Ch. 12

Question 1

An ______ examination should always be done as part of a _____ or ______ evaluation.

Answer 1

An orofacial examination should always be done as part of a speech or resonance evaluation.

Question 2

______ factors often contribute to the deviant _____ or _____ characteristics.

Answer 2

Structural factors often contribute to the deviant speech or resonance characteristics.

Question 3

Examination of the Oral Cavity:
Can evaluate oral _____ and oral ______
Cannot evaluate velopharyngeal _____ or VP ______
View well _____ area of ____

Answer 3

Can evaluate oral structures and oral function
Cannot evaluate velopharyngeal structure or VP function
View well below area of closure

Question 4

Examination of the Oral Cavity:
\_\_\_\_\_
\_\_\_\_\_
\_\_\_\_\_
\_\_\_\_\_ \_\_\_\_\_\_\_
\_\_\_\_\_\_\_ \_\_\_\_\_\_, preferably the \_\_\_\_\_\_\_ kind
\_\_\_\_\_\_\_ \_\_\_\_\_\_\_ \_\_\_\_\_

Answer 4

Tools
Gloves
Light
Dental mirror
Tongue blades, preferably the flavored kind
Antimicrobial hand rinse

Question 5

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 _____.

Answer 5

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.

Question 6

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 _______.

Answer 6

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.

Question 7

Dental mirror
Can be used like a _____ _____
Can be used to examine the ____ for a _____

Answer 7

Dental mirror
Can be used like a tongue blade
Can be used to examine the palate for a fistula

Question 8

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.

Answer 8

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.

Question 9

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 _____.

Answer 9

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.

Question 10

Orofacial Evaluation:
\_\_\_\_\_
\_\_\_\_\_
\_\_\_\_\_ and \_\_\_\_\_
\_\_\_\_\_ \_\_\_\_\_ and \_\_\_\_\_\_
\_\_\_\_\_
\_\_\_\_\_\_ and \_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_
\_\_\_\_\_\_\_
\_\_\_\_\_\_\_ and \_\_\_\_\_ \_\_\_\_\_\_
\_\_\_\_\_\_\_ and \_\_\_\_\_
\_\_\_\_\_\_\_ and \_\_\_\_\_ \_\_\_\_\_\_ \_\_\_\_

Answer 10

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 11

Eyes:
Look for the following:
Hypertelorism—_______ spacing between the eyes

Answer 11

Look for the following:

Hypertelorism—excessive spacing between the eyes

Question 12

Eyes:
Look for the following:
Hypotelorism—___ _____ spacing between the eyes

Answer 12

Look for the following:

Hypotelorism—too little spacing between the eyes

Question 13

Eyes:
Look for the following:
Narrow palpebral fissures—______ between the eyes

Answer 13

Narrow palpebral fissures—opening between the eyes

Question 14

Eyes:
Look for the following:
Epicanthal folds—excess ____ ___ ____ at the inner corner of the eye

Answer 14

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

Question 15

Ears:
Look for the following:
Microtia: simplified ______

Answer 15

Microtia: simplified helix

Question 16

Ears:
Look for the following:
Low-set or _____ ears

Answer 16

Low-set or malformed ears

Question 17

Lips:
Look for the following:
_____ or reduced _____ of the _____ lip

Answer 17

Short or reduced mobility of the upper lip

Question 18

Lips:
Look for the following:
Bilabial incompetence—inability to achieve ____ ______ at rest and during production of ______ sounds

Answer 18

Bilabial incompetence—inability to achieve bilabial closure at rest and during production of bilabial sounds

Question 19

Lips:
Look for the following:
Open-mouth posture—when the lips are chronically ____ and the _____ is also involved

Answer 19

Open-mouth posture—when the lips are chronically open and the mandible is also involved

Question 20

Lips:
Look for the following:
Bilateral lip ____ on the ___ lip

Answer 20

Bilateral lip pits on the lower lip

Question 21

Nose and Airway:
Look for the Following:
Flat \_\_\_\_\_ \_\_\_\_\_\_: bony structure between the eyes
\_\_\_\_\_ nasal \_\_\_\_\_\_
Short \_\_\_\_\_\_\_\_
\_\_\_\_\_\_ \_\_\_\_\_\_\_

Answer 21

Flat nasal bridge: bony structure between the eyes
Bulbous nasal tip
Short columella
Stenotic nares

Question 22

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

Answer 22

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 23

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 ____.

