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270
6 History andExamination ofLip andOral Cavity
6.4.2 Colour Atlas Showing
Ulceration ofOral cavity
(Fig.6.11)
a b c
d e
Fig. 6.11 Shows (a, b) Aphthous ulceration, (c, d)—Major RAS, (e) Herpetiform RAS numbers
6.4.3 Colour Atlas ofCommon
Diseases oftheFloor ofMouth
(Fig.6.12)
Fig. 6.12 Common disease of the oor of the mouth, (a) Squamous papilloma, (b) Ranula
6.4 Colour Atlas ofLip andOral Cavity Diseases
271
6.4.4 Colour Atlas ofCommon
Disease oftheCheek
(Fig.6.13)
Fig. 6.13 Common
diseases of the cheek,
(a) Benign broblastic
tumour, (b)
Erythroplakia, (c)
Leukoplakia, (d)
Traumatic ulcer
a b
c d
6.4.5 Colour Atlas ofCommon
Diseases oftheUpper
Alveolus (Fig.6.14)
a b
Fig. 6.14 Shows common lesion of upper alveolus, (a) Melanocytic naevi, (b) Melanoma, (c) Malignant melanoma
c
272
6.4.6 Colour Atlas ofCommon
Diseases oftheLower
Alveolus (Fig.6.15)
6 History andExamination ofLip andOral Cavity
a b
c
d e
Fig. 6.15 Shows (a) Proliferative verrucous Leukoplakia, (b) Proliferative growth due to SCC, (c) Endophytic Growth
due to SCC, (d) Eupulis, (e) Fibroma
6.4 Colour Atlas ofLip andOral Cavity Diseases
6.4.7 Colour Atlas ofCommon
Diseases oftheHard Palate
(Fig.6.16)
273
a b
d
e f
g
c
h
i
j
k
m n o
Fig. 6.16 Shows (a) Palatal cyst, (b) Nasopalatine cyst,
(c) high arched palate, (d) Globlomaxillary cyst, (e)
Midline palatal cyst, (f) Sarcoma, (g) Embryonal rhabdomyosarcoma, (h) Kaposi sarcoma of palate, (i)
Pleomorphic adenoma, (j) Rhinosporidiosis, (k) Basal
cell CA, (l) Adenoid cystic CA, (m) Mucoepidermoid carcinoma, (n) Squamous cell carcinoma, (o) Verrucous
carcinoma
l
274
6.4.8 Colour Atlas ofCommon
Diseases oftheTongue
(Fig.6.17)
6 History andExamination ofLip andOral Cavity
a
d
g
b c
e f
h
i
j
Fig. 6.17 (a) Traumatic ulcer, (b) SCC, (c) Traumatic
ulcer, (d) Lichen planus, (e) Geographical tongue, (f)
Leukoplakia tongue, (g) Lichen planus, (h) Erosive lichen
planus, (i) Haemangioma tongue, (j) Verruca vulgaris, (k)
k
l
Wart, (l) Fissured tongue, (m) Candidiasis, (n) Atrophic
glossitis, (o) Glossitis, (p) Hairy leukoplakia, (q)
Migratory glossitis, (r) Scalloped tongue
6.4 Colour Atlas ofLip andOral Cavity Diseases
275
a
p q
Fig. 6.17 (continued)
n om
r
History andExamination
ofOropharynx
7
History taking and examination of patient with
oropharyngeal diseases.
7.1 History/Symptoms/
Presentation
ofOropharyngeal Diseases
7.1.1 Throat Pain
Pain is a ubiquitous symptom. It may be acute or
chronic, constant or intermittent, and mild to
severe.
• Site of pain
– Lateral side—tonsillitis, Eagle’s syndrome,
glossopharyngeal neuralgia, superior cornu
syndrome.
– Central part—pharyngitis, retropharyngeal
abscess.
– Whole oropharynx—tonsillopharyngitis,
laryngopharyngitis.
