COM Patient Assessment & Evaluation 3 — Questions and Answers
Question 1: During a case history intake, a parent reports their child is a restless sleeper, grinds teeth at night, and wakes frequently. Which referral is most appropriate before initiating orofacial myofunctional therapy?
- Pediatric neurologist for sleep EEG
- Sleep medicine specialist or ENT for sleep-disordered breathing evaluation (Correct answer)
- Pediatric dentist for night guard fabrication
- Child psychologist for behavioral sleep intervention
Correct answer: Sleep medicine specialist or ENT for sleep-disordered breathing evaluation
Nighttime bruxism, restless sleep, and frequent waking are hallmark signs of sleep-disordered breathing, warranting evaluation by an ENT or sleep medicine specialist.
Question 2: The Friedman Tongue Position (FTP) grading system is used by orofacial myologists to assess:
- Tongue thrust severity during swallowing
- Tongue size and position relative to oral cavity structures at rest (Correct answer)
- Lingual frenum restriction severity
- Tongue strength in Newtons
Correct answer: Tongue size and position relative to oral cavity structures at rest
The FTP scale grades tongue visibility relative to palatal pillars and uvula, correlating tongue bulk/position with airway obstruction risk.
Question 3: Which cranial nerve is primarily responsible for tongue movement and should be assessed during orofacial myological evaluation?
- CN V (Trigeminal)
- CN VII (Facial)
- CN X (Vagus)
- CN XII (Hypoglossal) (Correct answer)
Correct answer: CN XII (Hypoglossal)
CN XII (Hypoglossal) is the primary motor nerve for intrinsic and extrinsic tongue muscles and is assessed by observing tongue protrusion, lateralization, and elevation.
Question 4: When assessing chewing function, the clinician observes that the patient consistently chews only on the right side. This finding is best described as:
- Bilateral rotary chewing pattern
- Unilateral chewing preference (Correct answer)
- Masticatory muscle hypertrophy
- Temporomandibular dysfunction
Correct answer: Unilateral chewing preference
Consistent chewing on one side is classified as a unilateral chewing preference and may contribute to asymmetric muscle development and jaw deviation.
Question 5: In pediatric orofacial myofunctional assessment, which finding would prompt immediate medical referral rather than proceeding with therapy?
- Mild lip hypotonia
- Adenoid facies with open mouth posture
- Asymmetric tongue movement with unilateral fasciculations (Correct answer)
- Interdental lisp associated with tongue thrust
Correct answer: Asymmetric tongue movement with unilateral fasciculations
Fasciculations (involuntary muscle twitches) and asymmetric tongue movement suggest a neurological etiology that requires medical evaluation before therapy.
Question 6: The OMES-E (Orofacial Myofunctional Evaluation with Scores – Expanded) protocol evaluates orofacial functions in which standardized domains?
- Lip posture, tongue posture, swallowing, and breathing only
- Face, lips, jaws, tongue, hard palate, teeth, pharynx, and speech (Correct answer)
- Lip seal, tongue thrust severity, and dental occlusion only
- Sleep quality, nasal patency, and dietary habits
Correct answer: Face, lips, jaws, tongue, hard palate, teeth, pharynx, and speech
The OMES-E is a validated, standardized assessment protocol examining multiple orofacial structures and functions including facial symmetry, lips, mandible, tongue, palate, teeth, pharynx, and speech.
Question 7: During a tonsil grading assessment, a patient's tonsils meet at the midline. This is classified as:
- Grade 1+ (tonsils in fossa)
- Grade 2+ (tonsils extending to pillars)
- Grade 3+ (tonsils beyond pillars)
- Grade 4+ (kissing tonsils) (Correct answer)
Correct answer: Grade 4+ (kissing tonsils)
Grade 4+ or 'kissing tonsils' describes tonsillar tissue meeting at midline, significantly reducing oropharyngeal airway space.
COM Patient Assessment & Evaluation 3
During a case history intake, a parent reports their child is a restless sleeper, grinds teeth at night, and wakes frequently.
Which referral is most appropriate before initiating orofacial myofunctional therapy?