Ch. 12 Flashcards
An ______ examination should always be done as part of a _____ or ______ evaluation.
An orofacial examination should always be done as part of a speech or resonance evaluation.
______ factors often contribute to the deviant _____ or _____ characteristics.
Structural factors often contribute to the deviant speech or resonance characteristics.
Examination of the Oral Cavity:
Can evaluate oral _____ and oral ______
Cannot evaluate velopharyngeal _____ or VP ______
View well _____ area of ____
Can evaluate oral structures and oral function
Cannot evaluate velopharyngeal structure or VP function
View well below area of closure
Examination of the Oral Cavity: \_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_\_\_ \_\_\_\_\_\_\_ \_\_\_\_\_\_, preferably the \_\_\_\_\_\_\_ kind \_\_\_\_\_\_\_ \_\_\_\_\_\_\_ \_\_\_\_\_
Tools Gloves Light Dental mirror Tongue blades, preferably the flavored kind Antimicrobial hand rinse
Have the patient say /___/ (as in “____”), instead of /___/ (as in “_____”)
Tell the patient to stick the tongue ____ and ____ as far as it will go during _____.
Have the patient say /æ/ (as in “hat”), instead of /ɑ/ (as in “father”)
Tell the patient to stick the tongue out and down as far as it will go during phonation.
For palatal palpation (if there is a suspicion of a ______ cleft:
Always use _____!
Use ____ _____ with children.
Begin by stimulating the ____ _____.
Move finger behind _____, and follow _____ _____ of _____ _____.
Palpate middle of ______ ____ _____ for _______.
For palatal palpation (if there is a suspicion of a submucous cleft:
Always use gloves!
Use little finger with children.
Begin by stimulating the alveolar ridge.
Move finger behind molars, and follow posterior border of hard palate.
Palpate middle of posterior nasal spine for indentation.
Dental mirror
Can be used like a _____ _____
Can be used to examine the ____ for a _____
Dental mirror
Can be used like a tongue blade
Can be used to examine the palate for a fistula
Positioning for uncooperative patients:
For toddlers and infants:
Place in _____ lap and lay child _____ so the head is _____ parent’s knees.
Sit _____ from parent (Child’s head can be in your ____)/
_____ child’s ____ if necessary.
_____ actually helps.
For toddlers and infants:
Place in parent’s lap and lay child back so the head is over parent’s knees.
Sit across from parent (child’s head can be in your lap)/
Close child’s nose if necessary.
Crying actually helps.
Positioning for uncooperative patients:
For preschoolers:
Place the ____ ____ between the upper and lower teeth to keep mouth _____.
Move the tongue blade to the _____ of the tongue, and apply steady _____.
Muscles will _____ and mouth will _____.
For preschoolers:
Place the tongue blade between the upper and lower teeth to keep mouth open.
Move the tongue blade to the middle of the tongue, and apply steady pressure.
Muscles will tire and mouth will open.
Orofacial Evaluation: \_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_ and \_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_ and \_\_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_\_ and \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_ \_\_\_\_\_\_\_ \_\_\_\_\_\_\_ and \_\_\_\_\_ \_\_\_\_\_\_ \_\_\_\_\_\_\_ and \_\_\_\_\_ \_\_\_\_\_\_\_ and \_\_\_\_\_ \_\_\_\_\_\_ \_\_\_\_
Eyes Ears Nose and airway Facial bones and profile Lips Dentition and occlusions Tongue Tonsils Alveolus and hard palate Velum and uvula Posterior and lateral pharyngeal walls
Eyes:
Look for the following:
Hypertelorism—_______ spacing between the eyes
Look for the following:
Hypertelorism—excessive spacing between the eyes
Eyes:
Look for the following:
Hypotelorism—___ _____ spacing between the eyes
Look for the following:
Hypotelorism—too little spacing between the eyes
Eyes:
Look for the following:
Narrow palpebral fissures—______ between the eyes
Narrow palpebral fissures—opening between the eyes
Eyes:
Look for the following:
Epicanthal folds—excess ____ ___ ____ at the inner corner of the eye
Epicanthal folds—excess folds of tissue at the inner corner of the eye
Ears:
Look for the following:
Microtia: simplified ______
Microtia: simplified helix
Ears:
Look for the following:
Low-set or _____ ears
Low-set or malformed ears
Lips:
Look for the following:
_____ or reduced _____ of the _____ lip
Short or reduced mobility of the upper lip
Lips:
Look for the following:
Bilabial incompetence—inability to achieve ____ ______ at rest and during production of ______ sounds
Bilabial incompetence—inability to achieve bilabial closure at rest and during production of bilabial sounds
Lips:
Look for the following:
Open-mouth posture—when the lips are chronically ____ and the _____ is also involved
Open-mouth posture—when the lips are chronically open and the mandible is also involved
Lips:
Look for the following:
Bilateral lip ____ on the ___ lip
Bilateral lip pits on the lower lip
Nose and Airway: Look for the Following: Flat \_\_\_\_\_ \_\_\_\_\_\_: bony structure between the eyes \_\_\_\_\_ nasal \_\_\_\_\_\_ Short \_\_\_\_\_\_\_\_ \_\_\_\_\_\_ \_\_\_\_\_\_\_
Flat nasal bridge: bony structure between the eyes
Bulbous nasal tip
Short columella
Stenotic nares
Nose and Airway:
Look for evidence of Upper Airway Obstruction:
Adenoid facies—______ under eyes, pinched _____, narrow and elongated ____, downward position of the ______
____-_____ posture
______ breathing
_____ and history of ______ sleeping
Adenoid facies—darkness under eyes, pinched nostrils, narrow and elongated face, downward position of the mandible
Open-mouth posture
Strident breathing
Snoring and history of restless sleeping
To test airway:
- Have patient to ____ the lips and breathe ___ for several minutes.