• Duration of pain—The time course of the pain
is a critical factor in establishing the diagnosis
– Acute—if pain exists <3months of dura-
tion caused by viral pharyngitis, bacterial,
pharyngitis, acute tonsillitis.
– Chronic—If pain persists more than
3 months, it is caused by chronic
pharyngitis, chronic tonsillitis, Eagle’s
syndrome, stylalgia, glossopharyngeal
neuralgia.
• Mode of onset
– Sudden onset—acute tonsillitis, acute
pharyngitis, FB in oropharynx.
– Gradual onset—Eagle’s syndrome, stylal-
gia, glossopharyngeal neuralgia.
• Side of pain
– Unilateral—stylalgia, glossopharyngeal
neuralgia, peritonsillitis, peritonsillar
abscess (quinsy).
– Bilateral/whole throat—chronic and acute
tonsillitis, acute and chronic pharyngitis.
• Type of pain
– Nociceptive pain—injury or inammation
– Functional pain—pain without obvious
cause
– Neuropathic pain—neural damage, pinch-
ing, irritation
• Severity of pain
– Mild—chronic tonsillitis,
– Moderate—acute tonsillitis, peritonsillar
abscess
– Severe—peritonsillar abscess
• Radiation of pain—If throat pain radiates to
neck and ear, it suggests glossopharyngeal
neuralgia, carcinoma of tonsil.
• Referred pain—unilateral otalgia in the
absence of ear disease suggests malignancy in
oropharynx.
• Aggravating and relieving factors
– Increase on swallowing—pharyngitis, ton-
sillitis, glossopharyngeal neuralgia, peritonsillitis, peritonsillar abscess.
© The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd. 2025
S. K. Kashyap, S. Sagar, Clinical Methods of Otorhinolaryngology, Skull Base & Head Neck
Surgery, https://doi.org/10.1007/978-981-96-1765-4_7
277
278
7 History andExamination ofOropharynx
• Associated symptoms or history—Other
symptoms with throat pain should be ruled
out.
– Dysphagia or odynophagia—pharyngitis,
tonsillitis.
– Stridor or other respiratory symptoms (may
indicate an underlying airway
obstruction).
– Vomiting.
– Dry cough.
– Bad breath.
– Dryness of throat.
– Change of voice.
(a) Hoarseness of voice—supraglottitis.
(b) Hot potato voice base of tongue
growth.
– Reux or heartburn-related symptoms.
– Bodyache, myalgia, fever—viral
pharyngitis.
Differential Diagnosis of Throat Pain
(Oropharynx) (Table7.1)
– Neck stiffness—retropharyngeal abscess.
– Neck mass, haemoptysis—oropharyngeal
carcinoma.
– Constitutional symptoms such as weight
7.1.2 Odynophagia (Painful Swallowing)
loss or night sweats.
– History of patient risk factors (tobacco,
alcohol, sick contacts, trauma, or foreign
body ingestion).
– Heartburn (GERD).
Table 7.1 Differential diagnosis of throat pain
Types of acute throat pain with associated symptoms and signs Diagnosis
Acute throat pain associated with fever, malaise Adenovirus, rhinovirus
Throat pain associated with vesicular or ulcerative lesion Herpes simplex
Throat pain with acute rhinitis, and conjunctivitis and intraoral Koplik spot
(erythematous lesion on buccal mucosa)
Severe sore /pain throat with odynophagia, dysphagia, high fevers, posterior
cervical lymphadenopathy, rashes, exudative tonsillitis and
hepatosplenomegaly
Severe throat pain with otalgia, dysphagia, odynophagia, cervical adenitis
and high fever
Unimmunized children >6years old presented with sore throat and airway
obstruction otalgia, dysphagia, odynophagia. Exam reveals grey-black
membrane rmly adherent to the underlying pharyngeal mucosa, with
extension to the larynx or nasopharynx.
Acute throat pain, whooping cough Pertussis
Sexually active patient with sore throat, tonsillar hypertrophy and cervical
adenitis
Hypertrophied tonsils with purulent exudates. May be associated with
trismus, dysphagia and odynophagia.
