Myofunctional Therapy in Atypical Swallowing: A Scoping Review

Abstract

Background: Orofacial myofunctional therapy (OMT) is frequently applied to correct atypical swallowing, yet its therapeutic strategies remain heterogeneous and poorly standardized. Objective: This scoping review aimed to characterize the strategies described in the literature for OMT in individuals diagnosed with atypical swallowing. Methods: Following Joanna Briggs Institute and PRISMA-ScR guidelines, and with a registered protocol, we included clinical and experimental studies without age restriction, conducted in clinical or research contexts. Studies were retrieved from PubMed, EMBASE, and Cochrane Library using MeSH terms and specific keywords. Data were extracted using a standardized form and summarized descriptively. Results: Twelve studies published between 1989 and 2024, involving 164 participants aged 5–26 years, were included. Interventions were mainly performed by speech-language pathologists in pediatric and adolescent populations, combining tongue posture exercises, muscle strengthening, orofacial mobility, and functional swallowing training. Treatment duration ranged from 8 weeks to 6 months, with weekly sessions and home practice recommendations. In 83% of studies, improvements in swallowing patterns and tongue posture were reported, especially when combined with orthodontic treatment. Conclusions: OMT is characterized as a multifactorial intervention integrating muscle training and functional re-education, but variability in protocols and lack of standardization limit clinical comparability. Future multicenter studies with greater methodological control are needed.

1. Introduction

Swallowing is a physiological process that, along with other orofacial functions such as chewing and sucking, allows the intake of food and liquids, thus ensuring body hydration [1]. The function of swallowing involves a series of coordinated movements between the muscles of the mouth, such as the tongue, lips, and cheeks, as well as the pharyngeal and esophageal muscles [2]. These movements are controlled by both the central and peripheral nervous systems, ensuring proper functional performance [3].

Throughout life, oral structures grow and change, allowing for the development and maturation of orofacial functions [1]. During this process, various adaptations occur in response to functional demands related to age and the passage of time [4]. One example is the evolution of the swallowing function, which is initially characterized by tongue movements interposed between the gingival ridges in early childhood. However, between 12 and 15 months, thanks to the eruption of teeth, these movements evolve, and the tongue tip begins to position itself in the anterior third of the hard palate. This phenomenon is described as the transition from infant swallowing to mature swallowing [5]. This mature swallowing process contributes to the growth of orofacial structures and the consolidation and maintenance of the morphofunctional balance of the stomatognathic system [6].

The persistence of the infant swallowing pattern is considered pathological. This dysfunctional process is most commonly referred to as atypical swallowing, and in the literature it may also appear as tongue thrust swallowing or infantile swallowing [7]. All of these terms describe an abnormal swallowing pattern that occurs during the oral preparatory and oral (propulsive) phases of swallowing, and is characterized by incorrect tongue positioning—typically pressing against the anterior or lateral teeth during swallowing and/or at rest [8]. This affects the myofunctional balance of the oral structures, leading to poor maxillofacial development and potentially resulting in dental malocclusions [9]. The causes of these inappropriate movements are varied and include unhealthy oral habits, lack of functional exposure during childhood (such as limited opportunities for chewing solid foods, delayed weaning from bottle feeding, or insufficient practice of adequate swallowing patterns), as well as mouth breathing, among other factors [10].

The diagnosis of atypical swallowing is part of the evaluation of orofacial myofunctional disorders and requires a comprehensive understanding of the muscular condition and functions of the stomatognathic system. This evaluation is commonly performed by speech-language pathologists in collaboration with orthodontists and other dental specialties [11]. Several clinical protocols guide the identification of atypical swallowing. These include procedures that assess lip competence during swallowing, the degree of tongue interposition, mandibular sliding, head movement, facial muscle tension, and the efficiency of swallowing solids and liquids. Such parameters are often quantified using numerical scoring systems to better capture functional impairments. Among these tools, standardized instruments like the Orofacial Myofunctional Evaluation with Scores (OMES) protocol have been increasingly adopted in both clinical and research settings to support diagnostic reasoning and inform evidence-based therapeutic planning [12].

Regarding orofacial myofunctional therapy for atypical swallowing, it is important to note that it focuses on restoring neuromuscular movement patterns with the goal of reorganizing muscle function, both at rest and during swallowing [8]. In atypical swallowing, these altered patterns may include tongue thrusting against or between the teeth, reduced elevation of the tongue tip to the hard palate, inadequate lip closure, and excessive or uncoordinated activation of perioral and mandibular muscles [6,7,8].

Although various clinical approaches have been described, there is currently no widely accepted set of intervention strategies specific to speech-language pathology treatment for atypical swallowing—defined here as a dysfunction involving the oral preparatory and oral (propulsive) phases of swallowing. Instead, most existing studies have primarily focused on improving early detection (such as identifying abnormal tongue posture, atypical swallowing patterns, or associated oral habits) and providing diagnostic guidance (establishing criteria and clinical indicators that support speech-language pathologists and dental specialists in determining the presence and severity of atypical swallowing). Consequently, there is limited information on structured, evidence-based therapeutic strategies targeting these two phases. It is important to note that effective and well-researched intervention approaches exist for other swallowing disorders, particularly those affecting the pharyngeal phase, commonly addressed in the context of dysphagia.

Thus, this study aims to characterize orofacial myofunctional therapy in patients diagnosed with atypical swallowing through a scoping literature review. Based on this objective, the following guiding question was established: “How has orofacial myofunctional therapy been characterized in patients diagnosed with atypical swallowing through the scientific literature?”.

2. Materials and Methods

2.1. Protocol

This scoping review was conducted following the methodology proposed by the Joanna Briggs Institute (JBI) for scoping reviews [13]. Furthermore, the writing of this article followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) [14]. The PRISMA checklist can be found in Table S1. The protocol for this review was registered in the Open Science Framework (https://osf.io/nftks/; accessed on 17 September 2024)

The population, concept, and context (PCC) strategy [13] was adopted for study inclusion: (a) regarding the population: individuals diagnosed with atypical swallowing, with no age restrictions; (b) regarding the concept: orofacial myofunctional therapy applied for the treatment of atypical swallowing; and (c) regarding the context: studies conducted in clinical or research settings describing orofacial myofunctional therapeutic interventions in patients with atypical swallowing.

2.2. Eligibility Criteria

Studies describing or analyzing the application of orofacial myofunctional therapy in patients diagnosed with atypical swallowing were included. Both clinical studies and experimental investigations were considered, observing how therapy has been applied across different age groups and populations.

The types of studies included were quantitative experimental, quasi-experimental, observational, descriptive, exploratory, correlational studies, and case analysis studies.

Studies that were not fully available, those focusing on descriptive analyses without presenting specific results on therapeutic intervention, as well as qualitative studies, secondary reviews, and authors’ opinions were excluded. Also excluded were conference presentations published in scientific proceedings and Master’s and Doctoral theses available on official university websites.

