Chapter 5 Oral facial examination-student version PDF

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Chapter 5 Oral facial examination No speech assessment would be complete without an Oral Facial Exam. The purpose of an oral-facial examination is to identify or rule out structural or functional factors that relate to a communication disorder.

Items needed for an oral-facial examination: 1. disposable gloves 2. stop watch to measure diadochokinetic rate (ddk rate how fast articulators can move) 3. small light to illuminate the oral cavity 4. tongue depressor to assist in holding the tongue down to observe the velum and to hold the cheek out so that we can examine dentition (teeth) a. You can use a dum dum or flavored tongue depressor

HOW TO GIVE ORAL PERIPH TO PRESCHOOLERS: 1. Don’t do oral facial exam first thing. 2. Introduce the exam as a game. a. Play a game of Copy Cat “i’m going to do this, then you do it” 3. Make him feel at ease by… a. The equipment is usually what makes kids scared so let them touch things like gloves and let them have their own gloves, blow one up like a balloon. “i’ll touch your nose and you can touch mine”

SAFETY RULES TO REMEMBER: Protect all parties from possible body fluids and infectious materials (always assume clients are an infectious risk and use appropriate barrier practices.) 1. Sterilize all equipment to be used in mouth 2. wash hands before and after contact 3. wear gloves

4. remove gloves without touching the outside of them and safely dispose.

INTERPRETING THE ORAL-FACIAL EXAMINATION Valid interpretation of findings from an oral-facial examination requires an understanding of the anatomic, physiologic and neurologic bases of the oral-facial structures and their functions. It takes time and lots of experience (many, many mouths to look at and compare) to assess the relationship between oral-facial integrity (how its all put together/how it looks and preforms) and communication function. Common observations from oral-facial exam and what they could mean (not an inclusive list) 1. Abnormal color of the tongue, palate or pharynx Pink/red of mouth = normal Gray color in mouth = muscle paralysis Blue tint in mouth= may result from excessive vascularity or bleeding Dark or translucent color on hard palate= palatal fistula (small hole) or cleft Dark spots= oral cancer Whitish color present along the border of the hard and soft palate= symptom of sub mucous cleft (when the skin of the palate comes together but the muscles under the skin has not come together so theres a hole Other signs of submucous cleft: THE MOST COMMON SIGN OF SUBMUCOUS CLEFT IS abnormal uvula . The uvula may be intact, but short and stubby or may have a bifid uvula. There may be a notch in bony structure. People with submucous cleft may have normal speech, but be at risk for hyper nasality after adenoidectomy. Hypernasality for up to 6 months following an adenoidectomy is normal, but should not persist longer than 6 months. Big tonsils or adenoids might make children snore. That is not okay! 2. abnormal height or width of palatal arch Client with high palate may have difficulty with palatal lingual sounds.

Pt with low or narrow arch may have consonant distortions. Often children with Down Syndrome will have a high palatal arch and to compensate for the intraoral crowding the mandible will lower and tongue may be forced down and forward. (other disorders too) Will appear that tongue is too big, but actually it is the lack of room in the oral cavity. THREE THINGS WE EVALUATE IN HARD PALATE=

