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Component 1: Lip Closure: Scoring Examples

This document provides information about assessing lip closure during a Modified Barium Swallow Study (MBS). Lip closure is scored on a scale from 0-4 based on the location of contrast material escaping from between the lips. A score of 0 means no escape, 1 means a trace amount in the interlabial space, 2 means escape onto the lower lip, 3 means beyond the lower lip to the chin, and 4 means profuse escape beyond the chin. Examples are given to illustrate each score. Common scoring errors are also discussed.

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150 views3 pages

Component 1: Lip Closure: Scoring Examples

This document provides information about assessing lip closure during a Modified Barium Swallow Study (MBS). Lip closure is scored on a scale from 0-4 based on the location of contrast material escaping from between the lips. A score of 0 means no escape, 1 means a trace amount in the interlabial space, 2 means escape onto the lower lip, 3 means beyond the lower lip to the chin, and 4 means profuse escape beyond the chin. Examples are given to illustrate each score. Common scoring errors are also discussed.

Uploaded by

amanda
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© © All Rights Reserved
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Component

1: Lip Closure
Lip Closure assesses the ability to seal the bolus within the anterior oral cavity. Like all other
components, lip closure is based on what is observable on the MBS video. Score the presence and
location of bolus material seen between or outside of the lip seal on the videofluorographic view. The
scores for this item are based on the location of all or a part of the contrast material seen during any
point of the swallow. While assessing this component is certainly easier in a true clinical situation
wherein you have a direct visual of the patient, this component should only be scored based on what
you see on the MBS video. It is best assessed using both “full screen” mode and using the “frame-by-
frame step" function.

SCORING EXAMPLES:

The following images are intended to help you differentiate between impaired Lip Closure scores 0-4:

(0) Contrast is contained within the oral cavity with no evidence of escape beyond the oral mucosa into
the interlabial space.


(1) A trace amount of contrast outlining the interlabial space but with no progression to the anterior lip:


(2) Escape from the interlabial space or lateral juncture onto but not beyond the vermillion boarder of
the LOWER lip:

NOTE: If contrast material is only observed on the


vermillion border of the upper lip, and in no other
lip location (including interlabial escape, score of 1),
this is consistent with common artifact related to
mode of administration, and is not considered
impairment and should receive a score of 0. For
example, when scoring the image to the right you
would note the presence of contrast within the
interlabial space but not consider the escape of
contrast onto the upper lip and assign a score of 1

(3) Escape of contrast material that progresses beyond the vermillion border of the lower lip to the mid
chin:


(4) Profuse escape between open lips beyond the chin regardless of the bolus consistency or swallow
task:




FREQUENT SCORING ERRORS

The videofluorographic image below shows increased lip density with the lips fully compressed. This
increase in density is similar in appearance to a Lip Closure score of (1), interlabial escape. By moving
forward several frames until the lips decompress, one is able to determine the presence or absence of
contrast. In this case, there is an absence and this individual would receive a Lip Closure score of (0),
no labial escape.

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