2.3. Search Strategy and Information Sources

Studies were extracted from the PubMed/Medline, EMBASE, and Cochrane Library databases, with no restrictions on year or language. Search terms were selected based on the research question, using validated Medical Subject Headings (MeSH) terms and supplemented with additional keywords relevant to the topic (

Table 1. Search Strategy.

#	Search Strategy
1	Myofunctional therapy.mp. or muscle training/
2	Atypical swallowing.mp.
3	Tongue interposition.mp.
4	Tongue thrust.mp. or tongue thrusting/
5	2 or 3 or 4
6	1 and 5
7	remove duplicates from 6

).

2.4. Study Selection and Data Extraction

During the selection process, all studies were analyzed by title/abstract, full text, and final review. The selection was conducted by two independent researchers, and in case of discrepancies, a third researcher intervened to resolve conflicts. This process was managed using the Covidence and Rayyan^® platforms, which facilitated the initial screening and analysis of titles and abstracts.

After the initial screening, the full texts of potentially relevant publications were read. Data extraction was carried out by one of the authors using a standardized form that collected detailed information in the following sections: study origin (first author, publication year, country, institution); participant characteristics (total number, age range, gender distribution, swallowing diagnosis, and dental diagnosis); general study description (research objective, study type, methodological design, and main conclusions); in situ dental treatment (details of orthodontic devices or treatments used); relationship with other myofunctional disorders (additional orofacial function disorders, such as oral breathing or speech sound disorders); specific activities for orofacial myofunctional therapy (methods, strategies, and approaches implemented); total therapy duration (number of sessions, weeks or months); duration of each therapy session (in minutes); therapy frequency (weekly, biweekly, or other); home exercises (whether prescribed or not); home training time (in minutes); professional in charge of the therapeutic process (speech-language pathologist or other); and achievement measures (criteria and tools used to evaluate treatment effectiveness).

Finally, the extracted data were reviewed by two other authors, consolidated into a single version, and systematically organized for analysis and synthesis.

3. Results

3.1. Selection of Evidence Sources

After removing duplicates, a total of 45 studies were identified. Based on the reading of titles and abstracts, 22 studies were selected, and after a full-text review, 12 records were chosen (Figure 1).

3.2. Characteristics of the Evidence Sources

Table 2 provides a detailed summary of the characteristics of the included studies, which includes information on the origin of the studies, participants, research objectives, methodologies used, and key conclusions obtained.

3.3. Results of Individual Evidence Sources

The characteristics of the orofacial myofunctional therapy are summarized in Table 3.

3.4. Synthesis of Results

Regarding the characteristics of the origin, participants, and general description of the studies presented in Table 2, the following can be summarized:

The 12 studies reviewed were published between 1989 [15] and 2024 [16,17]. Italy had the highest representation, contributing 50% of the studies (6/12) [17,18,19,20,21,22], followed by the United States [15], South Korea [16], Canada [23], Australia [24], Belgium [25] and Romania [26], each with one study (8.3% of the total each). 58.3% of the studies (7/12) were conducted in hospital institutions or dental schools, while the rest were carried out in academic or clinical settings without specifying a hospital environment.

In total, the reviewed studies included 164 participants, aged between 5 and 26 years. The gender distribution was relatively balanced: 54.8% females (90/164) and 48.1% males (74/164).

Regarding swallowing diagnoses, the studies used terms such as atypical swallowing [17,18,19,20,22,26], visceral swallowing pattern [25], tongue thrust [15,21,23,24], infantile swallowing with tongue thrust [16], and tongue interposition, among others. These terms are often employed to describe the presence of dysfunctions or alterations in the typical pattern of swallowing. Regarding dental diagnoses, 58.3% of the studies (7/12) reported anterior open bite as the primary condition addressed [15,16,19,21,22,24,25], while others identified Class II malocclusion [16,19] and unhealthy oral habits. Notably, 41.7% of the studies (5/12) did not specify any dental diagnosis [17,18,20,23,26].

All studies sought to assess the efficacy of orofacial myofunctional therapy (OMT) in treating swallowing pattern disorders and associated issues such as tongue thrust and malocclusions. Some studies also addressed secondary objectives, such as analyzing the role of dentition in the effectiveness of OMT or exploring strategies to improve motivation and adherence in pediatric patients [17].

In terms of study design, 91.7% (11/12) were prospectively designed, including descriptive case reports (6/12) [15,16,19,22,23,26], quasi-experimental studies (4/12) [18,20,21,24], and a randomized pilot study (1/12) [25]. Only 8.3% (1/12) of the studies were explicitly retrospective, corresponding to an observational, retrospective study [17].

In terms of methodological design, single-case pre-post designs with follow-up were the most common approach, appearing in 41.7% of the studies (5/12) [15,16,19,22,23]. Prospective single-group pre-post designs represented 33.3% (4/12) [18,20,21,24], while multiple single-case pre-post designs with a one-year follow-up were present in 8.3% (1/12) [19]. One study (8.3%) utilized a randomized controlled pilot trial with a 6-month follow-up [25], and another (8.3%) followed a prospective two-group pre-post design [26]. Lastly, a retrospective single-group pre-post design accounted for 8.3% of the studies [17]

In relation to in situ dental treatment, 41.6% of the studies (5/12) integrated some form of orthodontic intervention [15,16,18,19,25], such as palatal expansion devices, fixed or removable orthodontics in combination with OMT, to address malocclusions, particularly in cases of anterior open bite. Myofunctional therapy was associated with other orofacial disorders in 66.6% of the studies (8/12); in particular, oral breathing was reported in 50% (6/12) [17,18,19,22,23,26], speech sound disorders (SSD) in 25% (3/12) [15,23,25] and thumb sucking in 8.3% (1/12) [19].

The specific activities within the OMT protocols were diverse. 25% of the studies (3/12) implemented exercises based on the Garliner method, aimed at strengthening orofacial muscles through isometric and isotonic exercises involving the tongue, soft palate, and lateral pharyngeal walls [20,21,23]. Additionally, 16.7% of the studies (2/12) included activities focused on tongue posture and swallowing, which involved smiling, retracting the tongue, and swallowing while clenching molars, avoiding labial sealing [16,22]. Other studies focused on correcting open bite and tongue posture, instructing participants on the correct resting position of the tongue on the palate by using elastic bands, thus facilitating both strengthening and coordination of the tongue [21,22,23].

The total treatment duration varied between 8 weeks [24] and 6 months [17] in studies that provided this information. Studies reporting the number of sessions ranged from 12 [17] to 30 sessions [19]. Therapeutic sessions with the therapist lasted between 20 [24] and 60 min [25], with weekly frequency being predominant in 58.3% of the studies (7/12) [15,18,20,21,22,25,26], while 16.7% (2/12) used a biweekly frequency [17,24]. 75% of the studies (9/12) included home practice activities [15,16,17,18,20,21,22,25,26], with daily training times recommended to vary between 10 [16] and 90 min [22].

