CMT Evaluation & Treatment Planning 2 — Questions and Answers
Question 1: During an orofacial myofunctional evaluation, which standardized tool is most commonly used to assess tongue posture at rest?
- Iowa Oral Performance Instrument
- Clinical observation with visual inspection and palpation (Correct answer)
- Electromyography of the masseter
- Panoramic radiograph
Correct answer: Clinical observation with visual inspection and palpation
Visual inspection and palpation remain the primary clinical methods for assessing resting tongue posture in orofacial myofunctional evaluations.
Question 2: A patient presents with an open mouth posture and low tongue resting position. Which associated finding would MOST reinforce a myofunctional etiology?
- Enlarged tonsils grade III
- Nasal turbinate hypertrophy confirmed by ENT
- Habitual lip incompetence with no anatomical obstruction (Correct answer)
- Anterior crossbite on dental exam
Correct answer: Habitual lip incompetence with no anatomical obstruction
Habitual lip incompetence without structural cause strongly implicates a myofunctional pattern rather than a purely anatomical obstruction.
Question 3: When documenting swallowing function during a CMT evaluation, which phase is the primary focus of orofacial myofunctional assessment?
- Esophageal phase
- Pharyngeal phase
- Oral preparatory and oral phases (Correct answer)
- Upper esophageal sphincter relaxation
Correct answer: Oral preparatory and oral phases
The oral preparatory and oral phases involve tongue movement and lip seal, which are the core focus of orofacial myofunctional therapy.
Question 4: A myofunctional therapist notes that a 9-year-old patient uses significant mentalis muscle activity during swallowing. This observation BEST indicates:
- Normal swallowing for this age group
- Adequate lip seal with compensatory tongue posture
- A potentially atypical swallow pattern requiring further evaluation (Correct answer)
- Mandibular prognathism affecting lip closure
Correct answer: A potentially atypical swallow pattern requiring further evaluation
Visible mentalis muscle contraction during swallowing suggests the patient is compensating for poor lip seal or tongue posture, indicating an atypical swallow.
Question 5: Which area of the palate should the tongue tip contact during correct resting posture?
- Against the upper incisors
- At the incisive papilla just behind the upper front teeth (Correct answer)
- Mid-palate region
- Soft palate
Correct answer: At the incisive papilla just behind the upper front teeth
The correct resting posture places the tongue tip at the incisive papilla (the 'spot') just posterior to the upper central incisors.
Question 6: During an evaluation, a therapist observes that the patient thrusts the tongue between the teeth during the oral stage of swallowing saliva. The MOST appropriate next step is:
- Refer immediately to a speech-language pathologist
- Document the finding and design treatment targeting tongue tip elevation and seal (Correct answer)
- Dismiss as normal variation if occlusion is Class I
- Order a modified barium swallow study
Correct answer: Document the finding and design treatment targeting tongue tip elevation and seal
Documenting the atypical pattern and creating a targeted treatment plan for tongue-tip elevation is the standard myofunctional response.
Question 7: Which factor is MOST important to assess before establishing a myofunctional treatment plan for a patient with a tongue thrust?
- The patient's preferred learning style
- Whether nasal airway patency is sufficient to support nasal breathing (Correct answer)
- The patient's dental insurance coverage
- The number of teeth present
Correct answer: Whether nasal airway patency is sufficient to support nasal breathing
Nasal airway patency must be confirmed before treatment, as mouth breathing is a primary driver of tongue thrust that must be addressed first.
CMT Evaluation & Treatment Planning 2
During an orofacial myofunctional evaluation, which standardized tool is most commonly used to assess tongue posture at rest?