Types of lip seal

Competent lip :- lips are in contact when musculature is relaxed

Potential incompetent :- labial placed upper incisor interpose betweenthe lip and prevent the closure of lip

Incompetent lip :- anatomically short lip with wide gap between upper and lower lip in relaxed state

Everted lip :-this is a lip seal with weak tonicity of lip musculature , often due to bimaxillary dental protrusion

Lymph Node Lymph node are bean shaped organ found in clusters along the distribution of lymph channels of the body.Lymphadenopathy is an early indicator of some disease ,therefore physical examination of lymph nodes of head and neck is of great importance .

Clinical examination of lymph nodes Inspection and palpation for swelling • position:-which group of lymph node is affected • number:- one or more swelling • size:- 1cm or more of swelling • consistency :- hard or soft • fixity to underlying tissue

Tenderness of lymph nodes Swelling of lymph nodes Nodes of draining area of active infection are usually

tender. Underlying skin is warm red

Palpation of middle jugular lymph nodes palpation of lower jugular lymph node

Examination of preauricular lymphnode

Examination of postauricular

Clinical examination of occipital

Clinical examination of submental

Clinical examination of submandibular

Clinical examination of cervical lymphnode

Summary

• Extraoral examination is usually visual examination.• By seeing the patient extraorally we can asses for

following things:- 1. By looking at facial symmetry we can identify any large

intraoral abscess tumors, ankylosis .2. If person is having malocclusion intraorally than can

also assessed by checking face profile and lip seal .3. TMJ examination may help in assessment of any

internal abnormalities in TMJ.4. Lymph node examination for any enlargement can

suggest any underlying pathology .

Reference

Orthodontic by bhalaji Textbook of pedodontics by shobha tandon Textbook of oral medicine by ghom Textbook of prosthodontics by nallaswamy Manipal manual of surgery by shenoy A practical manual of public health dentistry

by cm marya