Chapter Twelve

Question 1

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.

Answer 1

speech or resonance

Structural factors

Question 2

Examination of the Oral Cavity

Can evaluate _____ and _____

Cannot evaluate ______or ______

View well ….

Answer 2

oral structures and oral function

velopharyngeal structure or VP function

below area of closure

Question 3

Examination of the Oral Cavity

Answer 3

Tools

Gloves

Light

Dental mirror

Tongue blades, preferably the flavored kind

Antimicrobial hand rinse

Question 4

Examination of the Oral Cavity

Have the patient…

Tell the patient to…

Answer 4

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.

Question 5

Examination of the Oral Cavity

For palatal palpation (if there is a suspicion of a submucous cleft:

Answer 5

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.

Question 6

Examination of the Oral Cavity

Dental mirror:
1.
2.

Answer 6

1. can be used like a tongue blade

2. Can be used to examine the palate or fistula

Question 7

Positioning for Uncooperative Patients

For toddlers and infants

Answer 7

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.

Question 8

Positioning for Uncooperative Patients

For preschoolers

Answer 8

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.

Question 9

Orofacial Evaluation

Answer 9

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

Question 10

Eyes
Look for the following:
1.
2.

Answer 10

Hypertelorism—excessive spacing between the eyes

Hypotelorism—too little spacing between the eyes

Question 11

Eyes
Look for the following:

3.
4.

Answer 11

Narrow palpebral fissures—opening between the eyes

Epicanthal folds—excess folds of tissue at the inner corner of the eye

Question 12

Ears

Look for the following:

Answer 12

Microtia: simplified helix

Low-set or malformed ears

Question 13

Lips

Look for the following:

Answer 13

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

Question 14

Nose and Airway

Look for the following:

Answer 14

Flat nasal bridge: bony structure between the eyes

Bulbous nasal tip

Short columella

Stenotic nares

Question 15

Nose and Airway

Look for evidence of upper airway obstruction:

Answer 15

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

Question 16

Nose and Airway

To test airway:

Answer 16

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.

Question 17

Facial Bones and Profile
Look for the following:
1.
2.
3.

Answer 17

Flattened zygomas—cheekbones

Maxillary retrusion/midface deficiency

Micrognathic or prognathic mandible

Question 18

Dentition and Occlusion

Look for the following:

Answer 18

Missing teeth, rotated teeth, supernumerary teeth, deep bite, overjet, and underjet

Class II malocclusion

Class III malocclusion

Question 19

Tongue

Look for the following:

Answer 19

Position of the tongue tip relative to the alveolar ridge

Macroglossia—abnormally large tongue

Lobulations of the tongue

Question 20

Tongue
Look for the following:
________—also called “tongue-tie,” where patient cannot:

1.
2.
3.

Answer 20

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

Question 21

Tonsils

Look for the following:
Presence of tonsils and their relative size

Answer 21

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

Question 22

Tonsils

Look for the following:

Answer 22

Asymmetry, which affects the position of the uvula

Question 23

Alveolus and Hard Palate

Look for the following:

Answer 23

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

Question 24

Alveolus and Hard Palate

Look for the following:

Answer 24

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

Question 25

Velum and Uvula

Look for the following normal findings:

Answer 25

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

Question 26

Velum

Look for the following abnormal findings:

Answer 26

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

Question 27

Uvula

Look for the following abnormal findings:

Answer 27

Deviation or pointing to one side

Question 28

Posterior and Lateral Pharyngeal Walls

Look for the following:

Answer 28

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

Question 29

Epiglottis

Look for the following:

Answer 29

Epiglottis can sometimes pop up in kids when they stick out their tongue and say /æ/.

Question 30

Oral-Motor Function

Look for the following:

Can use ______ and ______to evaluate the ability to sequence speech sounds

Answer 30

Drooling

Open-mouth posture

Anterior tongue position

Low facial tone

History of feeding problems

Inconsistent articulation errors

diadochokinetic exercises and multisyllabic words

Question 31

Infection Control

Answer 31

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

Question 32

Infection Control

A culture of …

Handwashing should always be done:

Answer 32

handwashing must be established, even if gloves are used.

Before and after every patient/client

In front of the client and any caregivers

Question 33

Summary

Examiner looks for…

The examiner may

Speech therapy should be begun

Answer 33

structural problems that may require surgical/orthodontic attention

detect undiagnosed issues.

after structural abnormalities are resolved.