Regarding the professionals in charge of therapy, 75% of the studies (9/12) identified the speech-language pathologist (SLP) as the primary professional responsible [17,18,19,20,21,22,23,24,26], while one study was led by an orofacial myologist [15], one by an orofacial myofunctional therapist [25], and another by an orthodontist [16].

Evaluation methods included the Orofacial Myofunctional Evaluation Protocol (OMES and OMES-Expanded) [20,21,26], measurement devices such as the IOPI System [21,23,25] and surface electromyography (sEMG) to quantify tongue strength, endurance, and muscle activation [18,19,20], and clinical assessments of oral rest posture, swallowing, speech articulation, and occlusion [15,16,17,22]. Additional methods included cephalometric analysis [19,24], electropalatography [24], dynamometry for orbicularis oris strength [17,18], extraoral and intraoral photographs, plaster models, and lateral cephalograms [19]. Functional evaluations were complemented by specific tests like the Rosenthal test [22], photogrammetry and fluorescein dye application to verify tongue posture [17]. Some studies also assessed patient compliance [17]. Primary outcomes focused on improvements in tongue posture, swallowing function, occlusal changes, and post-treatment stability.

Table 2. Characteristics of the Origin, Participants, and General Description of the Studies.

Origin				Participants						General Description of the Study
First Author	Year	Country	Institution of Origin	N°	Age (Years)	M	F	Swallowing Diagnosis	Dental Diagnosis	Objective	Study Type	Methodological Design	Main Findings
Zimmerman, J.B. [15]	1989	United States	NR	1	13	0	1	Bilateral tongue thrust with an anterior component	Open Bite	To describe the coordination between OMT and orthodontics in a case of AOB	Descriptive case report	Longitudinal single-case design with follow-ups at 1, 3, 6, and 12 months	OMT helped improve tongue posture and swallowing pattern, reducing tongue thrust and stabilizing orthodontic treatment
Gommerman, S.L. [23]	1995	Canada	Capital Health Authority, University of Alberta	1	16	0	1	Tongue thrust swallowing pattern	NR	To investigate the effects of OMT on tongue thrust swallowing and interdental sibilant distortion	Descriptive case report	Single-case pre-post design with 6-month follow-up	Significant improvements in swallowing, but not in the production of sibilant sounds after OMT
Cayley, A.S [24]	2000	Australia	Orthodontic Department, Perth Dental Hospital	8	9.08–11.75	8	0	Tongue thrust swallowing pattern	AOB	To assess the effect of tongue re-education therapy on tongue function and dentofacial form in patients with AOB	Quasi-experimental	Prospective single-group pre-post design	OMT showed partial effectiveness in enhancing swallowing function and contributing to the reduction in anterior open bite
Saccomanno, S. [18]	2012	Italy	Catholic University A. Gemelli	23	5–17	10	13	AS	NR	To analyze the causal relationship between malocclusion and oral muscle dysfunction, and the impact of OMT	Quasi-experimental	Prospective pre-post design	Patients who received OMT showed increased orbicularis strength. sEMG analysis indicated muscle activity imbalances related to bite type in skeletal Class I and II cases
Saccomanno, S. [19]	2014	Italy	Catholic University A. Gemelli	3	8–13	2	1	AS (lateral tongue); AS (anterior tongue); AS (anterior tongue)	Class II, lateral open bite AOB; Class II, AOB and maxillary contraction	To evaluate the effectiveness of OMT combined with orthodontics in patients with oral bad habits (thumb sucking, OB, AS and labial interposition)	Descriptive case report	Multiple single-case pre-post design with 1-year follow-up	The combination of orthodontics and OMT was effective in correcting oral habits and malocclusions
Van Dyck, C. [25]	2016	Belgium	University Hospitals Leuven	22	7.1–10.6	11	11	Visceral swallowing pattern	AOB	To investigate the effects of OMT on tongue behavior in children with AOB and a visceral swallowing pattern	Randomized pilot study	RCT pilot with 6-month follow-up	OMT produced significant changes in tongue elevation strength, resting tongue posture, and tongue position during solid food swallowing, but further research is needed
Begnoni, G. [20]	2020	Italy	University of Milan	15	17.72 ± 5.21	4	11	AS	NR	To analyze the effects of OMT on muscular function and orofacial behavior in a group of patients with AS and second dentition completed	Quasi-experimental	Prospective single-group pre-post design	OMT allows the shortening of the muscular activation pattern and increases submental muscle activity
Mozzanica, F. [21]	2020	Italy	Department of Clinical Sciences and Community Health, University of Milan	22	8.8 ± 1.1; 19.8 ± 4.7	9	13	Tongue thrust	AOB, Overjet	To evaluate the effects of OMT using a validated instrument and to explore the influence of dentition on its efficacy	Quasi-experimental	Prospective single-group pre-post design	OMT improves swallowing and tongue strength in patients with tongue thrust, regardless of dentition type
Saccomanno, S. [22]	2022	Italy	Department of Health, Life and Environmental Science, University of L’Aquila	1	9	0	1	AS	AOB	To verify the advantages of OMT through the description of a clinical case treated only with this kind of therapy	Descriptive case report	Single-case pre-post design with 1-year follow-up	In one clinical case, OMT alone resolved AS and improved malocclusion, helping to stabilize the treatment
Debucean, D. [26]	2023	Romania	Faculty of Medicine and Pharmacy, University of Oradea	61	12–26	25	36	AS	NR	To explore whether OMT combined with a physiotherapeutic rehabilitation program for postural problems adds benefits to swallowing rehabilitation in healthy young population	Analytical observational	Prospective two-group pre-post design	The OMT combined with physiotherapy (manual therapy and Global Postural Re-education) proved to be more effective than single OMT
Noh, H. [16]	2024	South Korea	Department of Orthodontics, School of Dentistry, Kyungpook National University	1	8 (follow-up until 23)	0	1	Infantile swallowing pattern	AOB, Class II (right side)	To correct AOB and tongue thrust through OMT and orthodontics	Descriptive case report	Single-case pre-post design with follow-up two months after bite stabilization	Controlling infantile swallowing is crucial for AOB treatment stability. The smile-clenching-swallowing exercise was key to long-term stability
Saccomanno, S. [17]	2024	Italy	University of L’Aquila	6	7–14	5	1	AS	NR	To explore the use of edible spread cream and small candies as tools to enhance motivation and compliance in children undergoing OMT for optimizing oral functions, including AS	Observational, retrospective	Retrospective single-group pre-post design	Young patients’ compliance limits OMT effectiveness in AS. Creative solutions like edible tools could improve cooperation and outcomes

Abbreviations: NR = Not Reported; OMT = Orofacial Myofunctional Therapy; AS = Atypical Swallowing; AOB = Anterior Open Bite; OB = Oral Breathing; RCT = Randomized Controlled Trial.