‘Hot potato’ voice, trismus, soft palate oedema/erythema with uvular
deviation, drooling, inability to tolerate secretions and otalgia
Hypertrophied cryptic tonsils with chronic sore throat, recurrent tonsillitis/
pharyngitis, halitosis, malaise and cervical adenopathy
Severe lancinating pain from the posterior pharynx to the ear, neck and head
that is short-lived (lasts seconds). The pain can be triggered by swallowing,
chewing or coughing
Pain along the course of the stylohyoid ligament. It is associated with a
chronic sore throat, difculty swallowing or globus sensation
It may present as a dull, burning pain, or a sharp,
stabbing pain in the mouth, throat or oesophagus
when swallowing or pain that gets worse when
swallowing dry foods, though in some cases liq-
Measles
Infectious mononucleosis (EpsteinBarr virus infection)
Group AB—Haemolytic
streptococcus infection pharyngitis
or tonsillitis
Diphtheria
Gonorrhoea
Acute tonsillitis
A peritonsillar abscess
Chronic tonsillitis
Glossopharyngeal neuralgia
Eagle’s syndrome
7.1 History/Symptoms/Presentation ofOropharyngeal Diseases
279
uids and solids cause the same amount of pain.
Other symptoms are sequel or effect of odynophagia like weight loss and dehydration.
• Presentation of odynophagia—It is presented
as pain during swallowing. The pain may be
dull, sharp or stabbing.
• Mode of onset
– Sudden—Sudden onset odynophagia can
be caused by Iatrogenic trauma (UGI
endoscopy caused mucosal tear, postintubation may cause arytenoid subluxation),
traumatic (whiplash injury, laceration), FB
(oesophagus, cricopharynx, base of
tongue), infective (acute pharyngitis, acute
tonsillitis, peritonsillar abscess, acute
supraglottitis, acute epiglottitis).
– Gradual—gastro-oesophageal reux,
Eagle’s syndrome, malignancy of oropharynx, hypopharynx, larynx, and oesophagus, oesophageal (FB, oesophagitis),
glossopharyngeal neuralgia.
• Duration
– Acute—common cold, acute pharyngitis,
acute tonsillitis, uvulitis, acute epiglottitis,
acute supraglottitis, traumatic, iatrogenic,
parapharyngeal abscess, retropharyngeal
abscess, FB in oesophagus.
– Chronic—oropharyngeal cancer, Candida
infection, HIV, chronic tonsillitis, chronic
pharyngitis.
• Progression
– Progressive—ring, stricture, Plummer–
Vinson syndrome, active FB, scleroderma,
polymyositis, mucositis, acute pharyngitis,
acute epiglottitis, GERD.
– Non-progressive—inert FB, Eagle’s
syndrome.
• Severity of odynophagia—It can be mild,
moderate and severe.
• Associated symptoms and history
– Fever, throat pain, URI—infective
aetiology
– Smoking, alcohol intake—neoplasm
– H/o GERD, H/o trauma
7.1.3 Dysphagia (Diculty
inSwallowing)
The swallowing has three phases: oral phase,
pharyngeal phase and oesophageal phase. The
dysphagia can develop due to lesion in oral cavity, oropharynx or laryngopharynx, and oesophagus. In this section, we will evaluate the
oropharyngeal dysphagia. The pharyngeal phase
of swallowing is involuntary and totally reexive,
so no pharyngeal activity occurs until the swallowing reex is triggered. This swallowing reex
lasts approximately 1 s and involves the motor
and sensory tracts from cranial nerves IX (glossopharyngeal) and X (vagus). Patients with oropharyngeal dysphagia may present with any one
of the following complaints.
• Presentation of oropharyngeal dysphagia
– Coughing or choking with swallowing
– Difculty initiating swallowing
– Food sticking in the throat
– Unexplained weight loss
– Change in dietary habits
– Recurrent pneumonia
– Change in voice or speech (wet voice)
– Nasal regurgitation
• Mode of onset of dysphagia
– Sudden—The sudden onset dysphagia can
be caused by trauma, tonsillitis, pharyngitis, brainstem cerebrovascular accident,
neurological (palatal paralysis, laryngeal
paralysis), GB syndrome.
