Orofacial Myofunctional Disorders 101

My deep passion for speech language pathology, and specifically feeding and swallowing disorders, was born from an undiagnosed orofacial myofunctional disorder (OMD) that impacted my life for over 20 years. An OMD, also known as a tongue thrust, is a disorder characterized by improper tongue, jaw and lip positioning during swallowing, feeding and speaking. Patients with an OMD often present with mouth breathing, low tongue posture (resting the tongue on the low teeth versus the roof of the mouth), malocclusion, and forward protrusion of the tongue or “tongue thrusting” during swallowing. Patients may also demonstrate a variety of other concerning symptoms (e.g. a history of oral fixation, disordered sleep breathing, chronic respiratory infections, etc.).

Patients often ask “why does tongue placement during rest and swallowing matter so much?” The fields of anatomy, physiology and evolutionary biology provide insight into this question. For thousands of years, the tongue has played a major role not only in feeding skills and language development but also in humanity’s cranial and facial development. Swallowing is one of humanity’s most frequent movement patterns. Proper tongue placement during rest and swallowing naturally expands the palate of infants throughout childhood and into adulthood. The average human swallows 500 to 1000 times per day. Swallowing is key to survival, from the time a full-term infant exits the womb until a patient’s end-of-life care.

Correct at-rest tongue posture includes:

• sealed and relaxed lips
• the tip of the tongue on the alveolar ridge behind the front teeth (but not pressing the teeth)
• the posterior 2/3’s of the tongue resting against the hard palate
• teeth slightly apart or lightly touching
• nasal breathing

Correct swallowing includes:

• lips sealed and relaxed
• vertical force exerted on the roof of the mouth
• relaxed facial muscles

In contrast, OMD tongue posture includes:

• low rest tongue posture (with the tongue resting on the low teeth)
• mouth breathing and forward head posture
• lips apart or over-recruited to maintain lip seal
• malocclussion (the malocclusion often aligns with the abnormal movement pattern of the tongue)

OMD swallowing includes:

• anterior or forward force of the tongue onto the teeth (e.g. tongue thrust)
• incorrect recruitment of oral and facial muscles during swallowing (often over-recruiting the facial muscles and making a “grimace”)
• messy eating and drinking (e.g. trouble sealing lips, seepage of liquid and food from corners of mouth, food pocketing etc.)

The oral rest tongue posture and swallowing patterns of an OMD can result in abnormal growth of the oral, mandibular and facial muscles, bones and dentition.

Orofacial Myofunctional Therapy (OMT) is the “neuromuscular re-education” or “re-patterning” of the oral and facial muscles. OMT includes behavior modification, mouth, face and tongue exercises and strategies to facilitate proper feeding, swallowing and oral rest tongue posture throughout the day. The remediation of an OMD not only impacts functional eating, drinking, oral rest tongue posture and swallowing, but can also improve facial structure by increasing muscular symmetry and balance. Recent studies have also shown that OMT can provide support for patients with temporomandibular joint dysfunction (TMD), sleep-disordered breathing (SDB) and obstructive sleep apnea (OSA).