HISTORY TAKING IN ORAL

CAVITY , THROAT , NECK

• Introduce
• Create rapport
• Make them comfortable
• See whether a reliable
informant is available.
PATIENT PARTICULARS

• NAME
• AGE
• SEX
• OCCUPATION
• ADDRESS
• INFORMANT
• DATE OF EXAMINATION
• Record complaints of patient in their own language in
chronological order
PRESENTING COMPLAINTS
• ULCERS
• SWELLINGS
• MUCOSAL COLOUR CHANGES/PATCHES
• HALITOSIS
• TRISMUS
• DROOLING OF SALIVA
• DYSPHAGIA/ODYNOPHAGIA
• BLEEDING
• LOSS OF TASTE
ULCERS

• BENIGN

• PRE MALIGNANT

• MALIGNANT
ULCERS HISTORY OF PRESENT ILLNESS
• SITE
• NUMBER
• ONSET
• DURATION
• PROGRESSION
• PAINFUL/PAINLESS
• AGGRAVATING/RELIEVING FACTORS
• ASSOSIATED SYMPTOMS
 BENIGN
• Young female

• Inner surfaces of lips, buccal mucosa, tongue, floor of mouth and soft palate,

• Sparing of mucosa of the hard palate and gingivae

• Multiple ,painful, short duration, heals spontaneously

• Intolerance to hot and spicy foods

• Absence of systemic features

• Other features of nutritional deficiencies

• History of similar illness in past, recurrence

• History of any autoimmune disorders/ drug allergy

APHTHOUS ULCER
• ACUTE NECROTISING GINGIVAL INFECTION/ VINCENTS
INFECTION
• Young children/elderly

• Whitish to grey painful ulcers in tongue and oral mucosa

• Burning sensation/soreness of mouth/intolerance to spicy foods

• Dysphagia in long standing cases

• Immunocompromised patients

• CANDIDIASIS/ORAL THRUSH
• Any age group

• Sudden onset, short duration, single or multiple ulcer

• In lips, under surface of lips, buccal mucosa, lateral border of tongue less common in
palate

• Ill fitting dentures or sharp tooth, cheek bite, injury with tooth brush /pencil/foreign
body.

• History of contact with any corrosive agents

TRAUMATIC ULCER
• Sudden onset , multiple ulcers, anywhere in oral
cavity,

• Following intake of a drug( systemic or local) ,

mouth washes, lozenges, chewing gum,
toothpastes or to prosthetic dental materials

• patients with known drug allergy

• DRUG REACTION/ALLERGIC REACTION

• Sudden onset, multiple ulcers which begins as
ulcers and progresses to bullae and ulcers,
especially in lips, buccal mucosa and tongue,
with history of bleeding and crusting and
associated with similar skin lesions

• Patient might have h/o drug allergy or herpes

simplex infection

• ERYTHEMA MULTIFORME
• Multiple painful ulcerations of sudden onset
and slowly progressive itchy ulcers involving
buccal mucosa, gingiva or lateral tongue
associated with similar lesions in skin as well
• LICHEN PLANUS
 PATCHES/MUCOSAL COLOUR
CHANGES
• 40 year old male patient

• White patch over buccal mucosa, oral commissures, floor of mouth tongue, buccal mucosa
and lips

• Usually painless

• may be associated with features of iron deficiency anaemia

• Past h/o dentures, tooth extraction, sharp tooth

• h/o smoking, alcoholism, betel nut chewing

• LEUKOPLAKIA
• 40 to 0 year male

• Red patches or plaques in the floor of mouth, lower alveolar mucosa

• ERYTHROPLAKIA
CARCINOMA ORAL CAVITY
• Elderly male patient from poor socio economic background

• Insidious onset of ulcer, of long duration of weeks to months

• Progressively worsening, starts as an ulcer/mucosal patch to become ulcero

proliferative to infiltrative/ fungating lesion

• Early lesions are asymptomatic

• Pain, halitosis, bleeding, trismus, drooling of saliva, slurring of speech dysphagia, earache

• Neck swelling
• Co morbidities, h/o dental procedures, artificial dentures
• h/o smoking, alcoholism, betel nut chewing, tobacco use, dietary habits.

