extraoral examination

2. Extraoral Examination
Under the guidance of:
 Dr. swati
 Dr. alankrita
 Dr. kuldeep
 Dr. prashant
Submitted by
 Neelam kumari

3. Table of contents
1. Abstract
2. Faceprofile
3. Facesymmetry
4. TMJexamination
a) Clicking
b) Tenderness
c) Deviation
5. LipSeal
6. LymphNodes
a) Tenderness

4. Introduction
The patient’sheadandneckregionshouldbeexaminedforanypathologicalcondition.
Extraoralexamination includefacialexamination,examination oflymphnodes,lip
examination andTMJexamination.

5. Face profile
Itis anteroposteriorrelationshipbetweenmaxillaandmandible.
Typesoffacialprofile
 Normal(straightprofile)
 Retrogenatic(convexprofile)
 Prognathic(concaveprofile)

6. Clinical examination of facial profile
Itisexaminedbyviewingthepatientfromtheside andbythejoiningofthesetwo
referenceline.
Glabellatodeepestpointofcurvatureofupperlip
Liptomostanteriorpointofchin
 Examinationoffacialprofileisveryimportantbecauseitdeterminesthejawrelation
andocclusionandhelpindiagnosisgrossdeviationinmaxilomandibular
relationship.

7. Face symmetry
facialsymmetrydetermineaboutthe disproportionofthefaceintransverse
andinverticalplanes.
Typesoffacialsymmetry
asymmetry symmetrical

8. Clinical examination of facial symmetry
visualinspectionoftheentireface
 Asymmetrythataregrossandaredetectedeasilyitshouldberecorded
facialasymmetrycausesbothfunctionalaswellasesthetic problems

9. TMJ examination
Thefunctionalexaminationshouldberoutinelyincludeauscultationand
palpationofthetempro–mandibularjoint.
 Auscultationexamination isdoneforchecking crepitusorgrindingand
clickingorpoppingsoundsduringmandibularmovement.

10. Extra-auricular intra-auricular

11. Beforetheexamitisalwayshelpfultogetahistoryfromthepatientconcerning
headachesandjointsoundsorpain.
 Palpatoryexamination isdoneforcheckingforpainandtenderness.
clinicalexaminationintothreeportions:extra-oral(muscleand
joint), externalauditorycanal(hearingchangesinassociationwithTMJ
symptoms)intra-oral.(medialpterygoidmuscle,dental,perioandsofttissue).

12. TMJ examination for deviation
Itdeterminedeviationofjawfromthemidlineduringtheopeningandclosing
ofjaw.
 Mandibledeviatedtowardtheaffectedsideduringopeningofmouth

13. Examination of the muscles
Functionaldisorderofthemasticatorymusclesareprobablythemostcommon
TMDcomplaintofthepatientwithpainandthesecomplaintgroupunder
“masticatorymusclesdisorder”.
Aswithanypathologicalstatetwomajorsymptomscanbeobserved:
 Pain
 dysfunction
Mostcommoncomplaintinpatientwithmasticatorymusclesdisorderispain
,whichmayrangefromslighttendernesstoextremediscomfort
Usuallydysfunctionisseenasdecreaseinrangeofmandibularmovement

14. Palpation of masseter muscles
Thesuperficialmusclesispalpatedatthreesites:-
 Theoriginalongtheinferiorborderofthezygomaticarch.
 Theinsertionalongthelateralaspectoftheramus,
 The deep masseter is palpated extraorally at the angles of mandible ,about
oneinchbelowthecondyle.

15. Clinical examination of masseter

16. Palpation of temporalis
Palpatedatthreesiteasitisafanshapedmuscles
 The anterior temporalis muscles is palpated posterior to the orbit in an area that is
slightlydepressed.
 The mid or dip temporalis is palpated directly above the zygomatic arch on a
verticallinewiththeTMJ.
 Thedeeptemporalisispalpateddirectlyover
thetopsofears

17. Clinical examination of temporalis

18. Lip seal
Upperandlowerlipcontactwhenmusculatureisrelaxed.
 Typesoflipseal
Competentlip:-lipsareincontactwhenmusculatureisrelaxed
Potentialincompetent:-labialplacedupperincisorinterposebetween
thelipandpreventtheclosureoflip

19. Incompetentlip:-anatomicallyshortlip withwidegapbetweenupperand
lowerlipinrelaxedstate
Evertedlip:-thisisalipsealwithweak tonicityoflipmusculature,often
duetobimaxillarydentalprotrusion

20. Lymph Node
Lymphnodearebeanshapedorganfoundinclustersalongthedistributionof
lymphchannelsofthebody.
Lymphadenopathyisanearlyindicatorofsomedisease,thereforephysical
examinationoflymphnodesofheadandneckisofgreatimportance.

21. Clinical examination of lymph nodes
Inspection andpalpationforswelling
• position:-whichgroupoflymphnodeisaffected
• number:- oneormoreswelling
• size:- 1cmormoreofswelling
• consistency:-hardorsoft
• fixitytounderlyingtissue

22. Tenderness of lymph nodes
 Swellingoflymphnodes
 Nodesofdrainingareaofactiveinfectionareusuallytender.
 Underlyingskiniswarm
 red
Palpationofmiddlejugularlymphnodes palpationoflowerjugularlymphnode

23. Examination of preauricular lymphnode

24. Examination of postauricular

25. Clinical examination of occipital

26. Clinical examination of submental

27. Clinical examination of submandibular

28. Clinical examination of cervical lymphnode

29. Summary
• Extraoralexaminationisusuallyvisualexamination.
• Byseeingthepatientextraorallywecanassesforfollowingthings:-
1. Bylookingatfacialsymmetrywecanidentifyanylargeintraoralabscesstumors,
ankylosis.
2. Ifpersonishavingmalocclusion intraorallythancanalsoassessedbychecking
faceprofileandlipseal .
3. TMJexaminationmayhelpinassessmentofanyinternalabnormalitiesinTMJ.
4. Lymphnodeexaminationforanyenlargementcansuggestanyunderlying
pathology.

30. 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