Table 2. Characteristics of the Origin, Participants, and General Description of the Studies.

Origin				Participants						General Description of the Study
First Author	Year	Country	Institution of Origin	N°	Age (Years)	M	F	Swallowing Diagnosis	Dental Diagnosis	Objective	Study Type	Methodological Design	Main Findings
Zimmerman, J.B. [15]	1989	United States	NR	1	13	0	1	Bilateral tongue thrust with an anterior component	Open Bite	To describe the coordination between OMT and orthodontics in a case of AOB	Descriptive case report	Longitudinal single-case design with follow-ups at 1, 3, 6, and 12 months	OMT helped improve tongue posture and swallowing pattern, reducing tongue thrust and stabilizing orthodontic treatment
Gommerman, S.L. [23]	1995	Canada	Capital Health Authority, University of Alberta	1	16	0	1	Tongue thrust swallowing pattern	NR	To investigate the effects of OMT on tongue thrust swallowing and interdental sibilant distortion	Descriptive case report	Single-case pre-post design with 6-month follow-up	Significant improvements in swallowing, but not in the production of sibilant sounds after OMT
Cayley, A.S [24]	2000	Australia	Orthodontic Department, Perth Dental Hospital	8	9.08–11.75	8	0	Tongue thrust swallowing pattern	AOB	To assess the effect of tongue re-education therapy on tongue function and dentofacial form in patients with AOB	Quasi-experimental	Prospective single-group pre-post design	OMT showed partial effectiveness in enhancing swallowing function and contributing to the reduction in anterior open bite
Saccomanno, S. [18]	2012	Italy	Catholic University A. Gemelli	23	5–17	10	13	AS	NR	To analyze the causal relationship between malocclusion and oral muscle dysfunction, and the impact of OMT	Quasi-experimental	Prospective pre-post design	Patients who received OMT showed increased orbicularis strength. sEMG analysis indicated muscle activity imbalances related to bite type in skeletal Class I and II cases
Saccomanno, S. [19]	2014	Italy	Catholic University A. Gemelli	3	8–13	2	1	AS (lateral tongue); AS (anterior tongue); AS (anterior tongue)	Class II, lateral open bite AOB; Class II, AOB and maxillary contraction	To evaluate the effectiveness of OMT combined with orthodontics in patients with oral bad habits (thumb sucking, OB, AS and labial interposition)	Descriptive case report	Multiple single-case pre-post design with 1-year follow-up	The combination of orthodontics and OMT was effective in correcting oral habits and malocclusions
Van Dyck, C. [25]	2016	Belgium	University Hospitals Leuven	22	7.1–10.6	11	11	Visceral swallowing pattern	AOB	To investigate the effects of OMT on tongue behavior in children with AOB and a visceral swallowing pattern	Randomized pilot study	RCT pilot with 6-month follow-up	OMT produced significant changes in tongue elevation strength, resting tongue posture, and tongue position during solid food swallowing, but further research is needed
Begnoni, G. [20]	2020	Italy	University of Milan	15	17.72 ± 5.21	4	11	AS	NR	To analyze the effects of OMT on muscular function and orofacial behavior in a group of patients with AS and second dentition completed	Quasi-experimental	Prospective single-group pre-post design	OMT allows the shortening of the muscular activation pattern and increases submental muscle activity
Mozzanica, F. [21]	2020	Italy	Department of Clinical Sciences and Community Health, University of Milan	22	8.8 ± 1.1; 19.8 ± 4.7	9	13	Tongue thrust	AOB, Overjet	To evaluate the effects of OMT using a validated instrument and to explore the influence of dentition on its efficacy	Quasi-experimental	Prospective single-group pre-post design	OMT improves swallowing and tongue strength in patients with tongue thrust, regardless of dentition type
Saccomanno, S. [22]	2022	Italy	Department of Health, Life and Environmental Science, University of L’Aquila	1	9	0	1	AS	AOB	To verify the advantages of OMT through the description of a clinical case treated only with this kind of therapy	Descriptive case report	Single-case pre-post design with 1-year follow-up	In one clinical case, OMT alone resolved AS and improved malocclusion, helping to stabilize the treatment
Debucean, D. [26]	2023	Romania	Faculty of Medicine and Pharmacy, University of Oradea	61	12–26	25	36	AS	NR	To explore whether OMT combined with a physiotherapeutic rehabilitation program for postural problems adds benefits to swallowing rehabilitation in healthy young population	Analytical observational	Prospective two-group pre-post design	The OMT combined with physiotherapy (manual therapy and Global Postural Re-education) proved to be more effective than single OMT
Noh, H. [16]	2024	South Korea	Department of Orthodontics, School of Dentistry, Kyungpook National University	1	8 (follow-up until 23)	0	1	Infantile swallowing pattern	AOB, Class II (right side)	To correct AOB and tongue thrust through OMT and orthodontics	Descriptive case report	Single-case pre-post design with follow-up two months after bite stabilization	Controlling infantile swallowing is crucial for AOB treatment stability. The smile-clenching-swallowing exercise was key to long-term stability
Saccomanno, S. [17]	2024	Italy	University of L’Aquila	6	7–14	5	1	AS	NR	To explore the use of edible spread cream and small candies as tools to enhance motivation and compliance in children undergoing OMT for optimizing oral functions, including AS	Observational, retrospective	Retrospective single-group pre-post design	Young patients’ compliance limits OMT effectiveness in AS. Creative solutions like edible tools could improve cooperation and outcomes

Abbreviations: NR = Not Reported; OMT = Orofacial Myofunctional Therapy; AS = Atypical Swallowing; AOB = Anterior Open Bite; OB = Oral Breathing; RCT = Randomized Controlled Trial.

Table 3. Characteristics of Orofacial Myofunctional Therapy.

