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!

Tongue tie (ankyloglossia) is where the strip of connective tissue that connects an individual’s tongue to the floor of their mouth is shorter, thicker or tighter than usual which restricts the tongue’s range of motion.

An individual with an oral restriction (tongue or lip tie) often has an unusually short, thick or tight band of tissue (lingual, labial or buccal frenulum) which inhibits the ability of the tongue, lips or cheeks to move freely in all directions necessary for speech, feeding, airway and speech. In babies this may interfere with breast or bottle feeding. And untreated oral restriction can lead to a multitude of compensatory health and oro-facial issues. 

Not all oral frenulums are restricted. However, when a restriction is present, it often requires a simple surgical procedure to correct and release.

Tongue tie is a congenital issue that may become apparent soon after birth and occurs when the tongue does not separate from the floor of the mouth during womb development. Note that an individual may be “tongue tied” or restricted to various degrees.

Tongue tie is estimated to affect 4-11% of newborns but may go unnoticed until other issues become evident – see signs and symptoms below.

Tongue ties limit tongue mobility which is important for speaking, chewing, drinking, breathing, swallowing and more. It is also extremely important for adequate craniofacial development. Without identification and intervention, a tongue tie in a child can have downstream affects as a child’s face and head develop.

Myofunctional Therapy is an important aspect for treating tongue tie. Surgery alone does not guarantee success.

Many adults experience symptoms such as swallowing, breathing, and/or sleeping issues and/or upper body tension for years, not knowing that this is a negative consequence of tongue tie. As individuals develop from children to adults, a cascade of Orofacial Myofunctional Disorders emerge as the body maladapts. These adaptations aren’t viewed as abnormal because the person just doesn’t know any different.

Adults most often complain of poor sleep quality, obstructive sleep apnea (OSA), digestive issues and swallowing problems, teeth grinding (Bruxism), Temprormandibular Joint Dysfunction (TMJ) pain, postural issues, upper body tension, speech impediments, head and neck pain and migraines just to name a few. Adults tend to learn about their own tongue-ties when a child is born with a tongue-tie, and the parents start to understand the familial relationship.

Tongue-tie correction is important for adults too. Even though the frenectomy is not done for breastfeeding issues (as it is done in an infant), or to prevent insufficient craniofacial growth and airway issues (as it is done in children), adults should proceed with a release if the lingual restriction is causing difficulty with correct oral lingual rest posture, nasal breathing, swallowing, speech, feeding or sleeping.

When parents hear about “tongue tie” or search on the internet, they most commonly see images where the tip of the tongue is tethered down to the floor of the mouth. Posterior oral restrictions cannot be visualized. With a posterior tongue tie (PTT) the anterior portion of the tongue is not “tied”. It is often not easily seen or identified as most practitioners are not trained to assess it. One of the most common statements from medical professionals is that “posterior tongue tie is not a thing”. Some of this confusion is the result of a misunderstanding of the anatomy and/or assuming that the tie is located in the posterior oral cavity near the tonsils. This is not accurate.

A posterior tongue tie is the presence of abnormal collagen fibers in a submucosal location surrounded by abnormally tight mucous membranes under the anterior portion of the tongue. ALL anterior ties have a posterior element. Therefore, any tongue tie causing breastfeeding problems is truly a posterior tongue tie; a percentage of those ties also have an anterior component. Failure to release ALL of the abnormal collagen fibers results in a continued lingual restriction. When providers are only able to release the anterior visual part of the restriction (incomplete release) there can be very limited improvement in tongue mobility and function. An anterior release only improves function of the very anterior (tip) of the tongue, but full function of all portions of the tongue (mid & posterior) is required for true mobility and range of motion required for feeding, speech, sleep and more. Without a full posterior release, the tongue remains restricted and function remains dysfunctional. I see this all the time in my practice.

CONSEQUENCES OF UNTREATED (or partially released) TONGUE TIE:   

Taken from; Tongue Tie – from Confusion to Clarity by Carmen Fernando

For Infants:

• Impact upon milk supply
• Termination of breastfeeding
• The baby failing to thrive
• Poor bonding between baby and mother
• Sleep deprivation
• Problems with introducing solids

Maternal Experience:

• Pain
• Nipple damage, bleeding, blanching, or distortion of the nipples
• Mastitis, nipple thrush or blocked ducts
• Severe pain with latch or loosing latch
• Sleep deprivation from baby being unsettled
• Depression or a sense of failure

For Children:

• Inability to chew age appropriate solid foods
• Gagging, choking or vomiting foods
• Persistent food fads
• Difficulties related to dental hygiene
• Delayed development of speech
• Dental problems starting to appear
• Strong incorrect habits of compensation being acquired

For Adults:

• Inability to speak clearly
• Clicky jaws
• Pain in jaws
• Migraines
• Receding jaw
• Effects on social situations, eating out, kissing, relationships
• Dental health, a tendency to have inflamed gums, increased need for fillings and extractions
• Difficulty keeping dentures in place

Because of recent increases in the popularity of breastfeeding, tongue-ties are being identified more frequently in infants. However, there are many children and adults who have tongue-ties but are unaware. It is estimated that 98% of all Pediatricians and Pediatric Dentists do not seek the additional training necessary to be qualified to properly assess for and identify oral restrictions. Oral restrictions can NOT be identified visually simply by “looking” in a child’s mouth. 