CARCINOMA ORAL CAVITY

CARCINOMA ORAL CAVITY
DYSPHAGIA

• Sudden onset: Foreign body or impaction of food on a pre-existing stricture or

malignancy, neurological disorders.

• Progressive: Malignancy.

• Intermittent: Spasms or spasmodic episodes over an organic lesion.

• More to liquids: Paralytic lesions.

• More to solids and progressing even to liquids: Malignancy or stricture.

• Intolerance to acid food or fruit juices: Ulcerative lesion

ASK ABOUT

• onset

• Duration

• Progression and severity of the symptoms

• Types of food that give problems.

• Neonate /child

• Nasal regurgitation /reduced feeding/ unable to suck properly

• CLEFT PALATE
Adult patient presents with dysphagia

• Heartburn, regurgitation, epigastric pain, frequent throat clearing and irritant cough,
associated with consumption of spicy foods

• GERD

• Middle aged elderly woman, dysphagia, abdominal pain associated with features of
iron deficiency anaemia―PLUMMER WILSON SYNDROME

• Middle aged men, dysphagia, heartburn, odynophagia, food bolus obstruction

• EOSINOPHILIC OESOPHAGITIS
Dysphagia associated with autoimmune disorders

• Scleroderma and CREST syndrome

• SLE

• Sjogren’s syndrome

• Dermatomyositis

• Pemphigous, mucosal pemphigoid and epidermolysis bullosa

• Adolescent male child with mental retardation or

• An elderly patient with h/o stroke and lower cranial nerve palsy

• Sudden onset dysphagia, refusal to eat food, drooling of saliva

• Time of last meal and what did he eat

• ?Previous history of similar episodes

FOREIGN BODY THROAT

 FB THROAT/FOOD BOLUS
• Type and size of FB—Sharp/soft

• Duration

• Site of FB sensation if appreciated

• Within hours.. Dysphagia, odynophagia, foreign body

sensation, pain while moving neck

• Within days..dysphagia, odynophagia , respiratory distress,

stridor

• Comorbidities, drug allergy, any previous oesophageal surgeries

• Time of last meal

• Elderly male, progressive dysphagia for 4 months more to solids associated with
odynophagia, hoarseness of voice

• h/o respiratory distress/noisy breathing

• h/o frequent cough /recurrent chest infections

• Loss of weight

• Previous history of any CVA/ neurological disorders/oesophageal surgeries

• Chronic smoker and alcoholic

• MALIGNANCY LARYNX
• Regurgitation, which can be immediate or delayed, can give an indication as to the level
of the problem. Delayed regurgitation of undigested food is typically seen in patients
with a pharyngeal pouch.

• Symptoms of retrosternal discomfort, belching and early satiety indicate GERD.

• Odynophagia is associated with infection, neoplasia or GERD.

• Hoarseness may indicate laryngeal fixation due to tumour or vocal cord palsy.
• Choking or coughing, during or after eating, or frequent chest infections may
suggest aspiration.

• Referred otalgia via the IX and X cranial nerves is usually secondary to malignancy

• Associated neurological symptoms such as bulbar dysfunction, dysarthria,

diplopia, limb weakness and fatigability can be seen in motor neuron disease and
myasthenia gravis.

• Tremor, ataxia and unsteady gait are features of Parkinson’s disease.

