From the Guidelines
The appropriate workup for a patient presenting with symptoms of an oral condition should include a thorough history and physical examination, including a complete head and neck exam, as well as a biopsy and imaging studies such as CT with contrast and/or MRI with contrast of the primary and neck as indicated. When evaluating a patient with oral symptoms, it is essential to consider the potential for head and neck cancers, as outlined in the study by 1. The workup should include:
- A complete head and neck exam, including mirror and fiberoptic examination as clinically indicated
- Biopsy to determine the presence and type of cancer
- Chest imaging to evaluate for metastatic disease
- CT with contrast and/or MRI with contrast of the primary and neck as indicated to assess the extent of disease
- Consideration of PET-CT for stage III-IV disease
- Examination under anesthesia with endoscopy, if indicated, to further evaluate the oral cavity and surrounding structures
- Preanesthesia studies to assess the patient's overall health and suitability for surgery
- Dental/prosthodontic evaluation, including jaw imaging as indicated, to assess the patient's dental health and potential need for dental interventions
- Nutrition, speech, and swallowing evaluation/therapy as indicated to address potential functional impairments
- Multidisciplinary consultation as indicated to ensure comprehensive care and management of the patient's condition.
From the Research
Initial Assessment
The initial assessment of a patient presenting with symptoms of an oral condition involves a thorough medical history, physical examination, and routine laboratory analyses 2. This formal initial assessment is the basis of every preliminary diagnosis.
Diagnostic Approach
A multi-step diagnostic approach is recommended, taking into account the differential diagnosis and prioritizing probabilities 2. In cases of life-threatening illnesses, the first diagnostic and therapeutic steps should be performed in a rapid sequence.
Review of Systems and Physical Examination
The review of systems and physical examination are valuable case-finding maneuvers in the periodic medical evaluation of ambulatory patients 3. These maneuvers can lead to new therapeutic interventions for unsuspected clinically important diagnoses.
Clinical Examination
The clinical examination of a patient is crucial for the formulation of a diagnostic and therapeutic plan 4. It should be performed in a structured manner, following the concept of "A B C", which stands for airways, breathing, and circulation.
Workup for Specific Conditions
For specific conditions, such as cutaneous flushing, a thorough taking of history and physical examination may be sufficient for diagnosis, but further laboratory, radiologic, or histopathologic studies may be necessary to differentiate between various clinicopathologic entities 5.
Routine Screening Tests
Routine preoperative screening tests, such as complete blood count, liver function tests, and chest X-ray, may be of low yield in patients with clinically node-negative breast cancer 6. Abnormalities found on these tests may not necessarily lead to a diagnosis of metastatic disease.
- Key points to consider in the workup of a patient with symptoms of an oral condition:
- Thorough medical history and physical examination
- Routine laboratory analyses
- Multi-step diagnostic approach
- Review of systems and physical examination as case-finding maneuvers
- Clinical examination in a structured manner
- Further laboratory, radiologic, or histopathologic studies as necessary
- Limitation of routine preoperative screening tests to patients with signs or symptoms