Santa Monica College The Thyroid Gland Discussion

Chapter 1:Face and Neck Regions
1
2
Case Study 1.0
Age
62 YRS
Scenario
Sex
Male
Height
6’ 2”
Weight
220 LBS
BP
95/75
Chief
Complaint
“Why does it
Patient of record
has not visited
the office for 4
years. He is
concerned about
the appearance
of his lower lip. A
limited
examination was
performed.
Medical
History
Past history of
basal
carcinoma on
the tip of his
nose
look like my
lower lip is
disappearing?”
Current
Medications
None
Social
History
Alaskan
fisherman
A clinical
photograph was
taken. He needs
routine
maintenance
appointments and
full mouth
radiographic
series.
Fehrenbach, MJ, Weiner J. Saunders Review of Dental Hygiene,
ed 2. Saunders, Philadelphia, 2009
3
Regions of the Face
 Frontal
 Orbital
 Nasal
 Infraorbital
 Zygomatic
 Buccal
 Oral
 Mental
4
Lymph Nodes
 Lymph nodes are bean-shaped bodies grouped in
clusters along the connecting lymphatic vessels,
positioned to filter toxic products from the lymph to
prevent their entry into the blood.
 What would you do if you notice an enlarged and firm
lymph node during an EO/IO exam?
5
Lymph Nodes
 The lymph nodes can be superficial in position with
the superficial veins, or deep in the tissue with the deep
blood vessels.
 All the nodes of the head and neck drain either the right
or left tissues in the area, depending on their location
(except for the midline submental nodes, which drain
the tissues in the region bilaterally).
 What is lymphadenopathy?
6
Superficial Nodes of the Head
7
Deep Nodes of the Head
8
DEEP LYMPH NODES OF THE HEAD
Drainage Patterns
Fehrenbach MJ and Herring SW. Illustrated Anatomy of the Head and Neck, ed 4.
Saunders, Philadelphia, 2012
9
LYMPH NODES OF THE HEAD REVIEW
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
10
LYMPH NODES OF THE HEAD REVIEW
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
11
Frontal Region
 Includes the forehead and the area above the eyes.
Figure 1-3
12
Nasal Region
 The root of the nose is
located between the eyes,
and the tip is the apex of the
nose.
 Inferior to the apex on each
side of the nose is a nostril,
or naris (plural, nares).
 The nares are separated by
the nasal septum
 The nares are also bounded
laterally by winglike
cartilaginous structures,
each ala (plural, alae).
Figure 1-4
13
Nasal Region Review
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
14
Nasal Region Review
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
15
Buccal and Zygomatic
Region
 The parotid salivary
gland has a small part
that can be palpated in
the buccal region as
well as in the zygomatic
region.
16
Parotid Salivary Gland
Review
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders,
Philadelphia, 2007
17
Parotid Salivary Gland
Review
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
18
Oral Region: Lips
 Width of lips should be
about same distance
between irises of the
eyes
 Vermillion borders are
only found in humans
19
Oral Region: Lips
Nanci A. Ten Cate’s Oral Histology, ed 7. Mosby, St. Louis, 2008
20
Lip Anatomy Review
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
21
Lip Anatomy Review
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
22
Clinical Considerations with Lips:
Angular Cheilitis
 Angular cheilitis
 At commissures
 Possible candida
inflection
 Possible nutritional
deficiency
 B2
 Iron deficiency
 Zinc deficiency
Ibsen OAC, Phelan JA. Oral Pathology for Dental
Hygienists, ed 5. Saunders, Philadelphia, 2009
23
Clinical Considerations with Lips:
Loss of Vermilion Border
 Any loss of the
vermilion border is very
important to note in the
patient record.
 With this loss, it is hard
to determine the border
between the lips and
the surrounding skin.
24
Mental Region
Figure 1-8
25
Mental Region: Mandible
 The posterior border of
the ramus is thickened
and extends from the
angle of the mandible
to a projection, the
mandibular condyle
with its neck.
 The articulating
surface of the condyle
is an oval head involved
in the TMJ.
Figure 1-9
26
Regions of Face Review
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders,
Philadelphia, 2007
27
Regions of Face Review
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
28
Vertical Dimension of the
Face
Facial dimensions:
May affect esthetics
May affect speech
VDO (Vertical Dimension of
Occlusion)
Small VDO – common with
edentulous patients means loss
of vertical dimension from
missing teeth
Large VDO – patient may not be
able to close lips
29
Loss of height in the lower third, which
contains the teeth and jaws, can occur
in certain circumstances.
30
Regions of the Neck
Figure 1-11
31
SCM Review
Fehrenbach MJ, editor. Dental Anatomy Coloring
Book. Saunders, Philadelphia, 2007
32
SCM Review
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
33
Superficial Cervical Nodes
Figure 1-12A
34
CERVICAL LYMPH NODES REVIEW
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
35
CERVICAL LYMPH NODES REVIEW
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
36
SUPERFICIAL CERVICAL
LYMPH NODES
Drainage Patterns
Fehrenbach MJ and Herring SW. Illustrated Anatomy of the Head and Neck, ed 4.
Saunders, Philadelphia, 2012
37
Regions of the Neck
 At the anterior midline is
the hyoid bone, which
is suspended in the
neck.
 Many muscles attach to
the hyoid bone, which
controls the position of
the base of the tongue.
Figure 1-11
38
Regions of the Neck
 Also found in the
anterior midline, inferior
to the hyoid bone, is the
thyroid cartilage,
which is the prominence
of the “voice box,” or
larynx.
 The vocal cords, or
ligaments of the larynx,
are attached to the
posterior surface of the
thyroid cartilage.
Figure 1-11
39
Regions of the Neck
 The thyroid gland
 Endocrine gland
 Temp, weight, digestion
 It is located inferior to
the thyroid cartilage,
at the junction of the
larynx and the trachea.