- Then have patient ____ deeply through the ____.
- Look for nasal _____ or listen for _____ sound.
- Have patient prolong an /__/, and listen for ____.
Have patient to close the lips and breathe nasally for several minutes.
Then have patient inspire deeply through the nose.
Look for nasal pinching or listen for strident sound.
Have patient prolong an /m/, and listen for hyponasality.
Facial Bones and Profile Look for the following: \_\_\_\_\_\_ \_\_\_\_\_\_\_\_—cheekbones Maxillary \_\_\_\_\_\_\_/midface \_\_\_\_\_\_ \_\_\_\_\_\_ or \_\_\_\_\_\_ mandible
Flattened zygomas—cheekbones
Maxillary retrusion/midface deficiency
Micrognathic or prognathic mandible
Dentition and Occlusion: Look for the following: \_\_\_\_\_\_ teeth \_\_\_\_\_\_ teeth \_\_\_\_\_\_ teeth \_\_\_\_\_\_ bite \_\_\_\_\_\_ \_\_\_\_\_\_
Missing teeth rotated teeth supernumerary teeth deep bite overjet underjet
Dentition and Occlusion:
Look for the following:
Class ______ malocclusion
Class II malocclusion
Dentition and Occlusion:
Look for the following:
Class _____ malocclusion
Class III malocclusion
Tongue
Look for the following:
Position of the tongue _____ relative to the _____ ______
_____—abnormally _____ tongue
Position of the tongue tip relative to the alveolar ridge
Macroglossia—abnormally large tongue
Tongue
Look for the following:
________ of the tongue
Lobulations of the tongue
Tongue
Look for the following:
Ankyloglossia—also called “____-_____,” where patient cannot:
______ the tongue _____ to touch the roof of mouth with mouth open.
Protrude the tongue tip past the mandibular gingival ridge or mandibular incisors.
Whether child can produce /__/ and /___/ (if age appropriate) must be checked.
Ankyloglossia—also called “tongue-tie,” where patient cannot:
Elevate the tongue tip to touch the roof of mouth with mouth open.
Protrude the tongue tip past the mandibular gingival ridge or mandibular incisors.
Whether child can produce /l/ and /θ/ (if age appropriate) must be checked.
Tonsils
Look for the following:
Presence of tonsils and their relative size
Grade 0: _______
Grade 1: _____ and fit within the ______ _______
Grade 2: extend to the _____ of the _____ ______
Grade 3: ______ beyond the ____ ______
Grade 4: very large and ____ in ______
Presence of tonsils and their relative size
Grade 0: absent
Grade 1: small and fit within the faucial pillars
Grade 2: extend to the edge of the faucial pillars
Grade 3: enlarged beyond the faucial pillars
Grade 4: very large and meet in midline
Tonsils
Look for the following:
_______, which affects the position of the ______
Asymmetry, which affects the position of the uvula
Alveolus and Hard Palate
Look for the following:
Presence of a ______ fistula (in alveolus under upper lip)
Presence of an ______ (palatal) fistula
For best visualization, put a dental mirror _____ the fistula and shine a light on the mirror.
Presence of a nasolabial fistula (in alveolus under upper lip)
Presence of an oronasal (palatal) fistula
For best visualization, put a dental mirror under the fistula and shine a light on the mirror.
