Examination of the pharynx is limited to inspection. To visualize the palate and oropharynx adequately, the examiner usually must use a tongue depressor. The patient is asked to open the mouth widely, stick out the tongue, and breathe slowly through the mouth. On occasion, leaving the tongue in the floor of the mouth provides better visibility. The examiner should hold the tongue depressor in the right hand and a light source in the left. The tongue blade should be placed on the middle third of the tongue. The tongue is depressed and scooped forward behind the front teeth. The examiner should be careful not to press the patient's lower lip or tongue against the teeth with the tongue depressor. If the tongue depressor is placed too anteriorly, the posterior portion of the tongue will mound up, making inspection of the pharynx difficult; if placed too posteriorly, the gag reflex may be stimulated.
Is infection present? Is candidiasis present?
An accessory for the oto-ophthalmoscope handle is a light source that holds the tongue depressor and makes the examination easier. Both techniques of holding the tongue depressor are demonstrated in Figure 12-40.
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