3. Assymetry of the face or palate- often associated with neurological impairment or muscle weakness (stroke/ TBI)

4. Deviation of the tongue or uvula to the left or right. With normal uvula movement the uvula should be in midline and hanging straight down. Deviation to one side may indicate neurological involvement (stroke/TBI) If so, the uvula may deviate to the stronger side as palatal muscles on strong side pull uvula farther toward the velophayngeal opening. Can be confusing because the tongue would deviate to the stronger side because the weaker ½ of the tongue is unable to match the extension of the stronger ½. 5. enlarged tonsils- tonsils are located between the anterior and posterior facial pillars. Many children have large tonsils with no adverse affect on speech production. Tonsils are largest in preschool and school-aged children and then begin to atrophy as child gets older and shrink around puberty. Tonsils are nonexistent in most adults. In some cases, big tonsils interfere with general health, normal resonance and hearing acuity if eustacian tubes are blocked. Client/Pt. may also have more forward resting posture of tongue to open airway and this can affect articulation. May keep mouth open and tongue protruded to establish airway and may drool because mouth is open (chronic open mouth posture increases production of saliva) May want to refer to an ENT child with artic problems, large tonsils and frequent ear infections, sick a lot. THEY DON’T REMOVE TONSILS AS OFTEN AS THEY USED TO 6. Missing teeth- In most cases missing teeth don’t seriously affect articulation, but it can and it can determine what sounds you will or will not address 1st in therapy.

7. Mouth breathing. Client may have a restricted passageway to the nasal cavity (ex: tonsils or adenoids) An open mouth posture may be caused by weak lips as well.

8. Poor intraoral pressure –poor maintainance of air in cheeks is a sign of labial weakness or velopharygeal inadequacy. (VPI- velopharygeal insufficiency is a structural problem, not enough tissue there to close VP passage. Velopharyngeal incompetence is functional, tissue is there but muscle is weak) 9. Prominent ruggae- may indicate an abnormally ______________ or low palate or both, or large ______________________ in relation to palatal areas. May also be associated with _________________________________. 10. short lingual frenum (ankyloglossia) if client is unable to place tongue against _____________________________ or the teeth to produce sounds such as __________________ the frenum may need to be _________________by a physician. THEY USED TO DO THIS MORE THAN THEY DO NOW It is a _____________________________that ankyloglossia often affects speech production and is a ______________________________ for speech problems. The truth is that it _____________________ affects speech. It will generally affect ________________________ more than speech. If the function is not impaired than there is no need to clip. Sometimes a w shape tongue upon protrusion is sign of a short _____________, but it can also be a sign of ___________________________ so have to be careful. 11. Weak or absent gag reflex can indicate _______________________in velopharyngeal area. Neurological impairment may be present. But, some clients just have a high tolerance for gagging and will not gag even if muscular integrity is normal. Others have a very sensitive gag. Could be a sign of ________________ or ______________ sensitivity and may want to assess that further based on this finding. 12. Weakness of the lips, tongue or jaw. Common in patients with neurological impairments such as _____________________________ or stroke.

DENTITION Occlusion:

1. Class I = Normal. Mandibular molar line up to be one half of a tooth in front of the maxillary molar. 2. Class II= Mandible is ________________ where it should be in relation to the maxillary arch 3. Class III= Mandible is _____________________ in relationship to the maxilla (class III malocclusion) Crossbite= the maxillary teeth are ___________________ the mandibular teeth. Openbite= the maxillary teeth don’t ______________ the madibular teeth (can be caused by tongue thrust or thumb sucking. Can affect position of tongue at rest.

PAGE 147 DDK average Diadochokinetics (DDKs) - syllable rates are used to evaluate a clients ability to make rapidly alternating speech movements - Count the number of syllable reps a client produces within a predetermined number of seconds (how many reps of “PUH-TUH-KUH”) - How many seconds it takes a client to repeat a predetermined number off syllables (how many seconds does it take to do 20 reps of “PUH-TUH-KUH”) - Toco Bell, Buttercup, mommy-daddy (if they don’t have the back sound yet) bilabial, linga dental, velar - In the report it will be written in the functional area of it REPORT STRUCTURE I. Intro: why you’re giving the Test - “An oral facial examination was given in order to evaluate the structure and function of ______’s oral mechanism” (mechanism or oral cavity is singular) II. Facts about structure: - Jaw’s alignment-dentition (class I, II, III) - not how wide because that would be function - color of lips, tongue, palate - ruggae height, width, color III. Facts about function - tongue movement (protrude, lateralize, elevate, depress) - palatal movement IV. All structures and functions were adequate for the production of normal speech...