I am indebted to Speech Pathologist and professional mentor Ms. Sharon Moore for permission to reference and quote excerpts from her book, The Sleep-Wrecked Child (2018)  Orofacial myology is a new area of speciality for Speech Pathologists.

For most of us breathing, eating and speaking are things we take for granted. Air goes in and out. We eat, drink and swallow automatically. Our mouths open and ideas and thoughts are expressed in clear words that are understood by others. The structures of our face and mouth (nose, lips, teeth, jaws), and the muscles that work to move them are aligned and synchronised with our breath and voice. We don’t even need to think –our bodies are designed for this and it just “happens”.

When the face, mouth and throat muscles are not used properly or don’t develop correctly, orofacial myofunctional disorder can result. Oral dysfunction can begin with a child’s first breath or feed. The way the muscles are used for sucking, swallowing, breathing and chewing, particularly in the early years, impacts how structures develop and shape the face, mouth and jaws. Underlying problems often go unnoticed, appear unrelated or can simply be explained by something else.

For example:

Does the child with persistent snoring and/or poor sleep quality or have a problem with airway patency or are they “just like their father”?

Does the child who refuses solids, gags and pushes food back out have a problem with their bite, chew, teeth alignment, airway or are they just a “fussy eater”?

Does the child struggling to make speech sounds accurately have a tongue thrust or reduced tongue mobility or are they “just being lazy”?

Common issues seen in children include:

• Open mouth posture
• Crooked and crowded mouths
• Poor chewing, messy eating
• Speech sound errors
• Asymmetrical appearance of the face or lips
• Uneven function of the face or lips (e.g. chewing on one side of the mouth)
• Tongue thrust (an incorrect swallowing pattern)
• Incorrect resting tongue position

What can cause these issues?

• Mouth breathing
• Sucking on thumbs, fingers, a dummy or blankets
• Nail-biting
• Enlarged tonsils or adenoids / nasal blockages
• A narrow or high palate
• A large tongue
• Allergies that restrict the airway
• Tongue-tie

Common reasons for referral include:

•  “My son is 6 and still has a dummy at night and it is wrecking his teeth”
• “Tim has a tongue-tie which will shortly be released. Please assess and provide exercises to help before and after surgery.
• “Please correct Johnny’s tongue thrust swallow”
• “Samantha has Down Syndrome that affects her ability to swallow, chew and speak”
• “Paul’s open bite corrected with braces, however he now shows regression due to tongue habits”
• “Michael is 3 years old and has saliva control problems”
• “Samuel is a mouth breather with accompanying open mouth posture”
• “Please assist Finlay with his poor chewing and swallowing habits”
• “Susan’s tongue thrust is not responding to orthodontic appliance treatment and may contribute to relapse”
• “Please assess Dion’s speech sound errors which are not correcting with traditional Speech Pathology techniques”
• “It hurts when I open my mouth wide like yawning, and I am grinding my teeth”
• “No matter how much sleep I get, I still wake up tired”

Reference: Sharon Moore (2018) Well Spoken: Speech Pathology and Orofacial Myofunctional Practice. 21.04.19. http://www.wellspoken.com.au/about

The Treatment Team…

For most people the first port of call is the family GP who can identify the need for specialist referral according to the presenting problem at the time. For example;

• An infant with feeding difficulties might be referred to a Lactation Consultant and a Paediatrician. Craniofacial Osteopaths / Chiropractors can also help with musculoskeletal balance.
• Children who mouth breathe might be referred to an Ear Nose and Throat Specialist and/or Allergist for investigation of airway blockage. Assessment by a sleep specialist may also be needed.
• Dental / Orthodontic referral for expansion of a narrow palate / investigate bite.
• Speech Pathologist for investigation of chewing and swallowing difficulties, tongue thrust patterns and speech articulation issues.

What will a Speech Pathologist do?

When assessing for orofacial myofunctional disorders Speech Pathologists look at how the face, mouth and throat look, sound and work – at rest and in movement – across everyday activities such as speaking and eating.  Specifically, we look at:

• Resting muscle postures
• Muscle movement when breathing, chewing, swallowing and talking
• Oral habits such as dummy use, thumb sucking

We also look at factors that are associated with or can influence function, such as;

• The size, shape and structures of the face and upper airways
• Soft tissues in the face and upper airways
• Medical, dental or orthodontic concerns
• Developmental anomalies

A functional problem is when body parts / muscles don’t move correctly because of weakness, impaired range of motion, injury, or habitual movement patterns. Dysfunction of any part of the upper airway, from the front of the face all the way to the voice box, is called an Orofacial Myofunctional Disorder. The face may look “unusual”. For example, if the upper jaw is narrow it’s difficult for the tongue to rest in its ideal position. This can result in a low and forward resting posture of the tongue that affects accurate production of speech sounds.

Orofacial Myofunctional Therapy (OMT)

The aim of orofacial myofunctional therapy is to re-establish correct oral posture at rest. Think about your oral and facial muscles. Where is your tongue? Are your lips sealed? Are you breathing through your mouth or nose? Correct oral rest posture includes the tongue resting on the palate, gently sealed lips, and nasal breathing.

When this does not happen naturally, we need to look at underlying issues or behaviours such as;

• Airway is affected by allergies that cause inflammation of the nasal passages, as well as enlarged tonsils/adenoids and resting tongue posture.
• Structures – tonsils, adenoids, tongue tie, narrow palate that influence breathing patterns and resting tongue position
• Habits – mouth breathing, dummies, thumb sucking that influence resting tongue posture and retention of immature swallow patterns/tongue movements
• Articulation errors – often secondary to the above which need to be corrected before articulation therapy can be effective.

Once any breathing, structural and behavioural problems have been corrected we can start a program of OMT exercises to strengthen and stabilise lip, tongue and jaw movements for optimal chewing, swallowing and speech production.

References
Moore, Sharon. (2018). Sleep Wrecked Kids. Melbourne: The Grammar Factory Pty. Ltd.
Article – ‘Clearing Up The Confusion’ By Angie Lehman, RDH, COM, and Joy Lantz, RDH, COM. RDH Magazine. April 1, 2019Oro