MYOFUNCTIONAL ASSESSMENT/TREATMENT

Myofunctional therapy is a program used to correct the improper function of the tongue and facial muscles.  It involves strengthening of the tongue and orofacial muscles by teaching individuals how to engage the muscles to the appropriate position.

Myofunctional Therapy is a type of treatment that looks at the way the tongue and oral muscles move and function. Some of the issues you may have may seem normal, because everyone else snores or breathes through their mouths. Even headaches, suffering from asthma and allergies, or ADHD have become more of the norm. However, oral dysfunction is never normal. What if you could teach your body, your mouth, and your tongue to work for you instead of against you? With myofunctional therapy, that is what we will work towards together!

Ideally, oral restrictions are identified in early infancy to prevent issues that persist into childhood and adulthood. Unfortunately, most oral restrictions go unidentified and untreated, leading to a cascade of resulting symptoms and orofacial myofunctional disorders (OMD)

A single part of the body can’t be isolated from the rest of the body. The tongue is no exception. The tongue is connected to so many muscles throughout the head and neck that if it is restricted it can throw off the balance of all of the other related muscles. Most people don’t realize that the base of the tongue connects all the way down to the level of the hyoid bone in your neck. In adult patients, the tongue-tie can show up as chronic TMJ pain, headaches/migraines, head and neck tightness, snoring and sleep apnea as well as chiropractic adjustment that doesn’t help long term. Releasing a tongue-tie allows the body to relax into a posture that was not possible with a tongue tie, relieving years of pain and tension.

Sometimes when infants and children with tongue-tie first begin eating solid foods, a tongue-tie may begin to reveal problems. This may appear to be picky eating, as the child will gag on certain food or become aversive to eating foods with certain textures well into adulthood. When a child has difficulty chewing their food they may be loud messy eaters or store/pocket food inside their cheeks. Problems chewing food properly can result in digestion issues or reflux or cause the person to avoid that food. If any of these things are problems for your child, you may want to have a formal assessment conducted by a speech-language pathologist trained in orofacial myofunctional disorders. 

Obstructive Sleep Apnea (OSA) is a serious condition. An obstructed occurs in the airflow through the upper respiratory system. This makes breathing extremely difficult. Children and adults who suffer from untreated OSA can have many associated health problems such as high blood pressure, memory problems, heart problems, strokes, and increases insulin resistance.

Myofunctional therapy can help to promote changes in the musculature of the upper airways.

These may include (Overbite/Overjet/Underbite/Overcrowding/Crossbite/Open Bite/Diastema). Tongue function and position also drives the development of the face and jaw. Proper positioning of the tongue at rest helps to form the palate, which drives proper tooth formation and spacing. When the tongue is tethered down, kids and adults may present with an overbite where the lower mandible is recessed.  A recessed mandible will cause the position of the tongue to be further back in the oral cavity resulting in a narrowed airway space thus impeding optimal breathing. Incorrect tongue function and position can contribute to various malocclusions.

Poor lingual strength and range of motion can impact one's ability to chew properly, or prepare the food (bolus) to be swallowed (oral phase swallow). During chewing and swallowing, the tongue should be going up to the spot on the roof of the mouth and then push the food or drink down and back, not forward. GERD (Gastroesophageal reflux disorder) may be related to tongue thrust. When swallowing with a tongue thrust, you can also burp excessively due to swallowing large amounts of air. These are some red flags that someone may need myofunctional therapy secondary to dysfunctional oral/swallow/eating patterns.

• Digestive issues more than once per week
• Acid reflux symptoms
• Bloating, burping, hiccupping or gas
• History or current issues with constipation or diarrhea
• SIBO, IBS, other digestive issues
• Alterations to diet - eliminating dairy, gluten

Your dentist may have referred you for speech/myofunctional therapy related to your tongue tie. Your speech pathologist can help to identify the need for the procedures described below. Speech pathologists also provide valuable training around pre- and post procedure exercises  that improve the results of these procedures. The tongue is one of the most critical organs in our bodies as it has the ability to regulate and shape orofacial structure and musculature. Free mobility of the tongue is required for optimal speech, chewing, swallowing, oral hygiene, and breathing functions, as well as for development of the skeletal structures of the jaw and the airway. Because the tongue plays such an important role in so many functions, restricted mobility of the tongue may lead to compensatory behaviors that may negatively affect nasal breathing and cause snoring due to low tongue posture or contribute to chronic stress on the other muscles of the head and neck. The tongue also has connections to the whole body through a system of connective tissue known as fascia, and a restrictive tongue may place tension on the fascia networks causing neck tension, pain, and postural dysfunction.