First Author (Year)	In Situ Dental Treatment	Other Functional Disorders	Specific Activities for the Treatment	Total Therapy Duration	Therapy Session Duration	Therapy Frequency	Home Practice	Home Training Time	Therapist in Charge	Outcome Measures
Zimmerman (1989) [15]	Orthodontic retainer with lingual spurs after palatal expansion and headgear	SSD	1. Increase awareness of the orofacial musculature to establish an appropriate resting posture of the tongue and lips, as well as functional movements during speech and swallowing. 2. Develop neuromuscular movement patterns to support conscious and coordinated swallowing of food, liquids, and saliva. 3. Assign therapeutic activities to promote the automatization of these motor skills, including speech therapy tasks to correct the interdental lisp.	16 weeks	NR	Once a week for 5 weeks and then every 15 days	Yes	NR	Orofacial myologist	Clinical evaluation of oral rest posture, speech and swallowing function, and occlusion at follow-up.
Gommerman (1995) [23]	NR	OB, SSD	1. Phase of OMT: 14 sessions included patient education on normal swallowing physiology, tongue strengthening exercises, and structured practice of correct swallows. Therapy incorporated modified versions of Garliner’s elastic swallowing exercises. 2. Phase of Articulation Treatment: 4 structured sessions followed a hierarchical model from isolated sounds to connected speech. Techniques included direct feedback, mental imagery, and structured self-monitoring with clinician-patient agreement on performance ratings.	18 sessions	NR	NR	NR	NR	SLT	Swallowing measures: frequency of tongue thrust swallowing, duration of swallows and ease of swallowing. Tongue strength and endurance measured with IOPI. Sibilant distortion and labial diadochokinetic rate.
Cayley (2000) [24]	No treatment	NR	1. Development of new muscle patterns needed as a foundation for proper swallowing and appropriate lip and tongue posture. 2. Swallowing training with liquids and semi-solids.	8 weeks	20 min	Every 15 days	NR	NR	SLT	Cephalometric analysis. Electropalatography to assess tongue-palate contact during speech and tongue position during the propulsive phase of saliva and water swallowing.
Saccomanno (2012) [18]	Rapid palatal expansion	OB	Therapeutic approach varied by malocclusion. For overbite ≤2 mm, a fixed grid/tongue crib was used to partially close the bite before starting speech therapy. For overbite >1 mm, speech therapy was applied. In overjet ≥4 mm, Class I patients received OMT only; Class II patients combined OMT with orthodontics. For overjet ≤0 mm, 20 speech therapy sessions plus daily home exercises preceded orthodontics. Exercises not specified.	20 weeks	NR	Once a week	Yes	NR	SLT	Strength of the orbicularis muscle measured with a dynamometer; sEMG used to assess masseter and temporalis muscle activity.
Saccomanno (2014) [19]	The 2nd case was treated with a palatal crib and Fränkel III appliance. The third case was treated with rapid palatal expander, and with a removable orthodontic appliance.	OB, thumb sucking	Functional rehabilitation of the orofacial musculature. No specific exercises were described. Emphasis was placed on patient and family compliance with home therapy and interdisciplinary collaboration among professionals involved.	20–30 sessions	NR	NR	NR	NR	SLT	Extraoral and intraoral photographs, plaster models, cephalometric analysis (lateral cephalogram), labial orbicular muscle contraction measurement, and tongue posture analysis.
Van Dyck (2016) [25]	Removable maxillary expansion device	SSD	Session 1. Explanation of treatment process and motivation; Sessions 2–3. Strengthen tongue and lip musculature; Sessions 4–5. Basis of the swallowing process; Session 6. Strengthen the anterior part of the tongue; Sessions 7–9. Strengthen the mid part of the tongue; Sessions 10–11. Strengthen the posterior part of the tongue; Sessions 13–14. Coordination of the total swallow movement; Sessions 15–16. Practice on conscious habit formation; Sessions 17–18. Practice on unconscious habit formation; Session 19. Control of physiological swallowing act; Session 20. Control of physiological swallowing act and follow-up.	4–6 months	30 or 60 min	Weekly or every 2 weeks	Yes	NR	OMT therapist	Maximum tongue elevation strength measured with IOPI. Functional characteristics such as resting tongue posture, swallowing pattern, and articulation were assessed through clinical evaluation performed by a speech pathologist.
Begnoni (2020) [20]	NR	NR	Myofunctional exercises based on the Garliner method.	10 weeks	45 min	Once a week	Yes	NR	SLT	Duration and intensity of electrical activation (sEMG) of masseter, temporal, and sublingual muscles. OMES protocol score.
Mozzanica (2020) [21]	No treatment	NR	Myofunctional exercises based on the Garliner method: Session 1: Education on physiology and dysfunctional habits, initial training on tongue posture. Session 2: Maintaining tongue posture for 5–10 min, practicing swallowing with 1–2 elastic bands, start strengthening. Session 3: Extending posture to 20 min, swallowing practice with bands and water retention, strengthening lips and masseter. Session 4: Maintaining posture for 30 min, swallowing with water and crackers, alternating chewing, strengthening exercises. Session 5: Maintaining posture for 45 min, correct swallowing during meals, reinforcement of tongue, lips, and masseter exercises. Session 6: Maintaining posture for 50 min with lip closure, swallowing during meals, strengthening continued. Session 7: Maintaining posture for 60 min, swallowing without bands, lip and masseter strengthening during meals. Session 8: Maintaining posture for 60 min, checking swallowing at two meals, establishing daily self-monitoring. Session 9: Maintaining posture twice daily for 15 min, monitoring swallowing at all meals, continuing self-recording. Session 10: Consolidating correct posture and swallowing habits with daily exercises and ongoing monitoring	10 weeks	45 min	Once a week	Yes	NR	SLT	OMES protocol scores. Tongue strength measured with IOPI.
Saccomanno (2022) [22]	No treatment	OB, difficulties chewing	1. Teach the child the correct resting position of the tongue, ensuring that the tongue remains lightly in contact with the alveolar ridge (incisive papilla) at rest, with the teeth apart and the lips gently closed. 2. Stimulate the anterior, middle, and posterior parts of the tongue through targeted exercises to promote balanced activation and correct tongue posture against the palate. 3. Instruct the child to place the tip of the tongue on the incisive papilla and the rest of the tongue pressed flatly against the hard palate, maintaining this posture both at rest and during swallowing. 4. Perform an exercise in which the child holds an elastic band with the tip of the tongue on the retroincisal papilla, initially for 10 min per day with lips open and teeth apart, progressively increasing the time and advancing to perform the exercise with teeth slightly in contact and lips closed.	3.5 months	NR	Once a week	Yes	30 min, 3 times a day	SLT	Clinical evaluation, through the Rosenthal test, observation of swallowing patterns, assessment of masticatory function, and caregiver interviews.
Debucean (2023) [26]	NR	OB	1. Nasal breathing. 2. Tongue training with a new resting position. Exercises stimulate the anterior tongue first, then the lateral parts, and finally the posterior tongue. 3. Restoration of lip seal. 4. Increase in facial muscle tone. 5. Restoration of soft palate tone. 6. Restructuring of proper swallowing.	20 weeks	40 min	Once a week	Yes	15 min daily	SLT	OMES-Expanded protocol scores.
Noh (2024) [16]	Habit control devices (tongue cribs) and fixed orthodontic treatment with microimplants	NR	OMT includes smiling to naturally move the tongue backward, positioning the tongue against the hard palate, and swallowing by clenching the molars and pushing the tongue toward the palatal rugae without lip seal, aiming to establish a mature swallowing pattern and correct resting tongue posture.	NR	NR	NR	Yes	10–20 min twice each day	Orthodontist	Closure of AOB, changes in tongue posture, post-treatment stability.
Saccomanno (2024) [17]	NR	OB	1. Development of oral awareness. 2. Correction of resting tongue posture. 3. Specific exercises to strengthen the anterior, middle, and posterior parts of the tongue, as well as the lip muscles. 4. Swallowing training: patients practice swallowing with liquids, semi-solids, and finally solids to ensure physiological swallowing function. 5. Automation of the swallowing function.	12 sessions over a 6-month period	30 min	Every 15 days	Yes	15 min daily	SLT	Increased strength of lip muscles measured with a dynamometer, appropriate tongue posture verified with fluorescein and photogrammetry. Level of cooperation assessed by the therapist.