Answer 23

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 24

Facial Bones and Profile
Look for the following:
\_\_\_\_\_\_ \_\_\_\_\_\_\_\_—cheekbones 
  Maxillary \_\_\_\_\_\_\_/midface \_\_\_\_\_\_
  \_\_\_\_\_\_ or \_\_\_\_\_\_ mandible

Answer 24

Flattened zygomas—cheekbones
Maxillary retrusion/midface deficiency
Micrognathic or prognathic mandible

Question 25

``` Dentition and Occlusion: Look for the following: ______ teeth ______ teeth ______ teeth ______ bite ______ ______ ```

Answer 25

``` Missing teeth rotated teeth supernumerary teeth deep bite overjet underjet ```

Question 26

Dentition and Occlusion: Look for the following: Class ______ malocclusion

Answer 26

Class II malocclusion

Question 27

Dentition and Occlusion: Look for the following: Class _____ malocclusion

Answer 27

Class III malocclusion

Question 28

Tongue Look for the following: Position of the tongue _____ relative to the _____ ______ _____—abnormally _____ tongue

Answer 28

Position of the tongue tip relative to the alveolar ridge | Macroglossia—abnormally large tongue

Question 29

Tongue Look for the following: ________ of the tongue

Answer 29

Lobulations of the tongue

Question 30

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.

Answer 30

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.

Question 31

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 ______

Answer 31

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

Question 32

Tonsils Look for the following: _______, which affects the position of the ______

Answer 32

Asymmetry, which affects the position of the uvula

Question 33

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.

Answer 33

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.

Question 34

Alveolus and Hard Palate Look for the following: Evidence of a ____ ____

Answer 34

Evidence of a tongue flap

Question 35

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

Answer 35

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 36

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 _____

Answer 36

- 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 37

Velum Look for the following abnormal findings: Signs of velar ______ after a palate repair

Answer 37

Signs of velar dehiscence after a palate repair

Question 38

Velum Look for the following abnormal findings: Signs of a _______ cleft ____ or ______ uvula _____ ______ (bluish area) Abnormal ______ of muscles causing a “____” shape with phonation

Answer 38

Signs of a submucous cleft Bifid or hypoplastic uvula Zona pellucida (bluish area) Abnormal insertion of muscles causing a “V” shape with phonation

Question 39

Uvula Look for the following abnormal findings: ______ or pointing to one side

Answer 39

Deviation or pointing to one side

Question 40

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

Answer 40

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 41

Epiglottis Look for the following: Epiglottis can sometimes ___ ___ in kids when they stick out their tongue and say /___/.

Answer 41

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

Question 42

``` Oral-Motor Function Look for the following: ________ ____-______ ________ ______ ______ _______ ____ _____ _____ _____ of _____ ________ ________ _______ _______ Can use _______ exercises and _______ words to evaluate the ability to _______ speech sounds ```

Answer 42

``` 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 ```

Question 43

``` Infection Control: ________ or _______ gel _________ _________ of materials and equipment For saliva, _______, not _________, is required. ______ or _____ ______ is sufficient. _____-______ for surface disinfection ```

Answer 43

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 44

``` Infection Control: A culture of _______ must be established, even if ______ are used. Handwashing should _____ be done: _____ and _____ every _____/______ In _______ of the client and any ______ ```

Answer 44

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

Question 45

Summary: Examiner looks for ______ problems that may require _____/orthodontic attention. The examiner may detect _____ issues. Speech therapy should be begun ______ structural abnormalities are resolved.

Answer 45

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.