Figure 1-13
40
Regions of the Neck
Examined
 The hyoid bone can be
effectively palpated by
feeling inferior to and
medial to the angles of
the mandible.
 Do not confuse the
hyoid bone with the
inferiorly placed thyroid
cartilage when
palpating the neck.
Fehrenbach MJ and Herring SW. Illustrated
Anatomy of the Head and Neck, ed 4. Saunders,
Philadelphia, 2012
41
THYROID GLAND REVIEW
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders,
Philadelphia, 2007
42
THYROID GLAND REVIEW
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
43
Regions of the Neck
 The submandibular salivary gland and the
sublingual salivary gland can also be
palpated in the neck region.
Figure 1-5
44
SUBMANDIBULAR
SALIVARY GLAND REVIEW
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
45
SUBMANDIBULAR
SALIVARY GLAND REVIEW
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
46
SUBLINGUAL
SALIVARY GLAND REVIEW
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
47
SUBLINGUAL
SALIVARY GLAND REVIEW
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
48
SALIVARY GLANDS
REVIEW
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
49
SALIVARY GLANDS
REVIEW
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
50
DH 356
1
Age
37 YRS
Scenario
Sex
Female
Height
5’ 5”
Weight
180 LBS
BP
135/105
Chief
Complaint
“What are the
hard bumps on
New patient is
scheduled for a
full examination.
Her last dental
appointment was
2 years ago. She
is concerned
about the floor of
her mouth.
the bottom of
my mouth?”
Medical
History
High blood
pressure
controlled by
medications
Current
Medications
Diuretic
Social
History
High school
biology teacher
Clinical
photograph was
taken. She has
moderate
deposits with
slight bleeding.
She wants to
know about the
latest in
homecare. Slight
dry mouth and
she grinds her
teeth during the
day and night.
Fehrenbach MJ, Extraoral and Intraoral Assessment; Darby, ML,
Walsh M. Dental Hygiene – Theory and Practice, ed 3, Elsevier,
2015
2
Answers are in your textbook… try to
fill in the answer before peeking!
3
Oral Vestibules
4
5
Fehrenbach MJ, Extraoral and Intraoral Assessment;
Darby, ML, Walsh M. Dental Hygiene – Theory and
Practice, ed 3, Elsevier, 2015
6
Jaws, Alveolar Processes,
and Teeth
7
8
Figure 2-6
9
Dental Arches
10
11
13
Ibsen OAC, Phelan JA. Oral Pathology for Dental Hygienists, ed 5. Saunders, Philadelphia, 2009
14
15
Ibsen OAC, Phelan JA. Oral Pathology for Dental Hygienists, ed 5. Saunders,
Philadelphia, 2015
16
Fehrenbach, MJ, Personal Collection
17
Elsevier, Imaging Consult, imaging.consult.com, 2015
18
Age
37 YRS
Scenario
Sex
Female
Height
5’ 5”
Weight
180 LBS
BP
135/105
Chief
Complaint
“What are the
hard bumps on
New patient is
scheduled for a
full examination.
Her last dental
appointment was
2 years ago. She
is concerned
about the floor of
her mouth.
the bottom of
my mouth?”
Medical
History
High blood
pressure
controlled by
medications
Current
Medications
Diuretic
Social
History
High school
biology teacher
Clinical
photograph was
taken. She has
moderate
deposits with
slight bleeding.
She wants to
know about the
latest in home
care. Slight dry
mouth and she
grinds her teeth
during the day
and night.
Fehrenbach MJ, Extraoral and Intraoral Assessment; Darby, ML,
Walsh M. Dental Hygiene – Theory and Practice, ed 3, Elsevier,
2015
19
Gingival Tissue
20
Figure 2-9
 The attached gingiva
may have areas of
melanin
pigmentation.
Figure 9-22
22
Ibsen OAC, Phelan JA. Oral Pathology for Dental Hygienists, ed 5. Saunders, Philadelphia, 2009
23
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
24
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
25
Oral Cavity Proper
Palate
26
Figure 2-11
Figure 2-12
28
Fehrenbach MJ, editor. Dental Anatomy Coloring Book.
Saunders, Philadelphia, 2007
29
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
30
Figure 2-13
31
Ibsen OAC, Phelan JA. Oral Pathology for Dental Hygienists, ed 5. Saunders, Philadelphia, 2009
32
Ibsen OAC, Phelan JA. Oral Pathology for Dental Hygienists, ed 5. Saunders, Philadelphia, 2009
33
Elsevier, Imaging Consult, imaging.consult.com, 2009
34
Oral Cavity Proper
Tongue
35
Figure 2-14
36
Fehrenbach MJ and Herring SW. Illustrated
Anatomy of the Head and Neck, ed 4. Saunders,
Philadelphia, 2012
37
Figure 2-15
38
 To examine the dorsal
and lateral surfaces of
the tongue, have the
patient gently extend the
tongue while a gauze
square is wrapped
around the anterior one
third of the tongue in
order to obtain a firm
grasp.
 The dorsal surface is
digitally palpated.
Fehrenbach MJ,
Extraoral and
Intraoral
Assessment; Darby,
ML, Walsh M.
Dental Hygiene Theory and
Practice, ed 3,
Elsevier, 2010
39
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
40
Fehrenbach, MJ, Personal Collection
41
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
42
Oral Cavity Proper
Floor of Mouth
43
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
44
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
45
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
46
Nasopharynx, Oropharynx, and
Laryngopharynx
47
 Entrance to the throat
 3 divisions:
 nasopharynx, oropharynx, and laryngopharynx
48
Fehrenbach MJ, editor. Dental Anatomy Coloring Book. Saunders, Philadelphia, 2007
49