Orofacial Myology & Speech Pathology

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

Dysfunction in oro-facial muscles may affect posture, breathing, swallowing and speech. The function of muscles also affects form – development of the jaw, expansion of the palate and tooth alignment.

As we grow, function is in turn affected by form. For example, it may not be possible to resolve certain speech difficulties if there is a large over-jet, open bite, narrow jaw or highly vaulted palate. It is also important to recognise that we may not be able to establish a functional swallowing pattern or age appropriate speech when certain behaviours, such as thumb sucking or nail biting habits, persist. 

As Speech Pathologists practicing Orofacial Myology, our aims are to eliminate barriers to successful remediation of speech and swallowing difficulties. Often, we are just one member of a care team, which may also include an Ear Nose & Throat Specialist, Dentist, Orthodontist or Sleep Specialist. This holistic team approach means that benefits often extend to overall health and well-being.

Possible Causes of an Orofacial Myofunctional Disorder

Habits

• Thumb or finger sucking
  
• Sucking dummies, blankets, clothing, hair, pens etc.
  
• Nail biting or cheek & lip biting
  
• Bruxism (teeth grinding)
  

Restricted airway due to:

• Enlarged tonsils &/or adenoids
  
• Allergies
  
• Narrow or vaulted palate
  
• Oversized uvula
  

Restrictive lingual frenum (tongue tie)

Neurological or developmental abnormalities, for example:

• Dyspraxia
  
• Cerebral Palsy
  
• Bells Palsy
  

What To Look Out For

• Mouth breathing (when awake or sleeping)
  
• Tongue position low and forward
  
• Chapped lips
  
• Lip licking
  
• Chewing with mouth open
  
• History of feeding difficulties (e.g. trouble attaching to breast)
  
• Messy eating
  
• Coughing when eating
  
• Gagging
  
• Slow or picky eating
  
• Gulping food and drink
  
• Preferring not to drink hot beverages
  

• Preferring not to use a straw
  
• Greeting cups and cutlery with tongue outside mouth
  
• Difficulties with saliva management (dribbling or drooling)
  
• Difficulty swallowing tablets
  
• Over-jet or open bite (gap between teeth)
  
• Cross bite
  
• Fillings and receding gums
  
• Adult teeth not descending
  
• Halitosis (bad breath)
  
• Scalloped or sore tongue
  

• Headaches or migraines
  
• Clicky or sore jaw (TMJ Disorder)
  
• Restrictive lingual frenum (tongue tie)
  
• Small lips
  
• Deviated septum
  
• Fatigue (particularly in the morning)
  
• Attention difficulties
  
• Darkness under the eyes
  
• Snoring
  
• Sleep apnoea
  
• Postural difficulties
  
• Neck or back pain
  

Intervention

In order to select the best path for intervention, a full assessment of speech, swallowing and oro-facial function, is recommended. Gathering a detailed case history will also be important.

A specific plan will then be devised, based upon the constellation of issues identified.

If it is felt that structural issues such as enlarged tonsils, a deviated septum or restrictive lingual frenum (tongue tie) are contributing to functional difficulties, the first step may be referral to an Ear Nose & Throat Specialist, Dentist or Orthodontist. Factors affecting the airway, such as allergies, must also be addressed as a top priority.

If there are habits such as thumb sucking, nail biting or bruxism (teeth grinding) present, your Speech Pathologist will help you to address them via a structured, cognitive-behavioural treatment program. We have come to realise that our helpful ‘tips’ are often not enough to ensure clients break these habits, and such a realisation led us to pursue specialist training in this field.

The next stage of our intervention plan will most likely be an Orofacial Myology exercise program, which will train the muscles of the lips, tongue, face and neck. The aim is to ensure the tongue and jaw are correctly aligned when at rest and during swallowing. This will extinguish postures that interfere with speech, enabling successful achievement of our ultimate goal - establishing accurate speech patterns, to support communication!

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