– Gradual—The gradual onset of dysphagia
can be caused by retropharyngeal abscess,
oropharyngeal carcinoma, benign growth
on base of tongue, parapharyngeal tumour,
multiple sclerosis, Parkinson’s disease.
• Duration of dysphagia
– Acute—trauma, tonsillitis, pharyngitis.
– Chronic—retropharyngeal abscess, oropha-
ryngeal carcinoma, benign growth on base
of tongue, parapharyngeal tumour, myasthenia gravis, Eaton-Lambert syndrome,
neurological (palatal, laryngeal paralysis).
280
7 History andExamination ofOropharynx
• Progression of dysphagia
– Progressive—oropharyngeal carcinoma,
scleroderma.
– Non-progressive—Myasthenia gravis,
Zenker’s diverticulum, Postsurgical, vertebral osteophytes, chronic tonsillitis.
• Associated symptoms and history—neck
swelling, change of voice, excessive salivation, being unable to swallow, foreign body
sensation in throat.
Causes of Oropharyngeal Dysphagia
(Table7.2)
7.1.4 Foreign Body Sensation
inThroat
It is the painless sensation of a lump/FB in the
throat and may be described as a foreign body
sensation, tightening or choking feeling.
• Presentation—It is often associated with some-
thing stick to throat, persistent clearing of the
throat, chronic cough, hoarseness and catarrh.
• Mode of onset
– Sudden—acute pharyngitis, trauma to oro-
pharynx, acute sinusitis, GERD, LPRD,
FB in oropharynx.
– Gradual—superior cornu of thyroid carti-
lage, GERD, psychiatric disorder, dry
mouth syndrome, chronic tonsillitis,
chronic pharyngitis, chronic sinusitis, thyroid disease, allergy, oropharyngeal
tumour.
• Duration
– Acute—acute pharyngitis, trauma to oro-
pharynx, acute sinusitis, GERD, LPRD,
FB in oropharynx.
– Chronic—superior cornu of thyroid carti-
lage, GERD, psychiatric disorder, dry
mouth syndrome, chronic tonsillitis,
chronic pharyngitis, chronic sinusitis, thyroid disease, allergy, oropharyngeal
tumour, globus pharyngitis, chronic LPRD.
• Associated symptoms and history—pain, dys-
phagia, H/o FB ingestion, cough, GERD,
postnasal drip, halitosis, smoking, dry mouth,
odynophagia, hysteria.
Causes of Foreign Body Sensation in Throat
(Table7.3)
7.1.5 Cough
It is a common protective reex action that clears
the throat of mucus, foreign body or irritants.
• Severity of cough—It can be mild, moderate
or severe.
• Time of cough
– Associated with swallowing—aspiration.
– Not associated with swallowing.
Table 7.2 Causes of oropharyngeal dysphagia
Structural Neurological disorders Iatrogenic
Neoplasm,
Zenker’s
diverticulum,
Postsurgical,
vertebral
osteophytes
Congenital web
Cricopharyngeal bar
Enlarged thyroid
gland, poor
dentition, mucosal
lesion,
oropharyngeal
tumour
Brainstem CVA
Multiple sclerosis,
Parkinson’s disease
Brainstem tumour
Alzheimer’s disease,
Amyotrophic lateral
sclerosis
Stricture due to
corrosive,
Post- surgery
Injury
Radiation
Myoneural junction/
muscular disorder Infectious
Myasthenia gravis,
Eaton-Lambert
syndrome, myositis,
muscular dystrophy,
poliomyelitis
Others like
hypertensive or
hypotensive motility
disorders of UES
(cricopharynx)
Pharyngitis
Retropharyngeal
abscess
Parapharyngeal
abscess
Diphtheria
Lyme disease
Viral infection