Palpation reveals the degree of sensibility of the parts, the existence of œdema, induration, cysts, and, more frequently, distension of the salivary ducts as well as the presence of calculi, tumours, the direction of fistulæ, etc.
Difficulties may occur, particularly when the submaxillary and parotid glands are affected; but methodical and complete examination will usually enable one to differentiate the conditions.
Pharynx. The pharynx may be examined externally by inspection and palpation, and internally by direct digital palpation. Inspection reveals possible deformities of the region of the gullet, palpation the condition of the tissues as well as abnormal sensibility and infiltration. Internally, digital examination must be cautiously conducted, and after a strong gag has been securely inserted in the mouth. Under such conditions it is without danger. The hand being inserted exactly in the median line will detect obstructions which may already have been partly identified by external palpation, as well as the existence of inflammation with or without the formation of false membranes, and of ulcerations, polypi, etc.
Œsophagus. In consequence of its anatomical formation, situation and course, the œsophagus may be divided into two distinct parts—viz., the cervical, which can be examined from the outside, and the thoracic, which cannot so be examined.
The cervical part may be examined by inspection, by palpation from one side, or by palpation with both hands and from both sides.
Fig. 59.—Examination of the pharynx.
Inspection leads to the detection of changes in the shape of the œsophagus and of the jugular furrow. In fat subjects, however, it is of little value. As the position and the course of the œsophagus are known, unilateral palpation, or, better still, bilateral palpation, employing both hands, is of very much greater service. These methods reveal the presence of swellings, infiltrations, changes in shape and sensibility, the presence of foreign bodies, the existence of dilatations or contractions of the tube, etc.
Auscultation and percussion, though recommended by some practitioners, are not of much service.
Inability to swallow, due to change in the œsophagus, is also detected by inspection. Its existence suggests a number of possible conditions, such as fissure or ulceration of the œsophagus, compression in the mediastinal region as a result of tuberculous or other disease, contraction or dilatation of the œsophagus, etc. Furthermore, inspection will betray the existence of dilatation of the tube, to which vomiting and regurgitation of food are sometimes due.