What Is Orofacial Myology and Why is it so Important?

The goal of Orofacial Myology is to establish, maintain or restore function to the muscles of the neck and face, and in particular, the lips and tongue.

Posture, breathing, swallowing and speech may all be affected by dysfunction in the control and use of orofacial muscles. As children grow, the functional use of orofacial muscles is essential for correct formation of the structures of the head and neck. The most critical time to foster correct muscular habits is under the age of 6, before the sutures of the palate have knitted together. Underdevelopment of the jaw, a narrow palate and issues with tooth alignment, are directly related to muscle behaviour. The good news is, we can have a significant positive impact on all these things by working with children early on. Adults may also be helped by Orofacial Myology & Speech Pathology, although Orthodontic involvement is also likely to be required for optimum results.

It is noted that the structure or ‘form’ of the face will in turn affect function. For example, resolving certain speech difficulties may not be possible if there is an open bite, large over-jet, narrow jaw or high, narrow palate. These issues may become more pronounced as a child grows older. A narrow palate, which also forms the base of the nasal cavity, means that the airway will not be optimal and issues with mouth breathing, snoring or sleep apnoea could become evident when they did not seem to be in childhood. 

It is very important to recognise that persisting habits, such as thumb sucking or nail biting, will invariably mean that a functional swallowing pattern and mature speech, cannot be established. This is why we are so committed to helping children and their families, right through to adults, in breaking those habits.

As Speech Pathologists practicing Orofacial Myology, our aims are to eliminate barriers to success in speech and swallowing therapy. We are often just one member of a care team, which includes Ear, Nose & Throat Specialists, Specialist Dentists, Orthodontists and Sleep Specialists. This holistic team approach means that we can truly offer our clients care that extends to general health and overall well-being.

Possible Causes of an Orofacial Myofunctional Disorder

Obstruction to the airway due to:

• Enlarged Tonsils
  
• Enlarged Adenoids
  
• Allergies
  
• Deviated septum
  
• Narrow, high vaulted palate
  
• Large uvula
  

Other structural differences:

• Cleft lip or palate
  
• Tongue Tie (restrictive lingual frenum)
  
• ‘Lip’ Tie (restrictive labial frenum)
  

Habits:

• Thumb sucking
  
• Finger sucking
  
• Nail biting
  
• Lip or cheek sucking or biting
  
• Prolonged dummy use
  
• Placement of blankets, hair or objects such as pens in the mouth (mouthing or sucking)
  
• Frequent use of ‘sippy’ cups with rigid spouts
  

Developmental or neurological factors, such as:

• Dyspraxia
  
• Cerebral Palsy
  
• Downs Syndrome
  
• Dwarfism
  
• Bells Palsy

What to Look Out For

• History of feeding difficulties (e.g. latching onto the breast or mother feeling she was not producing enough milk)
  
• Tongue position down or forwards
  
• Open mouth posture
  
• Chapped or dry lips
  
• Lip licking
  
• Small lips
  
• Dribbling or trouble managing saliva
  
• Mouth breathing (when awake or asleep)
  
• Halitosis (bad breath)
  
• Scalloped or sore tongue

• Mouth ulcers
• Bleeding or receding gums
  
• Fillings in teeth
  
• Chewing with mouth open
  
• Coughing when drinking or eating
  
• Gagging
  
• Messy eating
  
• Slow or picky eater
  
• Gulping food and drinks
  
• Difficulty swallowing tablets
  
• Preferring not to use a straw
  
• Greeting cups and cutlery with the tongue tip

• Open bite or over-jet
• Cross bite
  
• Adult teeth not descending
• Tongue tie (restrictive lingual frenum)
  
• Clicky or sore jaw (TMJ syndrome)
  
• Headaches or migraines
  
• Fatigue (particularly in the morning)
  
• Attention difficulties
  
• Snoring
  
• Darkness under the eyes
  
• Postural difficulties
  
• Neck or back pain
  

Intervention

In order to establish the most appropriate starting point for intervention, a full assessment of speech, swallowing and orofacial function, is recommended. Collecting a detailed case history is often very important, particularly for adults whose difficulties may have emerged later in life (e.g. following a car accident, neck injury or prolonged period of illness).

A plan that is systematic and sequential, will then be devised, to maximise the likelihood of success in therapy from the very start.

When structural issues such as enlarged tonsils or adenoids, a deviated septum or a tongue tie, are felt to be contributing to observed patterns of muscle function, the first step will most likely be referral to an Ear, Nose & Throat Specialist, Dentist or Orthodontist. Factors such as allergies must also be managed as a top priority.

When there are habits such as thumb sucking, teeth grinding or nail biting present, your Speech Pathologist will support you in overcoming them using a structured cognitive-behavioural treatment program. We have come to realise that helpful ‘tips’ are often not sufficient when it comes to breaking these habits (which is why we have pursued specialist training in this field!).

The next stage of intervention will most likely be an Orofacial Myology exercise program to re-train the muscles of the lips, tongue, face and neck. As mentioned above, ‘fixing’ structural issues and eliminating habits, will not automatically mean that muscles will begin to move appropriately. Ensuring that the tongue and lips are in the correct position when resting, and when swallowing, will enable us to achieve the ultimate goal – accurate speech which supports communication!

If you have any questions regarding this information, please do not hesitate to contact us for a chat.