Oral Cancer Exam

Title:
Oral Cancer Exam

Description:
This exam is abstracted from the standardized oral examination method recommended by the World Health Organization. The method is consistent with those followed by the Centers for Disease Control and Prevention and the National Institutes of Health. It requires adequate lighting, a dental mouth mirror, two 2" x 2" gauze squares, and gloves; it should take no longer than 5 minutes.

The examination is conducted with the patient seated. Any intraoral prostheses are removed before starting. The extraoral and perioral tissues are examined first, followed by the intraoral tissues.

The Extraoral Examination

FACE: (Figure 1) The extraoral assessment includes inspection of the face, head, and neck. The face, ears, and neck are observed, noting any asymmetry or changes on the skin such as crusts, fissuring, growths, and/or color change. The regional lymph node areas are bilaterally palpated to detect any enlarged nodes. If enlargement is detected, the examiner should determine the mobility and consistency of the nodes. A recommended order of examination includes the preauricular, submandibular, anterior cervical, posterior auricular, and posterior cervical regions.

Download:
Low-Resolution Image of Extraoral Examination
High-Resolution Image of Extraoral Examination

LIPS: (Figure 2) Begin examination by observing the lips with the patient's mouth both closed and open. Note the color, texture and any surface abnormalities of the upper and lower vermilion borders.

Download:
Low-Resolution Image of Examination of Lips 
High-Resolution Image of Examination of Lips

LABIAL MUCOSA: (Figures 3 and 4) With the patient's mouth partially open, visually examine the labial mucosa and sulcus of the maxillary vestibule and frenum and the mandibular vestibule. Observe the color, texture, and any swelling or other abnormalities of the vestibular mucosa and gingiva.

Download:
Low-Resolution Images of Examination of Labial Mucosa
High-Resolution Images of Examination of Labial Mucosa

BUCCAL MUCOSA: (Figures 5 and 6) Retract the buccal mucosa. Examine first the right then the left buccal mucosa extending from the labial commissure and back to the anterior tonsillar pillar. Note any change in pigmentation, color, texture, mobility, and other abnormalities of the mucosa, making sure that the commissures are examined carefully and are not covered by the retractors during the retraction of the cheek.

Download:
Low-Resolution Images of Examination of Buccal Mucosa
High-Resolution Images of Examination of Buccal Mucosa

GINGIVA: (Figure 7) First, examine the buccal and labial aspects of the gingiva and alveolar ridges (processes) by starting with the right maxillary posterior gingiva and alveolar ridge and then move around the arch to the left posterior area. Drop to the left mandibular posterior gingiva and alveolar ridge and move around the arch to the right posterior area.

Download:
Low-Resolution Image of Examination of Gingiva
High-Resolution Image of Examination of Gingiva

Second, examine the palatal and lingual aspects as had been done on the facial side, from right to left on the palatal (maxilla) and left to right on the lingual (mandible).

TONGUE: (Figure 8) With the patient's tongue at rest, and mouth partially open, inspect the dorsum of the tongue for any swelling, ulceration, coating, or variation in size, color, or texture. Also note any change in the pattern of the papillae covering the surface of the tongue and examine the tip of the tongue. The patient should then protrude the tongue, and the examiner should note any abnormality of mobility or positioning.

Download:
Low-Resolution Image of Examination of Tongue
High-Resolution Image of Examination of Tongue

(Figure 9) With the aid of mouth mirrors, inspect the right and left lateral margins of the tongue.

Download:
Low-Resolution Image of Inspection of Tongue Margins
High-Resolution Image of Inspection of Tongue Margins

(Figure 10) Grasping the tip of the tongue with a piece of gauze will assist full protrusion and will aid examination of the more posterior aspects of the tongue's lateral borders

Download:
Low-Resolution Image of Examination of Tongue Posterior
High-Resolution Image of Examination of Tongue Posterior

(Figure 11) Then examine the ventral surface. Palpate the tongue to detect growths.

Download:
Low-Resolution Image of Examination of Tongue Ventral Surface
High-Resolution Image of Examination of Tongue Ventral Surface

FLOOR: (Figure 12) With the tongue still elevated, inspect the floor of the mouth for changes in color, texture, swellings, or other surface abnormalities.

Download:
Low-Resolution Image of Examination of Floor of Mouth
High-Resolution Image of Examination of Floor of Mouth

PALATE: (Figures 13 and 14) With the mouth wide open and the patient's head tilted back, gently depress the base of the tongue with a mouth mirror. First inspect the hard and then the soft palate.

Download:
Low-Resolution Image of Examination of Palate
High-Resolution Image of Examination of Palate

(Figure 14) Examine all soft palate and oropharyngeal tissues.

Download:
Low-Resolution Image of Examination of Soft Palate and Oropharyngeal Tissues
High-Resolution Image of Examination of Soft Palate and Oropharyngeal Tissues

(Figure 15) Bimanually palpate the floor of the mouth for any abnormalities. All mucosal or facial tissues that seem to be abnormal should be palpated.

Download:
Low-Resolution Image of Palpation of Floor of Mouth
High-Resolution Image of Palpation of Floor of Mouth

Credit:
NIDCR publication: Detecting Oral Cancer: A Guide for Health Care Professionals