A full FUNCTIONAL oral assessment must be performed to 

• identify any oral frenulums
• determine if the frenulums are restricted (i.e., tongue ties) and affecting the child’s oral function. 

Since the majority of Pediatricians, Pediatric Otolaryngologists and Pediatric Dentists are not trained in performing Functional Oral Motor Assessment, the majority of pediatric oral restrictions are overlooked (especially posterior tongue ties that can only be identified by manually manipulating the tongue). 

These unidentified tongue-ties can cause problems not only in infancy but that continue through adolescence into adulthood, ranging from mild to life disrupting. It can take years for someone to stumble upon the right professional who is able to “tie” their troubling health symptoms to their unidentified oral restriction. Unfortunately, many people never realize that they have oral restrictions that are impacting their lives. It is never too late for a person to have their tongue-tie identified and released. The benefits of Frenectomy combined with Myofunctional Therapy for some people can be life changing and well worth the time and effort. 

Tongue-tie symptoms in adults and older children may include:

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. 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. 

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

Tongue-ties and crowded adult teeth are directly correlated.  When the tongue has proper mobility, it rests against the roof of the mouth.  This causes the roof of the mouth to widen, which allows for proper space of adult teeth growth.  Some children have straight primary teeth, but their adult teeth grow in crooked. Primary teeth should have large gaps. Adult teeth are much larger than primary teeth and therefore take up significantly more space. Without proper resting tongue posture against the roof of the mouth, the palate grows and forms with insufficient width to allow for proper teeth spacing and growth. Without those primary spaces, the adult teeth will grow in crowded.  

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.

Signs and symptoms of tongue tie include:

• Difficulty elevating the full tongue (anterior, middle and posterior portions)
• Difficulty lateralizing the tongue from side to side (without moving the jaw with it)
• Difficulty extending the tongue out of the mouth (without letting it touch the bottom teeth)
• Difficulty isolating tongue movements from the jaw.
• Discoordination with sucking, swallowing or breathing
• Heart-shaped tongue, or inability to form a point at the tip
• Tongue that appears notched
• Trouble breast-feeding / latching
• Problems with eating, speaking or reaching the back teeth with tongue
• Aerophagia which occurs from air swallowing
• Chronic ear infections
• Speech issues
• Delayed speech development
• Crowded teeth
• Dental problems
• Dental hygiene issues
• Overbite
• Jaw pain
• Chronic head and neck pain
• Migraines
• Digestive issues
• Rapid eating behaviors
• Food texture issues
• Picky eating
• Poor chewing or lack of chewing
• Drooling
• Mouth breathing (while awake or asleep)
• High arched palate
• Resting tongue posture laying on floor of mouth
• Narrow airways
• Snoring
• Sleep Apnea or sleep disordered breathing patterns
• Sleep disturbances

Your speech pathologist can help to identify the need for the procedures described below. Speech pathologist 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.

How to prepare for the procedure? 

• Work with a Speech Therapist or Orofacial Myologist who is skilled and experienced in providing myofunctional therapy prior to the procedure to ensure optimal results. 
• The exercises are designed to specifically train proper breathing, speaking, chewing and swallowing. 
• Bodywork can be very helpful to release tension and can be performed by trained Chiropractors, Craniosacral Therapists, or Physical Therapists. We can refer you to expertly trained therapists. 
• On the day of your procedure we recommend you have a full meal prior to your procedure. 
• We also encourage getting a good night's sleep the night before. 
• Please refrain from consuming caffeine prior to the procedure. 
• Some practitioners recommend that you use Ibuprofen 30 minutes prior to the procedure which may help to minimize discomfort. 
• Have soft, cold foods available to eat for the first few days after the procedure.

What to Expect? 

• The offices that we work directly with utilize a CO2 soft tissue laser to perform frenectomies. This maximizes precision while minimizing bleeding, inflammation, and post-operative discomfort. 
• A frenectomy is a straightforward outpatient procedure that can be completed in office without the need for general anesthesia. 
• If a release is recommended, the treatment takes less than an hour. 
• Many physicians will apply an effective topical anesthetic gel on the frenular tissue underneath the tongue prior to treatment, followed by an injection of a numbing agent, allowing for minimal discomfort during the procedure. 
• The anesthetic generally wears off approximately 30-45 minutes after the procedure is completed. 
• You will likely be given laser protective eye wear during treatment. 
• You may eat or drink immediately after the procedure once the numbing has worn off. 

