L6 Oro-facial exams

Question 2

purpose of oro-facial exams

Answer 2

Purpose: Determine whether the structure and function of the
articulators are adequate for age appropriate speech production (Rvachew and Brosseau-Lapré 2018)

Question 3

infection control guidelines

Answer 3

• Wash hands thoroughly with soap and water
• Wear surgical gloves
• Wash hands again when the gloves are removed
• COVID-19 protocols

Question 4

positioning for the exam

Answer 4

• Ensure that the child is seated in a stable position with their head comfortably facing you and not arched backwards or upwards.
• Position yourself face to face with the child (this may mean that you need to kneel on the floor

Question 5

equipment necessary for exam

Answer 5

• pen torch or Throatscope
• Tongue blade
• Mirror
• Gloves

Question 6

how to manage examining younger children

Answer 6

• Get them to imitate rather than follow instructions
• You can ask the child’s caregiver to do it first, and then the child imitates them
• Or have a puppet that they can imitate
• Have a mirror so that the child can see the ‘funny faces’ that they are making
• If needed, you can let the child look in your mouth first with them torch/Throatscope, and their caregiver.
• Make it fun
• Change the order in order to get them cooperating, e.g. start with sticking their tongue out

Question 7

forms to use

Answer 7

• See Quick Oral Motor Screening Form from Rvachew and Brosseau-Lapré 2018
• The DEAP assessment contains an oral motor screening assessment (has norms)
• See the more detailed Form for Oral Motor Exam from Paul et al 2018

Question 8

standardized measures of oro-facial exams

Answer 8

• See Rvachew and Brosseaul-Lapre (2018) p. 244-247 for
  descriptions
• Verbal Motor Production Assessment for Children (VMPAC)
• Oral Speech Mechanism Screening Examination, 3rd
  edition (OSMSE-3)
• DDK – Time-by-Count norms from Fletcher (1972

Question 9

frontal view examination

Answer 9

• Determine alignment (resting posture)
• Spacing of the eyes
• Proportions of the face
• Symmetry of the nares, philtrum and Cupid’s bow

Question 10

lip examination

Answer 10

• Observe whether the child’s lips close at rest
• Observe whether the lips retract symmetrically when the child smiles, or produces/i/
• Observe whether the lips contract symmetrically when the child produces /u/

Question 11

what is involved in external face and head examination

Answer 11

• frontal view
• lips
• functional integrity
• mandible/lower jaw

Question 12

functional integrity examination

Answer 12

• Raise eyebrows
• Close eyelids against resistance (use your finger to hold them open)
• Facial expression – smile and frown

Question 13

mandible examination

Answer 13

• Place fingers in mandibular condyles – Ask child to open their mouth widely – feel for symmetry
• Check length

Question 14

what is involved in intraoral examination

Answer 14

• dentition
• tongue
• hard palate

Question 15

dentition examination

Answer 15

• Alignment of the teeth
• Note tooth decay, missing teeth etc.
• Dental occlusion

Question 16

tongue examination

Answer 16

• Observe for lesions or growths
• Observe for symmetry and the absence of fasciculation
• Movement from side to side
• Stick it out
• Touch nose
• Touch chin

Question 17

hard palate examination

Answer 17

• Absence of fistulae (tiny holes)
• Note the colour
• General length and symmetry of the velum can be observed when the child produces a prolonged
  /a/ sound, then produced /a//a//a/
  
  • The velum should raise in a posterior direction and the /a/ sound should be produced without nasal resonance

Question 18

submucosal cleft palate

Answer 18

A submucosal cleft palate results from a lack of oral fusion of the muscles within the soft palate as the baby is developing in utero.

Question 19

signs of a submucosal cleft palate

Answer 19

• Split (bifid) uvula
• Translucency of the tissue along the middle of the soft palate
• A notch at the back of the hard palate
• History of velopharyngeal impairment