Your doctor will opt for one of the following procedures:

Quick and simple procedure with CO2 laser that does not require stitches. 

When the frenulum is too thick for a quick snip, your doctor may choose to perform a frenuloplasty.  This usually requires anesthetics and special tools and will require stitches that usually dissolve as the wound heals. Lasers are becoming more prevalent and do not require stitches.

Orofacial Myofunctional Therapy (OMT) or Oro-myofunctional Therapy is a series of exercises of the lips, jaw, tongue, cheeks and palate designed to re-pattern the oral and facial muscles to promote proper tongue position, improve proper breathing, chewing and swallowing.

Therapy is important before a surgery to:

• build strength and stability
• improve range of motion
• prepare for exercises that will be needed post-surgery

Therapy is important after a surgery to:

• promote post-surgical healing
• maximize surgical outcomes
• continue to build strength and stability
• help the tongue to re-adapt to its newly found freedom
• promote proper tongue resting position
• promote proper tissue healing
• prevent the tissues from re-attaching
• prevent continued improper oral patterns

Imagine if your tongue had limited motion and was not fully functional for your entire life. Whether you are a child or adult, that is a relatively long time for your tongue to get used to its current state. Important lingual muscles have atrophied, and other muscles have become stronger or larger than desired, in order to compensate for the loss of full muscle function. Myofunctional Therapy will help to instill good patterns so that your surgery is a success.

Myofunctional Therapy/Treatment

We provide pre and post frenectomy (i.e. tongue release) myofunctional therapy. We work closely with your tongue tie practitioner in collaborating the best individualized treatment/therapy plan to provide you the best outcome. Our therapy helps re-train the tongue and orofacial muscles during movement and at rest to create new neuromuscular patterns for proper oral function, including chewing, swallowing, speaking, and breathing. We want our clients who are considering a frenectomy for themselves or a loved one to understand that the best outcomes include therapy before and after this procedure. You will be training oral muscles that you may never have used in your lifetime. 

Myofunctional therapy (just like any therapy) can not provide any guarantees. There are numerous factors that contribute to the long term prognosis and outcome for each individual. This will be discussed with each client prior to making the commitment to begin any Myofunctional Therapy Program. It is important to find the proper Speech Language Pathologist to guide you through this process for the best outcome. Surgical frenulum release paired with Myofunctional Therapy is an investment into your health, and should be taken seriously, and only entered into when you are ready to fully commit to the process. There are many social media outlets that are providing "free self help myofunctional videos". Just like you would not use "self help videos' to treat yourself with physical therapy following a knee injury, it is not wise or advisable to attempt to resolve lifelong oral patterns yourself, without professional guidance.

Many individuals believe that treating a tongue tie is as simple as performing a frenectomy. However, because a tongue tie hinders the proper functioning of the mouth and tongue, correcting that dysfunction often requires therapy to train the tongue to function properly. Additionally, the longer this dysfunction has existed, the greater the need for therapy. Consider an individual that is getting any kind of corrective procedure on any other part of the body and the kind of therapy required to allow for that part of the body to function again.

Additionally, we have seen the aftereffects of oral restriction releases that did not include pre and post therapy that have grown back worse or reverted to their prior state AND continued dysfunction of the mouth and tongue. Some individuals will have to go back for a second tongue tie release if the tongue tie heals improperly and tethers the tongue even worse than before the frenectomy. At that time, you could also be dealing with scar tissue from the first surgery, which will further inhibit the procedure and subsequent healing. This is exactly what myofunctional therapy can prevent and by supporting better short term and long-term outcomes.

TEAMWORK

The best long-term outcomes are a direct result of teamwork and a closely collaborative interdisciplinary approach, and YOU are a critical part of the team. While we will work together in learning and practicing these critical pre/post procedure exercises, the main determining factor of success is YOUR participation and consistency outside of our therapy sessions. We may only meet once every 1-2 weeks. However, you will be instructed to practice these exercises multiple times per day. I will provide you with all of the tools that are required to successfully complete this program and reach your myofunctional goals. As with any new muscle training, consistency is KEY to the proper healing and re-training of your oral musculature in providing you the best overall results. 

Are you concerned that you may have an unidentified oral restriction or are you having symptoms of other Orofacial Myofunctional Disorders? Please contact me for more information