Gerald S. Fine, D.D.S.

   Oral and Maxillofacial Surgery

Brookline Office
Tel: 617-731-6060

Our commitment is to provide you the highest standard of oral and maxillofacial surgery in a professional manner.

Physical Examination

The examination of the patient involves anatomic areas including several areas not directly involving the mouth.

These areas are:

  1. The nasal passages
  2. The maxillary sinuses
  3. The neck

In addition the Mouth and Pharynx are extensively examined. The examination of nasal passages, sinuses and neck can be easily and quickly achieved.

  1. Nasal Passages--Gently occlude one side of the nose and ask the patient to "sniff". Note any nasal obstruction.
  2. Palpate for sinus tenderness. If tenderness is present transillumination of the sinuses should be considered. Non specific pain involving several maxillary teeth may be secondary to Sinusitis
  3. Nasal Passages--Gently occlude one side of the nose and ask the patient to "sniff". Note any nasal obstruction.
    - Palpate the Pre-Auricular nodes--in front of the ear.
    - Palpate the Tonsillar nodes--at the angle of the mandible.
    - Palate the Submaxillary nodes--half way between the angle and the tip of the mandible.
    - Palpate the Posterior Cervical chain--along the anterior edge of the Trapezius muscle.
  4. Place fingers bilaterally over the temporomandibular joint. Palpate for a "click" or "grating" sound. Observe any deviation of the mandible upon opening. Deviation upon opening usually occurs on the affected side. Restricted opening should be noted. The normal range of opening is 35mm--45mm.
  5. The lips should be inspected for color, moisture, ulcerations, raised areas or cracking.
  6. The buccal mucosa should be inspected for color, pigmentation, ulcers, and nodules. Patchy pigmentation may be considered normal within certain ethnic groups.
  7. Using a gauze sponge, the inner lining of the cheek should be dried, the cheek should then be gently massaged. A clear stream of saliva should easily flow from Stensen's (the Parotid) duct which is found on the buccal mucosa opposite the maxillary second molar tooth and its location is frequently marked by a small papilla.
  8. The Tongue should now be gently grasped using a gauze sponge again. At its undersurface is located the Submaxillary ducts (Wharton's ducts) bilaterally. Again, saliva should be freely flowing with gently pressure. The tongue should be fully examined. The lateral, ventral and dorsal aspects of the tongue should be examined. Note any white or reddened areas, nodules, or ulcerations. If any abnormalities or pigmented lesions are detected, palpate the area noting lymphadenopathy or areas of induration. In particular, the posterior- lateral aspects of the tongue warrants particularly close evaluation because it is a high risk area for oral carcinoma.
  9. The patient's occlusion should now be evaluated and Angle's classification of occlusion ( i.e. prognathic or retrognathic) noted.
  10. The patient's periodontal status should be considered. Gingival coloration, stippling, hypertrophy recession, etc. observed.
  11. Above and behind the tongue rises an arch formed by the anterior and posterior pillars, the soft palate, and uvula. The tonsils can be seen in the cavities between the anterior and postrtior pillars. Any exudate, ulceration, or growth warrants follow up examination.
      

‍Gerald S. Fine, D.D.S.
Practice limited to oral & maxillofacial surgery‍