Chapter Twelve Flashcards
Examination of the Oral Cavity
An orofacial examination should always be done as part of a ______ evaluation.
________often contribute to the deviant speech or resonance characteristics.
speech or resonance
Structural factors
Examination of the Oral Cavity
Can evaluate _____ and _____
Cannot evaluate ______or ______
View well ….
oral structures and oral function
velopharyngeal structure or VP function
below area of closure
Examination of the Oral Cavity
Tools
Gloves
Light
Dental mirror
Tongue blades, preferably the flavored kind
Antimicrobial hand rinse
Examination of the Oral Cavity
Have the patient…
Tell the patient to…
say /æ/ (as in “hat”), instead of /ɑ/ (as in “father”)
stick the tongue out and down as far as it will go during phonation.
Examination of the Oral Cavity
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.
Examination of the Oral Cavity
Dental mirror:
1.
2.
- can be used like a tongue blade
2. Can be used to examine the palate or fistula
Positioning for Uncooperative Patients
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 (vhild’s head can be in your lap)
Close child’s nose if necessary.
Crying actually helps.
Positioning for Uncooperative Patients
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
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:
1.
2.
Hypertelorism—excessive spacing between the eyes
Hypotelorism—too little spacing between the eyes
Eyes
Look for the following:
3.
4.
Narrow palpebral fissures—opening between the eyes
Epicanthal folds—excess folds of tissue at the inner corner of the eye
Ears
Look for the following:
Microtia: simplified helix
Low-set or malformed ears
Lips
Look for the following:
Short or reduced mobility of the upper lip
Bilabial incompetence—inability to achieve bilabial closure at rest and during production of bilabial sounds
Open-mouth posture—when the lips are chronically open and the mandible is also involved
Bilateral lip pits on the lower lip
Nose and Airway
Look for the following:
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—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
Nose and Airway
To test airway:
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: 1. 2. 3.
Flattened zygomas—cheekbones
Maxillary retrusion/midface deficiency
Micrognathic or prognathic mandible
Dentition and Occlusion
Look for the following:
Missing teeth, rotated teeth, supernumerary teeth, deep bite, overjet, and underjet
Class II malocclusion
Class III malocclusion
Tongue
Look for the following:
Position of the tongue tip relative to the alveolar ridge
Macroglossia—abnormally large tongue
Lobulations of the tongue
Tongue
Look for the following:
________—also called “tongue-tie,” where patient cannot:
1.
2.
3.
Ankyloglossia
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: 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:
Asymmetry, which affects the position of the uvula
Alveolus and Hard Palate
Look for the following:
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.
Evidence of a tongue flap
Alveolus and Hard Palate
Look for the following:
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 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 dehiscence after a palate repair
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:
Deviation or pointing to one side
Posterior and Lateral Pharyngeal Walls
Look for the following:
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 pop up in kids when they stick out their tongue and say /æ/.
Oral-Motor Function
Look for the following:
Can use ______ and ______to evaluate the ability to sequence speech sounds
Drooling
Open-mouth posture
Anterior tongue position
Low facial tone
History of feeding problems
Inconsistent articulation errors
diadochokinetic exercises and multisyllabic words
Infection Control
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 …
Handwashing should always be done:
handwashing must be established, even if gloves are used.
Before and after every patient/client
In front of the client and any caregivers
Summary
Examiner looks for…
The examiner may
Speech therapy should be begun
structural problems that may require surgical/orthodontic attention
detect undiagnosed issues.
after structural abnormalities are resolved.
