[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [ENT](https://durgical.com/en/ent/) › [The ENT examination](https://durgical.com/en/ent/areas/exam/) › Oral cavity and oropharynx exam

# Oral cavity and oropharynx exam

- Examination

A careful look and feel of the whole mouth and throat finds early cancer, premalignant patches and infections that need urgent care.

Updated Nov 5, 2026

## Key points

- The highest-risk sites for oral cancer are the floor of the mouth and the lateral and under-surface of the tongue.
- Any sore, white or red patch, or lump in the mouth or throat lasting more than 2 weeks needs specialist review.
- Feel what you see: cancers are often firm and indurated with a rolled edge, and early ones cause no symptoms.
- Tobacco and alcohol (much worse together) and HPV are the key risk factors; HPV is linked mainly to oropharyngeal cancer.
- A mouth or throat lesion with a neck lump, hoarseness, difficulty swallowing or ear pain is a red flag.

## What it is

The ENT exam of the mouth and oropharynx follows the general semiology (see the mouth and pharynx page) but adds what the specialist looks for: every subsite of the oral cavity seen and palpated, the tongue base and tonsils assessed as hiding places for cancer, and the neck examined in the same visit. The exam takes a few minutes, needs good light, gloves and two tongue depressors, and is the main way to detect oral cancer early. Tobacco, alcohol and HPV are the key risk factors to keep in mind.

## Findings and interpretation

- A white patch that cannot be scraped off (leukoplakia) is usually benign, but carcinoma can arise within it; suspicious areas are biopsied.
- A red velvety patch (erythroplakia) on a high-risk site is more worrying and needs biopsy.
- A firm ulcer with a raised, rolled edge on the lateral tongue or floor of mouth is squamous cell carcinoma until biopsy says otherwise.
- Any oropharyngeal lesion other than simple pharyngitis or a dental infection is a red flag, especially with a neck mass.
- Trismus, a uvula pushed to one side and a muffled voice suggest a peritonsillar abscess.
- Oral cancer spreads first to the neck nodes, so the neck is part of every mouth exam.

## How it is done

- Wear gloves, use a good head light and two tongue depressors; ask the patient to remove dentures.
- Look at the lips and mouth corners, then retract each cheek to see the buccal mucosa and gums.
- Tongue: the dorsum, then each lateral border (hold the tip with gauze and pull it to the side), then the under-surface and floor of the mouth.
- Look at the hard and soft palate and the uvula, and watch the palate rise when the patient says «ah».
- Look at the tonsils and posterior pharyngeal wall: size, symmetry, exudate, ulcers and bulging.
- Palpate the floor of the mouth bimanually, and palpate any lesion, the tongue and the tongue base if cancer is possible.
- Percuss the teeth when pain or swelling suggests a dental source.
- Finish with the neck nodes and, when there are symptoms or risk factors, a mirror or endoscopic view of the larynx and hypopharynx.

## Mouth and throat findings and the next step

| Finding | Concern | Next step |
| --- | --- | --- |
| White patch on the floor of mouth or lateral tongue | Leukoplakia (can harbour carcinoma) | Biopsy if suspicious; stop tobacco |
| Red velvety patch | Erythroplakia | Biopsy |
| Firm ulcer with rolled edge for more than 2 weeks | Squamous cell carcinoma | Urgent referral for biopsy |
| Trismus, deviated uvula, bulging soft palate | Peritonsillar abscess | Same-day referral |
| Oropharyngeal mass with a neck lump | Oropharyngeal carcinoma | Urgent ENT referral |

## Common mistakes

- Examining with dentures in place: lesions under them are missed.
- Looking without palpating: induration is felt before it is seen.
- Skipping the lateral and under-surface of the tongue and the floor of the mouth, the commonest cancer sites.
- Treating a persistent ulcer with repeated topical remedies instead of referring it.

## Next step / Initial management

- Lesion that persists more than 2 weeks after removing an obvious cause (sharp tooth, ill-fitting denture): refer for biopsy.
- Suspected cancer (indurated ulcer, red patch, lesion with a neck node): urgent referral to ENT or head and neck surgery.
- Signs of peritonsillar abscess or any airway compromise: same-day referral.
- Advise stopping tobacco and reducing alcohol, and record the findings with site and size for follow-up.

## Test yourself

Think of the answer, then tap the question to see it.

## Where in the mouth is squamous cell carcinoma most often found?

The floor of the mouth and the lateral and under-surface of the tongue.

## A 58-year-old smoker has a painless, firm ulcer on the lateral tongue for 5 weeks. What is the next step?

Urgent referral for biopsy: a persistent indurated ulcer at a high-risk site is suspicious for cancer.

## Why must the floor of the mouth be palpated as well as inspected?

Early cancers are often painless and small; they are frequently felt as firm induration before they are obvious to the eye.

[Add to my cards (3)](https://durgical.app/estudiar/?add=/en/ent/oral-cavity-and-oropharynx-exam/)

## Elsewhere in DurgiPedia

- [Mouth and pharynx examination](https://durgical.com/en/clinical-exam/mouth-and-pharynx-examination/)

## Connections

## Related 1

- [Approach to mouth ulcers](https://durgical.com/en/ent/approach-to-mouth-ulcers/)

[← All of ENT](https://durgical.com/en/ent/)

Educational content; it does not replace a medical assessment and is not a clinical instruction. For a real case, follow current guidelines and specialist advice.

Sources: [Oral Cancer](https://www.nidcr.nih.gov/health-info/oral-cancer) (NIDCR, National Institutes of Health, 2024); [Oral Squamous Cell Carcinoma](https://www.msdmanuals.com/professional/oncology/tumors-of-the-head-and-neck/oral-squamous-cell-carcinoma) (MSD Manual Professional Edition, 2024); [Neck Mass](https://www.msdmanuals.com/professional/ear-nose-and-throat-disorders/approach-to-the-patient-with-nasal-and-pharyngeal-symptoms/neck-mass) (MSD Manual Professional Edition, 2026); [Evaluation of the Patient With Nasal and Pharyngeal Symptoms](https://www.msdmanuals.com/professional/ear-nose-and-throat-disorders/approach-to-the-patient-with-nasal-and-pharyngeal-symptoms/evaluation-of-the-patient-with-nasal-and-pharyngeal-symptoms) (MSD Manual Professional Edition, 2026).

## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake

Representative model, for educational purposes only.

---
Source: https://durgical.com/en/ent/oral-cavity-and-oropharynx-exam/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/ent/oral-cavity-and-oropharynx-exam/