Abbreviations: NR = Not Reported; OMT = Orofacial Myofunctional Therapy; AOB = Anterior Open Bite; OB = Oral Breathing; sEMG = Surface Electromyography; SSD = Speech Sound Disorder; SLT = Speech-Language Therapist; OMES = Orofacial Myofunctional Evaluation with Scores.

Table 3. Characteristics of Orofacial Myofunctional Therapy.

First Author (Year)	In Situ Dental Treatment	Other Functional Disorders	Specific Activities for the Treatment	Total Therapy Duration	Therapy Session Duration	Therapy Frequency	Home Practice	Home Training Time	Therapist in Charge	Outcome Measures
Zimmerman (1989) [15]	Orthodontic retainer with lingual spurs after palatal expansion and headgear	SSD	1. Increase awareness of the orofacial musculature to establish an appropriate resting posture of the tongue and lips, as well as functional movements during speech and swallowing. 2. Develop neuromuscular movement patterns to support conscious and coordinated swallowing of food, liquids, and saliva. 3. Assign therapeutic activities to promote the automatization of these motor skills, including speech therapy tasks to correct the interdental lisp.	16 weeks	NR	Once a week for 5 weeks and then every 15 days	Yes	NR	Orofacial myologist	Clinical evaluation of oral rest posture, speech and swallowing function, and occlusion at follow-up.
Gommerman (1995) [23]	NR	OB, SSD	1. Phase of OMT: 14 sessions included patient education on normal swallowing physiology, tongue strengthening exercises, and structured practice of correct swallows. Therapy incorporated modified versions of Garliner’s elastic swallowing exercises. 2. Phase of Articulation Treatment: 4 structured sessions followed a hierarchical model from isolated sounds to connected speech. Techniques included direct feedback, mental imagery, and structured self-monitoring with clinician-patient agreement on performance ratings.	18 sessions	NR	NR	NR	NR	SLT	Swallowing measures: frequency of tongue thrust swallowing, duration of swallows and ease of swallowing. Tongue strength and endurance measured with IOPI. Sibilant distortion and labial diadochokinetic rate.
Cayley (2000) [24]	No treatment	NR	1. Development of new muscle patterns needed as a foundation for proper swallowing and appropriate lip and tongue posture. 2. Swallowing training with liquids and semi-solids.	8 weeks	20 min	Every 15 days	NR	NR	SLT	Cephalometric analysis. Electropalatography to assess tongue-palate contact during speech and tongue position during the propulsive phase of saliva and water swallowing.
Saccomanno (2012) [18]	Rapid palatal expansion	OB	Therapeutic approach varied by malocclusion. For overbite ≤2 mm, a fixed grid/tongue crib was used to partially close the bite before starting speech therapy. For overbite >1 mm, speech therapy was applied. In overjet ≥4 mm, Class I patients received OMT only; Class II patients combined OMT with orthodontics. For overjet ≤0 mm, 20 speech therapy sessions plus daily home exercises preceded orthodontics. Exercises not specified.	20 weeks	NR	Once a week	Yes	NR	SLT	Strength of the orbicularis muscle measured with a dynamometer; sEMG used to assess masseter and temporalis muscle activity.
Saccomanno (2014) [19]	The 2nd case was treated with a palatal crib and Fränkel III appliance. The third case was treated with rapid palatal expander, and with a removable orthodontic appliance.	OB, thumb sucking	Functional rehabilitation of the orofacial musculature. No specific exercises were described. Emphasis was placed on patient and family compliance with home therapy and interdisciplinary collaboration among professionals involved.	20–30 sessions	NR	NR	NR	NR	SLT	Extraoral and intraoral photographs, plaster models, cephalometric analysis (lateral cephalogram), labial orbicular muscle contraction measurement, and tongue posture analysis.
Van Dyck (2016) [25]	Removable maxillary expansion device	SSD	Session 1. Explanation of treatment process and motivation; Sessions 2–3. Strengthen tongue and lip musculature; Sessions 4–5. Basis of the swallowing process; Session 6. Strengthen the anterior part of the tongue; Sessions 7–9. Strengthen the mid part of the tongue; Sessions 10–11. Strengthen the posterior part of the tongue; Sessions 13–14. Coordination of the total swallow movement; Sessions 15–16. Practice on conscious habit formation; Sessions 17–18. Practice on unconscious habit formation; Session 19. Control of physiological swallowing act; Session 20. Control of physiological swallowing act and follow-up.	4–6 months	30 or 60 min	Weekly or every 2 weeks	Yes	NR	OMT therapist	Maximum tongue elevation strength measured with IOPI. Functional characteristics such as resting tongue posture, swallowing pattern, and articulation were assessed through clinical evaluation performed by a speech pathologist.
Begnoni (2020) [20]	NR	NR	Myofunctional exercises based on the Garliner method.	10 weeks	45 min	Once a week	Yes	NR	SLT	Duration and intensity of electrical activation (sEMG) of masseter, temporal, and sublingual muscles. OMES protocol score.
Mozzanica (2020) [21]	No treatment	NR	Myofunctional exercises based on the Garliner method: Session 1: Education on physiology and dysfunctional habits, initial training on tongue posture. Session 2: Maintaining tongue posture for 5–10 min, practicing swallowing with 1–2 elastic bands, start strengthening. Session 3: Extending posture to 20 min, swallowing practice with bands and water retention, strengthening lips and masseter. Session 4: Maintaining posture for 30 min, swallowing with water and crackers, alternating chewing, strengthening exercises. Session 5: Maintaining posture for 45 min, correct swallowing during meals, reinforcement of tongue, lips, and masseter exercises. Session 6: Maintaining posture for 50 min with lip closure, swallowing during meals, strengthening continued. Session 7: Maintaining posture for 60 min, swallowing without bands, lip and masseter strengthening during meals. Session 8: Maintaining posture for 60 min, checking swallowing at two meals, establishing daily self-monitoring. Session 9: Maintaining posture twice daily for 15 min, monitoring swallowing at all meals, continuing self-recording. Session 10: Consolidating correct posture and swallowing habits with daily exercises and ongoing monitoring	10 weeks	45 min	Once a week	Yes	NR	SLT	OMES protocol scores. Tongue strength measured with IOPI.
Saccomanno (2022) [22]	No treatment	OB, difficulties chewing	1. Teach the child the correct resting position of the tongue, ensuring that the tongue remains lightly in contact with the alveolar ridge (incisive papilla) at rest, with the teeth apart and the lips gently closed. 2. Stimulate the anterior, middle, and posterior parts of the tongue through targeted exercises to promote balanced activation and correct tongue posture against the palate. 3. Instruct the child to place the tip of the tongue on the incisive papilla and the rest of the tongue pressed flatly against the hard palate, maintaining this posture both at rest and during swallowing. 4. Perform an exercise in which the child holds an elastic band with the tip of the tongue on the retroincisal papilla, initially for 10 min per day with lips open and teeth apart, progressively increasing the time and advancing to perform the exercise with teeth slightly in contact and lips closed.	3.5 months	NR	Once a week	Yes	30 min, 3 times a day	SLT	Clinical evaluation, through the Rosenthal test, observation of swallowing patterns, assessment of masticatory function, and caregiver interviews.
Debucean (2023) [26]	NR	OB	1. Nasal breathing. 2. Tongue training with a new resting position. Exercises stimulate the anterior tongue first, then the lateral parts, and finally the posterior tongue. 3. Restoration of lip seal. 4. Increase in facial muscle tone. 5. Restoration of soft palate tone. 6. Restructuring of proper swallowing.	20 weeks	40 min	Once a week	Yes	15 min daily	SLT	OMES-Expanded protocol scores.
Noh (2024) [16]	Habit control devices (tongue cribs) and fixed orthodontic treatment with microimplants	NR	OMT includes smiling to naturally move the tongue backward, positioning the tongue against the hard palate, and swallowing by clenching the molars and pushing the tongue toward the palatal rugae without lip seal, aiming to establish a mature swallowing pattern and correct resting tongue posture.	NR	NR	NR	Yes	10–20 min twice each day	Orthodontist	Closure of AOB, changes in tongue posture, post-treatment stability.
Saccomanno (2024) [17]	NR	OB	1. Development of oral awareness. 2. Correction of resting tongue posture. 3. Specific exercises to strengthen the anterior, middle, and posterior parts of the tongue, as well as the lip muscles. 4. Swallowing training: patients practice swallowing with liquids, semi-solids, and finally solids to ensure physiological swallowing function. 5. Automation of the swallowing function.	12 sessions over a 6-month period	30 min	Every 15 days	Yes	15 min daily	SLT	Increased strength of lip muscles measured with a dynamometer, appropriate tongue posture verified with fluorescein and photogrammetry. Level of cooperation assessed by the therapist.

Abbreviations: NR = Not Reported; OMT = Orofacial Myofunctional Therapy; AOB = Anterior Open Bite; OB = Oral Breathing; sEMG = Surface Electromyography; SSD = Speech Sound Disorder; SLT = Speech-Language Therapist; OMES = Orofacial Myofunctional Evaluation with Scores.

4. Discussion

This scoping review aimed to characterize OMT in patients diagnosed with atypical swallowing (AS), considering the profile of participants, clinical, geographical, and methodological contexts, as well as the therapeutic strategies used. The publications span a wide temporal range, from 1989 [15] to 2024 [16,17], reflecting a sustained interest in OMT. Pioneering studies, such as Zimmerman [15], focused on correcting tongue patterns and malocclusions, while more recent studies, such as those by Debucean [26] and Noh [16], incorporate motivational strategies, edible materials, or interdisciplinary approaches in combination with orthodontic treatment.

Italy stands out as the country with the highest scientific output on this topic, accounting of the studies reviewed. From 2012 to 2024, its research has addressed various therapeutic approaches, both in combination with orthodontic techniques and aimed at improving treatment adherence. Italy is also a leader in OMT research, particularly in older adult populations [27]. Countries such as South Korea [16] and Romania [26] have also emerged as new players, bringing methodological diversity by integrating OMT with orthodontic approaches and interdisciplinary postural rehabilitation programs.

Regarding the population, the analyzed studies included a total of 164 participants, aged 5 to 26 years, with a predominance of children and adolescents. This trend is justified both by the high prevalence of tongue thrust during school-age—ranging between 5.4% [28] and 62.3% [29]—and by neurophysiological factors. The first decade of life provides a therapeutic window of opportunity, due to active bone growth [30], neuromuscular plasticity [31], and adaptability of orofacial muscle fibers [32]. In this regard, myofunctional and orthopedic intervention aims to promote harmonious craniofacial development and prevent skeletal discrepancies [33,34].

From a methodological perspective, the included studies exhibit significant heterogeneity. Case studies such as those by Noh [16] and Saccomanno [22] provide detailed clinical descriptions, allowing for a deep understanding of individual therapeutic processes. However, their small sample sizes limit the generalizability of the results. In contrast, prospective studies with larger sample sizes, such as those by Mozzanica [21] and Debucean [26], offer greater empirical robustness and the ability to compare different strategies.

Recent literature has highlighted the potential of OMT when combined with orthodontic treatment. Literature reviews such as those by Cenzato, Iannotti, and Maspero [8] have reported significant improvements in swallowing patterns and tongue posture by integrating both interventions. However, other authors, such as Homem, Vieira-Andrade, Falci, Ramos-Jorge, and Marques [35], caution about the high risk of bias present in many of these studies, which limits the strength of the available evidence. This therapeutic integration is based on an updated view of the stomatognathic system, where the orofacial musculature is understood as a functionally interconnected network, rather than a set of isolated symptoms [36,37].

This synergistic effect has also been demonstrated in other clinical contexts. AlQahtani [38] reported that patients who combined OMT with orthodontics not only experienced greater occlusal stability but also better facial esthetics and higher satisfaction. Additionally, in cases of bruxism [39], obstructive sleep apnea [40], and other sleep disorders [41], the incorporation of OMT has led to significant functional benefits. These findings underscore the value of OMT as a structuring intervention within the stomatognathic system, with benefits extending beyond atypical swallowing to related functions such as oral breathing and speech [10,42,43].

The therapeutic activities described in the studies included a wide range of strategies, personalized according to individual needs. These strategies encompassed activities focused on tongue posture, muscle strengthening, and orofacial mobility, using isotonic and isometric exercises based on methods such as Garliner’s (1974), aimed at strengthening the tongue, soft palate, and lateral pharyngeal walls, promoting stable and balanced orofacial function [44].

An important shortcoming is that most studies do not clearly report the fundamental parameters of muscle training. The prescription of exercises in speech therapy must consider multiple interrelated factors: objectives (mobility, strength, or endurance), muscle specificity, type of contraction (isotonic, isometric, resistance), number of repetitions, weekly frequency, rest, intensity relative to maximum effort, total volume, program duration, and load progression [45,46,47]. This omission complicates both the comparison and replication of studies and limits the potential to optimize therapy based on the physiological properties of orofacial muscles, which are highly adaptable to directed stimuli [32,48,49].

Complementarily, the functional training of motor patterns such as swallowing requires integrating principles of sensorimotor learning. Acquisition during practice does not guarantee consolidated learning, which is only evident through retention and transfer to untrained contexts [50]. According to Madill [51], to achieve clinically significant results, tasks that not only favor correct execution in-session but also the integration of new patterns into daily life, should be taken into account.

Pre-practice considerations such as motivation, modeling, and clear verbal instruction represent fundamental pillars in the early stages of sensorimotor learning, as they prepare the motor and cognitive systems of the patient for effective execution with therapeutic meaning [50,51]. These conditions seek to establish a conducive environment for the acquisition of the new motor pattern, facilitating attention, understanding, and willingness to actively participate. Some studies included in this review reported concrete strategies in this stage, such as simple functional explanations about the importance of tongue posture [15,22] and visual or tactile supports to facilitate the precise placement of the tongue. Moreover, Saccomanno [17] reported the use of edible tools as a motivational resource, which not only stimulates participation but also incorporates relevant sensory elements for neuromuscular reorganization. However, these elements are still reported in a superficial manner and lack explicit systematization in protocols.

Regarding practice conditions, essential aspects such as the number of trials or sessions (small vs. large), distribution (massed vs. distributed), variability (constant vs. variable), organization (blocked vs. random), attentional focus (internal vs. external) and progressive task complexity (simple vs. complex) are crucial for strengthening motor learning and its generalization [50]. However, most of the studies reviewed did not clearly specify these parameters. Only a few, such as Saccomanno [17], indicated a hierarchical progression in tasks, moving from liquids to semisolids and then to solids, which can be interpreted as a planned organization based on functional complexity. This progressive task planning is key to achieving effective transfer of the motor pattern to natural contexts such as feeding. Still, the lack of detail in describing these elements limits the ability to replicate or adjust practice conditions for different populations.

Finally, feedback—an essential component for error correction, learning consolidation, and motor autonomy promotion—was scarcely described in the studies analyzed. According to Madill [51], feedback parameters should be adapted to the learning stage: high and frequent in the initial phases to favor acquisition, and spaced and reflective in advanced stages to promote retention and generalization. Nevertheless, Van Dyck [25] mentioned the use of verbal correction or tactile guidance by the therapist. The absence of more detailed information on the type (knowledge of results vs. performance), modality (auditory, visual or tactile), timing (immediate vs. delayed), and frequency of feedback (high vs. low), highlights a significant gap in the description of myofunctional interventions. This omission limits the understanding of how new functional patterns are effectively learned and emphasizes the need for future research that integrates and documents these essential variables for therapeutic design.

Regarding treatment time, there was considerable variability, with protocols ranging from 8 [24] to 6 months [17]. This lack of consensus contrasts with other clinical conditions, such as obstructive sleep apnea [52], temporomandibular disorders [53], or post-orthognathic surgery patients [54], where interventions of 3 to 4 months have shown functional benefits and improvements in participants’ quality of life. In the specific case of atypical swallowing, studies are needed to analyze the relationship between duration, frequency, and clinical impact.

Home practice was identified as a central component. Research by Saccomanno [17] and Debucean [26] highlights that daily home practice promotes motor automation. Additionally, variability in practice has been shown to allow the nervous system to optimize motor patterns through trial and error [55], while strategies such as using playful materials or digital devices can enhance adherence [17,56].

As for the professionals involved, most interventions were carried out by speech-language pathologists. According to the Brazilian Society of Speech-Language Pathology (SBFa), Orofacial Myology is a specialization in Speech-Language Pathology that covers the promotion, diagnosis, and intervention of orofacial functions across the life cycle [57]. Complementary, the American Speech-Language-Hearing Association (ASHA) [58,59] states that speech-language pathologists are trained to identify orofacial strengths and weaknesses, intervene functionally, and design supports to facilitate an individual’s participation in their environment. Both institutions agree on the speech-language pathologist’s leading role in these interventions, integrating evaluation, functional intervention, and interdisciplinary guidance.

Regarding evaluation and follow-up, the studies reviewed employed diverse tools. Some used non-standardized clinical protocols [15,22,23], while others applied the OMES Protocol [20,21,26] validated for assessing orofacial functionality [60]. Furthermore, instrumental methods such as dynamometers [17,18], IOPI [21,23,25], and surface electromyography [18,19,20] were integrated. Some studies also applied techniques such as electropalatography to analyze tongue patterns with precision [24]. However, the heterogeneity in the choice of instruments and the lack of longitudinal follow-up make it difficult to compare results and analyze post-treatment stability.

4.1. Clinical Implications and Future Research Directions

This review emphasizes the need for an integrated approach to the intervention of atypical swallowing, combining principles of muscle training, sensorimotor learning, and contextualized functional practice. While there has been progress toward more systematic interventions, challenges remain, such as the lack of standardized protocols, methodological heterogeneity, and limited longitudinal follow-up. Future research should design comparable multicenter studies, define clear therapeutic parameters, use validated instruments, and evaluate functional retention. These steps are essential to optimizing clinical practice, strengthening evidence, and ensuring effective and sustainable interventions for treating orofacial myofunctional disorders.

4.2. Limitations

This review has some limitations that should be considered when interpreting its findings. First, the search was restricted to three main databases, which may have excluded relevant studies available in other sources or gray literature. Additionally, although rigorous inclusion and exclusion criteria were applied, some pertinent studies may have been omitted due to the choice of keywords or search terms, which could have been expanded or adjusted. Lastly, while this review provides a broad overview of myofunctional therapy in atypical swallowing, its scope does not allow for causal relationships to be established, reinforcing the need for future experimental and multicenter studies with greater methodological control.

5. Conclusions

This review characterized the therapeutic strategies employed in orofacial myofunctional therapy (OMT) for patients with atypical swallowing, showing an evolution toward multidimensional approaches that integrate oromotor exercises, functional training, and principles of sensorimotor learning. The studies highlight the effectiveness of combining OMT with orthodontic interventions, as well as the importance of home practice for reinforcing the automation of motor patterns. Interventions included specific activities aimed at tongue posture, muscle strengthening, mobility, and swallowing reeducation, although with significant methodological variability.

Despite advances, there remains a lack of standardization in training parameters, practice conditions, and therapeutic evaluation. This heterogeneity limits comparisons across studies and clinical replicability. Therefore, future research should adopt multicenter designs, define clear therapeutic criteria, incorporate objective measurements, and evaluate long-term functional retention. These steps are critical for optimizing the efficacy, sustainability, and clinical applicability of OMT in the comprehensive treatment of orofacial myofunctional disorders.