Any of the structures of the mouth may be involved in local disease or may be part of wider systemic pathology. Therefore a thorough history is needed to determine between the two. Certain symptoms such as xerostomia (dry mouth) should not be considered in isolation. This may be as a result of drugs, gland dysfunction or diabetes. Ulcerations of the oral mucosa could be as a result of local disease such as poor dental hygiene, gingivitis or systemic illnesses including anaemia, AIDS or HIV. Any ulceration that is red, white or pigmented lasting for longer than 3 weeks should be investigated. Angular stomatitis and tongue/mouth soreness could be from a haematological cause or iron deficiency. Any intraoral swellings that increase in size or pain associated with eating are usually as a result of salivary gland pathology. Patients who present with any lumps in the neck should be referred to an ENT specialist, so that they can be appropriately investigated to determine if they are secondary lymph nodes and the likely primary source. In patients presenting with a neck lump, it is worth investigating any symptoms of the tongue, mouth, nose or throat as these may identify the primary site. Enlarged lymph nodes may be a result of a previous infection, so the clinician should determine if the patient has had any recent illnesses or infections. Symptoms associated with under-active or over-active thyroid should be determined. Associated symptoms such as weight loss, night sweats and malaise are suggestive of systemic diseases such as AIDS or lymphoma.

All patients with an unexplained lump in neck that recently appeared, or a lump that was not diagnosed before and has changed during a period from 3 to 6 weeks, should be referred urgently to an ENT specialist.

Patients with persistent unexplained swelling of a parotid, sublingual, or submandibular gland should be referred urgently to ENT.

The facial nerve controls the muscles of the facial expression and stapedius, the lacrimal and submandibular glands, and the sensory function of the anterior 2/3 of the tongue. Hence, as well as facial droop, patients may present with drooling, hyperacusis, altered taste, speech issues, earache, dry eye and reduced corneal reflex. Facial palsy can be classified in central or peripheral. The two forms are differentiated clinical examination since the facial motors nuclei are two, one top and one bottom bilaterally innervated that receives only a contra-lateral innervations. It follows that: