COM Assessment & Diagnosis of Orofacial Disorders 3 — Questions and Answers
Question 1: A COM uses the Tongue Tie Rating Scale (Kotlow or similar). A Class IV restriction means:
- Only the frenum attachment to the tongue tip is involved
- The frenum attaches to the mid-tongue with no tip involvement
- The restriction involves a submucosal or posterior tethered oral tissue (Correct answer)
- The frenum is completely absent
Correct answer: The restriction involves a submucosal or posterior tethered oral tissue
Class IV in Kotlow's classification describes a submucosal (posterior) tongue tie where the restriction is not visible but limits posterior tongue elevation.
Question 2: What is the clinical significance of assessing the 'swallowing frequency at rest' during orofacial myology evaluation?
- It determines the patient's hydration status
- Excessive dry swallows at rest may indicate a habitual swallowing pattern or airway-related dysfunction (Correct answer)
- It measures salivary gland output directly
- It predicts dental erosion risk from acid reflux
Correct answer: Excessive dry swallows at rest may indicate a habitual swallowing pattern or airway-related dysfunction
Monitoring swallowing frequency at rest can reveal abnormal patterns such as excessive saliva management issues or compensatory behaviors linked to tongue posture or airway problems.
Question 3: Which assessment tool is specifically designed to evaluate nasal airway patency in a quick clinical setting?
- Glatzel mirror test (Correct answer)
- Iowa Oral Performance Instrument
- Tongue depressor strength test
- Nellcor pulse oximetry
Correct answer: Glatzel mirror test
The Glatzel mirror test involves placing a cold mirror under the nares to visualize condensation patterns, providing a quick clinical estimate of nasal airflow.
Question 4: A patient shows a crossbite on the right side and the COM observes the tongue habitually resting to the left. What is the most likely relationship between these findings?
- The crossbite caused the tongue to shift left for comfort
- The leftward tongue posture likely contributed to underdevelopment of the left palatal arch (Correct answer)
- Crossbites are unrelated to tongue rest posture
- The tongue position indicates glossoptosis
Correct answer: The leftward tongue posture likely contributed to underdevelopment of the left palatal arch
The tongue at rest to the left provides insufficient lateral support to the left palate, potentially contributing to constriction on that side and crossbite development.
Question 5: During a clinical interview for a 9-year-old, the parent reports the child frequently breathes through the mouth during the day. The COM's next step should be:
- Begin myofunctional therapy immediately to correct mouth breathing
- Document the observation and refer to a physician before initiating therapy (Correct answer)
- Prescribe nasal rinses and begin lip exercises
- Test the child for sleep apnea using a home kit
Correct answer: Document the observation and refer to a physician before initiating therapy
Mouth breathing requires medical clearance to rule out obstructive causes (allergies, enlarged adenoids/tonsils) before myofunctional therapy can be effective.
Question 6: A COM assesses a patient's resting facial profile and notes a convex profile, retruded chin, and increased lower facial height. These findings most likely suggest:
- Skeletal Class III malocclusion
- Skeletal Class II malocclusion with vertical growth pattern (Correct answer)
- Brachycephalic facial type
- Prognathic mandible
Correct answer: Skeletal Class II malocclusion with vertical growth pattern
A convex profile, retruded chin, and increased lower facial height are hallmarks of a skeletal Class II malocclusion with a hyperdivergent (vertical) growth pattern.
Question 7: Which observation during the clinical exam would prompt a COM to suspect a buccal tie rather than a lingual tie?
- Restricted tongue elevation and mid-sagittal groove
- Tension or blanching of the buccal mucosa when the cheek is stretched laterally (Correct answer)
- Inability to protrude the tongue beyond the lower incisors
- A heart-shaped tongue tip at rest
Correct answer: Tension or blanching of the buccal mucosa when the cheek is stretched laterally
Buccal ties are identified by tension, blanching, or dimpling in the buccal mucosa when the cheek is stretched, restricting lateral jaw movement and cheek mobility.
COM Assessment & Diagnosis of Orofacial Disorders 3
A COM uses the Tongue Tie Rating Scale (Kotlow or similar).
A Class IV restriction means: