Page 45 - Olfaction regained_Flipbook-subtitles

be moved downwards in one movement. The tongue must then return to the starting position almost effortlessly. Then the movement may be repeated. Organic handicaps Often the liquid in the manometer does not move correctly or a patient is unable to smell using the polite yawning technique due to an incorrect execution of one or more of the steps in the method. The cause may be organic or functional. Following are a few tips and exercises to improve certain parts of the polite yawning technique. Functional problems will be better tackled than those of an organic nature using these exercises. In the case of organic problems, it is extremely important that the patient learns to make the movements as correctly as possible in spite of the disorder. This may be attained by compensational tactics. For each individual patient it must be determined which tips and exercises are best for his situation and in which order they should be offered. Facial paralysis Unilateral facial paralysis may cause a dysfunction of the muscles around the mouth and of the muscles of the cheek of that side of the face. Patients with this type of paralysis may find it difficult to keep the lips closed while moving the mandible. These patients may find it easier to make use of the refined polite yawning technique. Using this method, only the back of the tongue is moved, making it easier to keep the lips closed. For these patients it may be better to omit the standard polite yawning technique. If the refined polite yawning technique is too difficult for the patient, he/she may wish to consider manually keeping the lips closed. Glossectomy Although the tongue plays an important role in the polite yawning technique, it is not indispensable. There are a few patients who have had a total laryngectomy as well as glossectomy and are still able to perform the polite yawning technique with success. By keeping the lips firmly closed and using the remaining musculature of the oropharynx and mouth still enough underpressure can be build up. To prevent disappointment, these patients should be explained before rehabilitation that total restoration of olfaction is not guaranteed using the polite yawning technique. Because the tongue is missing, these patients must learn compensating strategies using other musculature, which requires great concentration and often a lot of practice. For these patients, practice with the manometer is often more important that instructions on how to perform the polite yawning technique itself. Standard explanation of the technique is obviously not applicable to this small group of patients. The patient him/herself can discover what he/she must do to create orthonasal airflow, using the manometer. Showing the patient the floor of mouth movement (such as visible during the 44