COM Assessment & Diagnosis of Orofacial Disorders 2 — Questions and Answers
Question 1: During a clinical assessment, a patient presents with the tongue resting against the upper front teeth at rest. This is best classified as:
- Anterior tongue thrust
- Anterior tongue rest posture deviation (Correct answer)
- Lateral tongue thrust
- Tongue tie
Correct answer: Anterior tongue rest posture deviation
A tongue resting against or between the teeth at rest (not during swallowing) is classified as an abnormal tongue rest posture, not a tongue thrust.
Question 2: Which of the following best describes the 'palatal suction' method for assessing tongue elevation capacity?
- The patient places tongue tip on incisive papilla and opens the mouth as wide as possible
- The patient sucks the tongue to the palate and holds while the jaw drops (Correct answer)
- The patient clicks the tongue repeatedly to measure speed
- The patient retracts the tongue to touch the soft palate
Correct answer: The patient sucks the tongue to the palate and holds while the jaw drops
Palatal suction requires the patient to adhere the tongue to the palate using suction and maintain contact while the mandible drops, revealing the range of tongue elevation.
Question 3: A child presents with an open mouth posture, dark under-eye circles, and restless sleep reported by parents. The COM's primary concern for further referral should be:
- Orthodontist for malocclusion
- Pediatrician or ENT for airway obstruction (Correct answer)
- Speech-language pathologist for articulation
- Neurologist for sleep disorders
Correct answer: Pediatrician or ENT for airway obstruction
Open mouth posture combined with sleep disturbance and allergic shiners strongly suggests airway compromise, warranting ENT or pediatric evaluation before orofacial myology intervention.
Question 4: When assessing lip strength, a COM uses a lip-seal device. A reading significantly below age-matched norms indicates:
- Hypermobility of the temporomandibular joint
- Inadequate orbicularis oris muscle function (Correct answer)
- Hypertonicity of the mentalis muscle
- Excessive nasolabial fold depth
Correct answer: Inadequate orbicularis oris muscle function
Low lip-seal device readings indicate weakness or hypotonic function of the orbicularis oris, which is responsible for lip closure force.
Question 5: Which swallowing pattern is characterized by simultaneous contraction of the perioral and mentalis muscles visible during the swallow?
- Mature swallow
- Adaptive swallow
- Compensatory tongue thrust swallow
- Immature or deviant swallow with muscular substitution (Correct answer)
Correct answer: Immature or deviant swallow with muscular substitution
Visible perioral and mentalis muscle activity during swallowing indicates muscular substitution and is characteristic of an immature or deviant swallow pattern.
Question 6: An orofacial myologist observes that a patient's upper lip is short and cannot comfortably reach the lower lip without strain. This is referred to as:
- Lip incompetence (Correct answer)
- Lip retrognathism
- Chronic mentalis strain
- Perioral hypotonia
Correct answer: Lip incompetence
Lip incompetence is the clinical term for the inability to achieve comfortable lip closure, often due to a short upper lip or dental protrusion.
Question 7: During a frenum assessment, the COM notes that tongue elevation is restricted and a mid-sagittal groove appears on tongue elevation. This finding is most consistent with:
- Macroglossia
- Ankyloglossia (tongue tie) (Correct answer)
- Buccal frenum restriction
- Posterior tongue thrust
Correct answer: Ankyloglossia (tongue tie)
A mid-sagittal groove or heart-shaped tongue tip on elevation, combined with restricted range of motion, is a classic presentation of ankyloglossia.
COM Assessment & Diagnosis of Orofacial Disorders 2
During a clinical assessment, a patient presents with the tongue resting against the upper front teeth at rest.
This is best classified as: