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Table 2. Essential Components of a Targeted Physical
Examination in a Patient at Increased Risk for
Head and Neck Malignancy
Anatomic site Examination details
Skin and scalp May reveal a cutaneous malignancy
Otoscopy Unilateral serous otitis media may suggest a nasopharyngeal
malignancy
Cranial nerves Itemized assessment of ocular motility, facial sensation and
movement, hearing, palate elevation, presence of gag reflex,
vocal fold movement, tongue mobility and shoulder elevation
Oral cavity Visual and digital exam of ventral and lateral surfaces of oral
cavity, tongue and floor of mouth
Oropharynx Visual exam of so palate, tonsillar fossae and posterior wall.
Palpation of the tongue base and tonsillar fossae
Nasal cavity Visual exam of the septum, floor, and turbinates
Nasopharynx Visual exam of the eustachian tube orifices, superior and
posterior walls
Hypopharynx Visual exam of pyriform sinuses and posterior pharyngeal wall
Larynx Visual exam of the epiglottis, vocal folds, and subglottis
Neck Assessment of the neck mass—firmness, size, fixation, location,
and presence of additional lymphadenopathy
Bimanual palpation of floor of mouth and entire neck
Salivary glands Palpation of parotid and submandibular glands to assess
for mass
yroid gland Palpation to assess for mass
