Skip to main content
Medicine LibreTexts

6.9.9: 9. Clinical Evaluation- History and Examination

  • Page ID
    53886
  • \( \newcommand{\vecs}[1]{\overset { \scriptstyle \rightharpoonup} {\mathbf{#1}} } \) \( \newcommand{\vecd}[1]{\overset{-\!-\!\rightharpoonup}{\vphantom{a}\smash {#1}}} \)\(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\) \(\newcommand{\id}{\mathrm{id}}\) \( \newcommand{\Span}{\mathrm{span}}\) \( \newcommand{\kernel}{\mathrm{null}\,}\) \( \newcommand{\range}{\mathrm{range}\,}\) \( \newcommand{\RealPart}{\mathrm{Re}}\) \( \newcommand{\ImaginaryPart}{\mathrm{Im}}\) \( \newcommand{\Argument}{\mathrm{Arg}}\) \( \newcommand{\norm}[1]{\| #1 \|}\) \( \newcommand{\inner}[2]{\langle #1, #2 \rangle}\) \( \newcommand{\Span}{\mathrm{span}}\)

    Oropharyngeal Cancer: History & Exam

    Objectives

    • Select appropriate treatment
    • Avoid unnecessary surgery
    • Avoid surgery that is beyond the scope of the surgeon

    Primary tumor

    • Location and extent by visual inspection, palpation
    • Mobility of tumor with swallowing and on palpation: if mobile it suggests that PPS is not involved
    • Trismus
    • Fixation to prevertebral fascia: Gently rock soft tissue of tonsil fossa medially and laterally using bimanual palpation with one finger intraorally and opposite hand extra-orally
    • Function of lingual, inferior alveolar, mental and hypoglossal nerves
    • Position of internal carotid artery (inspection and palpation)

    Mandible

    • If adherent, then assess for mandible invasion
    • Check for dental caries if to receive radiation therapy

    Neck

    • Palpable nodes in Levels 1-3: assume metastases
    • Nodes outside lymphatic basin e.g. lateral cancer with contralateral nodes: Consider FNAC / nodal biopsy

    Distant metastasis: CXR / CT / PET

    Synchronous Primary (upper aerodigestive tract, lungs)

    • History and office examination
    • Panendocopy
    • CXR / CT / PET

    Functional impairment resulting from treatment

    • Pharyngeal function is complex (Swallowing/speech/aspiration)
    • Will soft palate resection cause significant nasal regurgitation and rhinolalia aperta?
    • Can function be maintained with reconstruction with a flap?
    • Will nonsurgical treatment ensure better swallowing and speech?

    Access for transoral resection (incl. TORS)

    • Mouth opening
    • Trismus (possible medial pterygoid and/or infra-temporal involvement)
    • Dentition
    • Cervical spine extension
    • Mallampati score

    Mallampati