Discomfort 

• Discomfort is typically mild to moderate and usually lasts for the first several days (occasionally up to 5 days). 
• Mild swelling of the lip will also occur if a lip revision was performed. 
• Your tongue may feel larger than usual and more painful to move. 
• If recommended, Ibuprofen (Motrin/Advil) or Acetaminophen (Tylenol) may be given and can be rotated every 4 hours or as instructed by doctor. 
• Avoid citrus or spicy food or foods that require a lot of chewing to minimize discomfort. 
• Antibiotics are typically not administered. 
• We recommend rinsing with salt water and/or alcohol-free mouthwash several times a day to keep the wound clean and reduce the risk of infection.
• Please continue normal tooth brushing, flossing and oral care.

Post Procedure Care

• If the wound is closed with sutures at the time of procedure then no post-op stretches are required. 
• The tongue should only be used minimally the first 1-5 days after the procedures. 
• Avoid sticking your tongue out in the first 5 days. 
• It is normal to experience some bloody oozing during the first 1-2 days. If steady bleeding occurs, place gauze under the tongue to hold pressure and call your practitioner. 
• At your post-op examination, the doctor will evaluate healing of the wound.
• As the wound heals, a white diamond-shaped area may appear where the frenum was. This is normal and not an infection, rather, it is granulation healing tissue that will heal and disappear in approximately two weeks.
• Please understand that once your tongue tie is released, any speech, tension, sleep or dental growth improvements will not occur by themselves.
• Working with a speech/myofunctional therapist PRIOR to your procedure is critical. 
• As the granulation tissue heals, this tissue will begin to contract by day 5-7. This is when the myofunctional therapy exercises become the most important. 
• A pre-established relationship with a therapist ensures customized exercises to address your unique problem areas. 

Expectations & Improvement 

• Speech Therapy, Orofacial Myology Therapy, Chiropractic (Gentle Bodywork) and Orthodontic support is essential for an ideal outcome. 
• Sometimes speech temporarily worsens, and a lisp can be heard in the first few days until healing is complete. The lisp is not permanent. 
• Possible (but very rare) complications of frenectomy may include bleeding, pain, numbness, failure of procedure, scarring, and injury to adjacent structures which may result in salivary gland dysfunction. 
• Full healing takes a few weeks.
• Full functional use of tongue can take anywhere from 3-12 months, with Myofunctional Therapy.

Myofunctional Treatment/Therapy

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 help you achieve 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. It is important to find the right Speech Therapist to properly guide you through this process for the best outcome.

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.

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 physical 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 myofunctional 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.

Importance of Myofunctional Therapy paired with Frenectomy

Exercises before and after a frenectomy are very important to a successful outcome. Exercises help thin out the skin, increase range of motion, push back nerves and blood vessels. Consistency with myofunctional therapy exercises is important for the best long-term outcomes. Start these exercises ideally a month before surgery. 

Lingual (Tongue) Exercises

Lingual (tongue) shaping exercises will allow the tongue to use a variety of muscles that you have never been freely able to use; therefore, attempting to coordinate the muscles to perform new movement patterns. Prior to your tongue tie release/revision your tongue has been performing the same movements, making use of only “some” of the muscles within the tongue. There are important exercises to work both extrinsic and intrinsic muscles of the tongue so that you will have optimum coordination, strength, shape, and range of motion. Lingual (tongue) exercises also aim to generate proper tongue-palate placement, correct the resting positioning of your tongue in your mouth, and during swallowing patterns.

Labial (Lip) Exercises

Labial (lip) exercises help to relax tightened tense muscles, improve flexibility and range of motion, increase muscle tone, increase awareness of resting labial position and promote lip closure.

BEWARE

Following your Myofunctional Evaluation, your myofunctional therapist will develop and build an Individual Myofunctional Treatment Plan based on your results and specific needs. Your therapist will analyze the baseline data and measurements taken during your evaluation and will create a treatment plan that will best achieve your myofunctional goals. 

Myofunctional therapy has been around forever, however there is currently a lot of “social media noise” surrounding myofunctional therapy, including uncredentialed and unlicensed social media influencers promising “at home” myofunctional treatment. Attempting to “self-treat” your oral dysfunction via YouTube videos, would be comparable to attempting to rehabilitate your own knee with “self-help physical therapy” videos following a knee surgery. Not only will you likely NOT see any results, but you could also actually do more damage, reverse progress or inhibit healing. Based on your evaluation and progress, your Myofunctional Therapist will know which muscles/functions to target and when. Many of the exercises build upon one another, so if they are performed at the wrong time or out of order, it can be detrimental to progress and healing. Your therapist will help guide you through your individualized program and ensure that you are performing the exercises correctly to meet your myofunctional goals. 

Myofunctional therapy does take a certain level of commitment, however when guided properly by a licensed myofunctional therapist, the results are often described as life changing. 

TEAMWORK

The best 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. 

During this program, we will be in close communication. I will be in close communication with your physician as well. Please feel free to reach out to me at any time with any questions or concerns. I can be reached at info@myofunctionalspot.com or by clicking here.