Updated: Feb 6, 2020
Myofunctional therapy is an exercise-based treatment used to establish proper muscle function and a normal resting posture of the tongue, lips, and jaw.
The 4 main goals of treatment are to establish nasal breathing, proper oral rest posture, correct swallow pattern, and accurate speech sound production.
Nasal breathing: Mouth breathing leads open mouth posture and low tongue posture at rest, which negatively impacts correct swallow pattern, speech production, and overall health. Referral to an ENT may be necessary to rule out nasal obstruction or establish a patent airway before working on nasal breathing exercises.
Oral rest posture: Lips together, tongue up in the palate, nasal breathing
Swallowing: A backward swallow pattern is the goal. Swallowing is a learned reflex. Changing the structure will not change the function, it must be re-learned.
Speech: An incorrect oral rest posture of the tongue and lips can result in the tongue initiating speech productions from an abnormal rest position. Correcting the oral rest posture and the associated compensations can positively impact the correction of speech production errors.
Children and adults with orofacial myofunctional disorders (OMDs) may present with any of the following symptoms:
Snoring/ sleep apnea: Research has shown that myofunctional therapy can reduce the symptoms of sleep disordered breathing by reducing the obstruction to the airway (toning the muscles so they don’t fall back into the airway).
Mouth breathing: Switching from mouth to nasal breathing requires two parts. First, we work to increase tone in the tongue and lips to establish proper oral rest posture (lips together with tongue up in the palate). Second, we work through a series of nasal breathing exercises to change the body's chemistry (oxygen/ CO2 ratio) and mechanics (diaphragmatic breathing, slow and light breathing).
Feeding issues/ picky eating: Can be due to reduced tongue movement needed for effective and efficient chewing of more advanced textures, which can lead to unpleasant and/or aversive experiences with certain textures (e.g., gagging, choking, digestive issues).
Dysfunctional oral habits: Thumb sucking, nail biting, pacifier use and other behaviors emerge in place of normal function (e.g., if tongue is not up in the palate, the thumb, pacifier, finger…etc. will take it’s place).
Tongue thrusting: Refers to the forward protrusion of the tongue against or between the teeth when swallowing. The constant pressure of the tongue against the teeth can lead to misalignment of the teeth (e.g., open bite).
Speech sound errors/ distortions: Prolonged difficulty with production of certain speech sounds (e.g., t, d, l, n, r, k, g, s, z, “SH”, “CH”, “J”) and/or reduced overall speech intelligibility.
Myofunctional therapy encompasses many aspects of health and often requires an integrated team approach. Members of the interprofessional team may include any/all of the following:
Craniosacral therapist/ body worker
Besson NA (2015). Improving overall function in childhood: the SLPs role in the identification of sleep-disordered breathing. 2015 ASHA Convention Presentation. American Speech-Language Hearing Association.
Besson NA (2015). The tongue was involved, but what was the trouble? The ASHA Leader. 2015 Sep 20(9):36.
Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R, Kushida CA (2015). Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis. Sleep. 2015 May 1;38(5):669-675.
Guilleminault C, Huang YS, Monteyrol PJ, Sato R, Quo S, Lin CH. Critical Role of Myofacial Reeducation in Pediatric Sleep-disordered-breathing. Sleep Med. 2013. Jun;14(6):518-25. Epub 2013 Mar 21.
Hanson, M., & Mason, R. (2003). Orofacial Myology: International Perspectives. Charles C. Thomas, Publisher, Springfield, IL.
Harari, D., Redlich, M., Miri, S., Hamud, T., & Gross, M. (2010). The effect of mouth breathing versus nasal breathing on dentofacial and craniofacial development in orthodontic patients. The Laryngoscope, 120(10), 2089-2093.
Huang YS & Guilleminault C. Pediatric Obstructive Sleep Apnea and the Critical Role of Oral-Facial Growth: Evidence. Frontiers in Neurology. 2012. Published online 2013 January 22.
Ralli G, Ruoppolo G, Mora R, Guastini L. Deleterious sucking habits and atypical swallowing in children with otitis media with effusion. International Journal of Pediatric Otorhinolaryngology, 2011; 75:1260–1264. doi:10.1016/j. ijporl.2011.07.002
Saccomanno S, Antonini G, D’Alatri L, D’Angelantonio M, Fiorita A, Deli R. Causal relationship between malocclusion and oral muscles dysfunction: a model of approach. Europaen Journal of Paediatric Dentistry; 2012. 13(4):321-323