Alveolus and Hard Palate
Look for the following:
Evidence of a ____ ____
Evidence of a tongue flap
Alveolus and Hard Palate
Look for the following:
____ _____ and size of oral cavity in relation to size of _____
_____ in the posterior border of the hard palate
A “__” shape that indicates a _____ cleft in the underlying bone
Palatal vault and size of oral cavity in relation to size of tongue
Notch in the posterior border of the hard palate
A “V” shape that indicates a submucous cleft in the underlying bone
Velum and Uvula
Look for the following normal findings:
-Velum that is _____ and _____ in color
-Median raphe—pale white _____ down the middle of _____
-Velar ____ in midline and about _____ back during _____
-______ velar elevation
-Uvula that is not _____ and is in midline during ____ and _____
- Velum that is pinkish and consistent in color
- Median raphe—pale white line down the middle of velum
- Velar dimple in midline and about 80% back during phonation
- Symmetrical velar elevation
- Uvula that is not bifid and is in midline during rest and phonation
Velum
Look for the following abnormal findings:
Signs of velar ______ after a palate repair
Signs of velar dehiscence after a palate repair
Velum
Look for the following abnormal findings:
Signs of a _______ cleft
____ or ______ uvula
_____ ______ (bluish area)
Abnormal ______ of muscles causing a “____” shape with phonation
Signs of a submucous cleft
Bifid or hypoplastic uvula
Zona pellucida (bluish area)
Abnormal insertion of muscles causing a “V” shape with phonation
Uvula
Look for the following abnormal findings:
______ or pointing to one side
Deviation or pointing to one side
Posterior and Lateral Pharyngeal Walls:
Look for the following:
-______ border of _____ pad on the _____ pharyngeal wall
-Evidence of a _____ ______ or sphincter pharyngoplasty
-Movement of _______ at the oral level is irrelevant to ____ closure
Inferior border of adenoid pad on the posterior pharyngeal wall
Evidence of a pharyngeal flap or sphincter pharyngoplasty
Movement of LPWs at the oral level is irrelevant to VP closure
Epiglottis
Look for the following:
Epiglottis can sometimes ___ ___ in kids when they stick out their tongue and say /___/.
Epiglottis can sometimes pop up in kids when they stick out their tongue and say /æ/.
Oral-Motor Function Look for the following: \_\_\_\_\_\_\_\_ \_\_\_\_-\_\_\_\_\_\_ \_\_\_\_\_\_\_\_ \_\_\_\_\_\_ \_\_\_\_\_\_ \_\_\_\_\_\_\_ \_\_\_\_ \_\_\_\_\_ \_\_\_\_\_ \_\_\_\_\_ of \_\_\_\_\_ \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_ \_\_\_\_\_\_\_ Can use \_\_\_\_\_\_\_ exercises and \_\_\_\_\_\_\_ words to evaluate the ability to \_\_\_\_\_\_\_ speech sounds
Drooling Open-mouth posture Anterior tongue position Low facial tone History of feeding problems Inconsistent articulation errors Can use diadochokinetic exercises and multisyllabic words to evaluate the ability to sequence speech sounds
Infection Control: \_\_\_\_\_\_\_\_ or \_\_\_\_\_\_\_ gel \_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_ of materials and equipment For saliva, \_\_\_\_\_\_\_, not \_\_\_\_\_\_\_\_\_, is required. \_\_\_\_\_\_ or \_\_\_\_\_ \_\_\_\_\_\_ is sufficient. \_\_\_\_\_-\_\_\_\_\_\_ for surface disinfection
Handwashing or antimicrobial gel
Gloves
Disinfection of materials and equipment
For saliva, disinfection, not sterilization, is required.
Dishwasher or rubbing alcohol is sufficient.
Sani-Cloths for surface disinfection
Infection Control: A culture of \_\_\_\_\_\_\_ must be established, even if \_\_\_\_\_\_ are used. Handwashing should \_\_\_\_\_ be done: \_\_\_\_\_ and \_\_\_\_\_ every \_\_\_\_\_/\_\_\_\_\_\_ In \_\_\_\_\_\_\_ of the client and any \_\_\_\_\_\_
A culture of handwashing must be established, even if gloves are used.
Handwashing should always be done:
Before and after every patient/client
In front of the client and any caregivers
Summary:
Examiner looks for ______ problems that may require _____/orthodontic attention.
The examiner may detect _____ issues.
Speech therapy should be begun ______ structural abnormalities are resolved.
Examiner looks for structural problems that may require surgical/orthodontic attention.
The examiner may detect undiagnosed issues.
Speech therapy should be begun after structural abnormalities are resolved.
