After a thorough inspection of the tongue, the examination proceeds with palpation. The patient sticks out the tongue onto a piece of gauze. The tongue is then held by the examiner's right hand as the sides of the tongue are inspected and palpated with the left hand. This is illustrated in Figure 12-29. To examine the other side of the tongue, the examiner reverses hands.
The anterior two thirds and the lateral margins of the tongue can be evaluated without stimulating the gag reflex. The examiner should palpate the lateral margins of the tongue because more than 85% of all lingual cancers arise in this area. All white lesions should be palpated. Is there evidence of induration (hardness)? Induration or ulceration is strongly suggestive of carcinoma. After the tongue is palpated, it is unwrapped, and the gauze is discarded. Any intraoral lesion, ulcer, or mass present for more than 2 weeks should be examined through biopsy and evaluated by an oral pathologist.
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