Extraoral examination
Inspect and palpate facial symmetry, skin, lymph nodes, salivary glands, muscles and temporomandibular joints as indicated. Record positives and relevant negatives.
Understand
Inspect symmetry, skin, eye and lip function, lymph nodes, salivary glands, muscles and TMJs. The examination should answer a question from the history without overlooking the whole head and neck.
Assess
Note size, mobility, tenderness and site of nodes or swelling. Compare both sides, assess opening and joint movement, and examine cranial nerve function when indicated.
Apply
A fixed mass, facial nerve weakness or rapidly spreading swelling changes urgency. Record objective findings and arrange appropriate imaging or referral instead of labelling a lump by feel alone.
Key distinctions
Examination is both inspection and palpation. Compare sides and assess whether a swelling is in skin, salivary gland, lymph node, muscle or deeper tissue. For suspected malignancy, a fixed node or cranial nerve deficit may be more important than pain. For infection, swallowing, tongue position and voice can be more urgent than surface size.
Think through a case
A painless firm neck node is found during an assessment for a small oral ulcer. The node changes the urgency and referral information even if the intraoral lesion appears modest.
The distinction to remember
Do not document only “nodes palpable”. Site, size, mobility, tenderness and laterality make the finding interpretable.
Test your recall
Why palpate cervical nodes in an oral lesion assessment?
Show answer
Nodal findings may alter urgency, staging and referral.