A complete physical exam with vital signs, weight and neck circumference should be performed on every patient. Included in this evaluation is a detailed head and neck examination. Specific attention is focused in the regions that have been well described as potential sites of upper airway obstruction, such as the nose, palate, and base of tongue (20-25). Nasal obstruction can occur as a result of alar collapse, septal deviation, and turbinate hypertrophy or sinonasal masses. These can be identified on anterior rhinoscopy. The oral cavity should be examined for dental occlusion, periodontal disease and any lesions, including torus mandibulae or torus palatinus. Examination of the oropharyngeal and hypopharyngeal regions includes a description of the tonsils, palate, lateral pharyngeal walls, and tongue base. A variety of grading systems, such as Mallampati's, have been developed to establish a standard of describing the degree of obstruction caused by these structures (26,27). However, it was Fujita who first proposed a classification system to define the levels of upper airway obstruction in OSA patients (28,29). Laryngeal anatomy can be evaluated by indirect laryngoscopy or fiberoptic exam (see Fiberoptic Nasophar-yngolaryngoscopy section).
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