• 12 year old child presented with throat pain and odynophagia

• Five days duration, started as a sorethroat progressed to severe odynophagia and

dysphagia with h/o halitosis

• Associated with fever, malaise and earache

• No h/o mouth breathing, snoring, nasal obstruction, nasal discharge

• No h/o change in voice/drooling of saliva

• Previous history of similar illness in the past, 3 episodes in the last year precipitated
by consumption of cold water/drinks/exposure to cold
• ACUTE TONSILLITIS

• ACUTE PHARYNGITIS
• 20 year old female patient

• Severe throat pain of days duration progressively worsening

• Associated with odynophagia, dysphagia, halitosis, drooling of saliva, slurring of

speech pain on mouth opening

• h/o fever, malaise, bodyache ＋

• no h/o respiratory distress, noisy breathing

• h/o reccurent throat infections in the past, no other co morbidities

• PERITONSILLAR
ABSCESS/QUINSY
 CHANGE IN VOICE

• Hoarseness

• Huskiness

• Reduced pitch

• Loss of part of the range of the voice

• Pitch instability

• Increased effort to speak

• Vocal fatigue and pain or discomfort on speaking

• Throat symptoms, such as globus sensation and irritation, dryness, throat clearing or
chronic cough.
• Nature and chronology of the voice problem
• Exacerbating and relieving factors

• Lifestyle, dietary and hydration issues

• Contributing medical conditions or the effects of their treatment

• Patient’s voice use and requirements

• Impact on their quality of life, social and psychological well-being

• Their expectations for outcome of the consultation and treatment.

BENIGN INFLAMMATORY CONDITIONS

• Hoarse (rough, strained, breathy or

whispery) with productive cough and
fever, throat pain and discomfort and
in severe cases respiratory distress and
stridor﹣LARYNGITIS
• EPIGOTTITIS
 STRUCTURAL LESIONS
• 48 year old male

• Sudden onset hoarseness of voice associated with lowered

pitch loss of part of the range and strain to speak

• occupation

• h/o voice abuse/misuse( usually immediately following a

phonotrauma)

• h/o GERD

• Chronic smoker

VOCAL CORD POLYP

• 21 year old female patient who is a singer

• Husky and breathy voice worsening with voice

use , and breaks when speaking in higher pitch

• Associated with perilaryngeal discomfort or

throat soreness on phonation.

• h/o allergies/stress/nasal or throat

infections/GERD

• VOCAL CORD NODULE

• Children or neonates presenting with abnormal cry/ noisy breathing/stridor

• Laryngomalacia (congenital laryngeal stridor)

• Congenital vocal cord paralysis

• Congenital subglottic stenosis － precipitated by URTI

• Laryngeal web － airway obstruction, weak cry, aphonia

• Subglottic haemangioma － normal cry

• Laryngo-oesophageal cleft

• Laryngocele

• Laryngeal cyst
• Elderly male patient

• presented with progrssive/ non progressive hoarsness of voice assosiated with

dysphagia, dyspnea on exertion on prolonged phonation

• h/o choking, cough, chest pain

• h/o previous surgeries especially thyroid surgeries/ surgeries that require intubation

• weakness/tremor/dysarthria

• h/o tuberculosis/other chest diseases especially malignancies

• h/o exposure to neurotoxic agents

• h/o smoking
• VOCAL CORD PARALYSIS
NECK SWELLINGS

• Onset and duration of neck mass

• Site

• Associated symptoms including dysphonia, dysphagia, odynophagia, sore throat,

referred otalgia, nasal obstruction, cranial nerve neuropathies, weight loss,
anorexia,

• Malaise and night sweats.

• CONGENITAL

• Lymphangiomas － painless swelling present from birth

• dermoid cysts painless, in submental region, 2nd or 3rd decade of life

• Throglossal cyst.. mean age five years, midline swelling,usually at level of hyoid
bone, painless

• Branchial cyst.. upper third of neck at the anterior borde of

Sternocleidomastoid,precedingg URTI history may be present.
 • CERVICAL LYMPHADENITIS

AQUIRED • NECK ABSCESS

• Pain at site of abscess / referred pain to ear

• Odynophagia trismus or torticollis, dysphonia,

dysphagia, sialorrhoea or cough.

• Fever,malaise

• h/o FB ingestion

• Co morbidities/immunocompromise

• THYROID SWELLINGS