Orofacial Myofunctional Disorders

An Orofacial Myofunctional Disorder (OMD) refers to abnormal muscle postures, strength, range of motion and patterns of movements involving the lips, tongue , face and jaw. A tongue-tie or lip-tie may be present, dentition may be abnormal, the. Palate may be unusually high and narrow.

Nasal breathing is important to our health and sleep. Breathing with an open mouth posture while awake and/or sleeping is most often caused by a structural obstruction. This can include enlarged adenoids and/or tonsils, a tongue tie, allergies or sinus congestion. These can lead to sleep apnea.

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Why do OMDs matter?

When the muscles and structures of the face, lips, tongue or jaw are out of balance, they can cause disorders of the temporomandibular joint (TMJ), sleep disorders (including apnea), dental abnormalities, extended thumb sucking and use of pacifier, jaw clenching and teeth grinding (bruxism). They can also lead to abnormal suckling, chewing, swallowing, breathing, speech patterns and orthodontic problems. If left untreated after orthodontic work, they can cause the teeth to return to their original positions which is known as "dental relapse".

Speech impairments

Speech impairments include a tongue thrust, lateral and frontal lisps and difficulty producing sounds requiring tongue elevation. The most common sounds impacted include (/t, d, l, r, n, k, g, s, z, ch, sh, and j/. Speech can be difficult to understand, sound like mumbling and also be too fast for the individual's mouth.

The oral stage of drinking and eating

The oral stage of drinking and eating can cause difficulty swallowing, sleeping, moving food to the back of the mouth, food pocketing, food scattered throughout the mouth and coating the tongue, difficulty drinking from an open cup, messy eating, difficulty latching to the breast, difficulty transitioning to solids, reflux, gagging, vomiting and trouble handling specific textures.

What is a tongue-tie?

With a tongue-tie, the tongue is attached to the floor of the mouth by a membrane called the frenum which is too short, tight or prevents normal movement of the tongue in any direction, especially elevation, it is a type of TOTS known as a tongue-tie or ankyloglossia. Tongue-ties can interfere with latching while breast feeding, leading to unsatisfied hunger during breast feeding and sore nipples. Because the tongue has trouble lifting, it can not attain the natural resting position against the palate, which can limit the natural expansion of the palate, resulting in a high, narrow or “vaulted” palate. It can also have a significant impact on speech and management of food and beverages. Many messy eaters, droolers, food stuffers and children having trouble drinking from an open cup have a tongue tie.

What is a lip-tie?

A lip-tie refers to a band of connective tissue which attaches the lip to the soft tissue of the upper jaw and restricts various lip movements. It can impact latching to the breast, limited flanging of the upper lip required for production of /r/, cause a large gap between the two upper teeth and lead to dental decay. Lip-ties can impact facial movements and an inability to round the lips, smile broadly and move the lip to either side.

How are OMDs evaluated and diagnosed?

A speech pathologist with extensive training in OMDs will perform an oral exam and assess the range of motion, strength and coordination of the muscles of the face, tongue, lips and jaw as well as the shape of the palate. Measurements of the tongue elevation, compared to the widest opening of the jaw will be compared to assess discrepancies. Photos of the structures and many postures and movements will be taken. Extensive background history and information regarding eating, sleeping, ear infections, upper respiratory infections, tonsils and adenoids, headaches and jaw pain will be taken to complete the assessment and aid in diagnosis and goal setting.

What can be done to treat OMDS?

Collaboration with a team of other professionals is important. Members of this team includes oral surgeons, ENTs, orthodontists, dentists and the primary care provider. I completed the first level of the IAOM certification training in 2017. Since then I have attended international workshops and completed approximately 50 more hours of continuing education in this specialized area. I work closely with ENTS, oral surgeons, dentists, orthodontists and other speech pathologists.

Myofunctional exercises will be assigned and must be practiced daily. Weekly therapy will assess progress and adjust the exercises as needed. In the case of a tongue or lip-tie, surgical revision may be recommended. It is essential that the individualized thorough exercise plan is followed daily for 4-6 weeks prior to the revision and for 6 weeks following the surgery.

What do tongue and lip-ties look like?

Get Started:

If you or a loved one is experiencing challenges related to orofacial myofunctional disorders, Speech Matters is here to help. Contact Jackie to schedule an assessment and take the first step towards improved oral function and overall well-being. Speech Matters is committed to empowering individuals through effective communication and optimal oral health.