International Journal of Orofacial Myology and Myofunctional Therapy

18 pages, 334 KB

Open AccessArticle

Lingual Frenuloplasty with Myofunctional Therapy: Improving Outcomes for the Treatment of Ankyloglossia (Tongue-Tie) with Refined Techniques and Endpoints

by Soroush Zaghi, Amanda Ramirez, Sabrina Espadas, Gloria Nguyen, Lesley McGovern Kupiec, Nora Ghodousi-Zaghi, Maryam Nouri-Norouz, Sandraluz Gonzalez, Sanda Valcu-Pinkerton, Jennifer Rodriguez, Chad Knutsen and Leyli Norouz-Knutsen

Int. J. Orofac. Myol. Myofunct. Ther. 2025, 51(2), 11; https://doi.org/10.3390/ijom51020011 - 27 Oct 2025

Abstract

Purpose: Ankyloglossia (tongue-tie) can lead to oromyofascial dysfunction which affects breathing, swallowing, speech, and posture. This study presents the evolution and outcomes of a refined lingual frenuloplasty protocol that integrates individualized myofunctional therapy to address compensatory patterns. Methods: A prospective cohort of 445 [...] Read more.

Purpose: Ankyloglossia (tongue-tie) can lead to oromyofascial dysfunction which affects breathing, swallowing, speech, and posture. This study presents the evolution and outcomes of a refined lingual frenuloplasty protocol that integrates individualized myofunctional therapy to address compensatory patterns. Methods: A prospective cohort of 445 patients (≥4 years) was treated between 2021 and 2023 using a fascia-preserving CO₂ laser protocol with structured pre- and postoperative myofunctional therapy. Patients were stratified as pediatric (<12 years) or adolescent/adult (≥12 years). Key refinements included fascia-sparing dissection, reduced suture tension with cyanoacrylate adhesive, defined functional endpoints, structured myofunctional therapy, and standardized wound-healing strategies. Results: Among 379 patients (85% response) with >2 months follow-up, the 2025 protocol achieved an 86% satisfaction rate and significantly fewer complications compared with 2019 (pain 3.7% vs. 15.8%; bleeding 1% vs. 13%; revision 2.1% vs. 6.6%). Deeper genioglossus dissection increased swelling risk (OR = 4.0, p < 0.0001) but did not affect satisfaction. Conclusions: The refined 2025 protocol represents an outcome-tracked advancement in ankyloglossia management. By emphasizing fascia preservation, functional diagnostics, and integrated myofunctional therapy, the approach improves safety, efficacy, and patient-centered outcomes. Full article

(This article belongs to the Special Issue 50 Years of the IJOM: Perspectives and Future Directions in Orofacial Myology and Myofunctional Therapy)

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20 pages, 644 KB

Open AccessReview

Myofunctional Therapy in Atypical Swallowing: A Scoping Review

by Pedro Contreras Salinas, Felipe Inostroza-Allende, Cristóbal Caviedes-Ulloa, Patricio Soto-Fernández and Giédre Berretin-Felix

Int. J. Orofac. Myol. Myofunct. Ther. 2025, 51(2), 10; https://doi.org/10.3390/ijom51020010 - 15 Oct 2025

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: [...] Read more.

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. Full article

(This article belongs to the Special Issue 50 Years of the IJOM: Perspectives and Future Directions in Orofacial Myology and Myofunctional Therapy)

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12 pages, 1220 KB

Open AccessArticle

Objective Assessment of Orofacial Muscle Strength: Validation of an Alternative Low-Cost Measurement Device

by Eduardo J. Correa, James Curtis, Laura Rodriguez Alcalá, Juan Antonio Ibañez-Rodriguez, Marta Morato-Galán, Gislaine Aparecida Folha, Cristina Rodriguez Alcalá, María Teresa García Iriarte, Guillermo Plaza and Carlos O'Connor-Reina

Int. J. Orofac. Myol. Myofunct. Ther. 2025, 51(2), 9; https://doi.org/10.3390/ijom51020009 - 29 Sep 2025

Abstract

Objective: Accurate measurement of orofacial muscle strength is essential for phenotyping patients with obstructive sleep apnea (OSA), and particularly those with hypotonic phenotypes. High costs associated with gold standard devices such as the Iowa Oral Performance Instrument (IOPI^®) limit their clinical [...] Read more.

Objective: Accurate measurement of orofacial muscle strength is essential for phenotyping patients with obstructive sleep apnea (OSA), and particularly those with hypotonic phenotypes. High costs associated with gold standard devices such as the Iowa Oral Performance Instrument (IOPI^®) limit their clinical use. This study aims to validate the Sandway^® manometer, a low-cost alternative to the IOPI^®, by comparing its performance against the IOPI^® and the Tongue Digital Spoon (TDS) in both laboratory and clinical settings. Methods: We conducted a two-phase study. In the laboratory phase, pressure readings from the IOPI^® and Sandway^® devices were compared using standardized force application methods. In the clinical phase, 60 patients with moderate-to-severe untreated OSA underwent orofacial strength evaluation using IOPI^®, Sandway^®, and TDS devices. Intraclass Correlation Coefficient (ICC), Bland–Altman analysis, and Pearson correlation were used to assess reliability and agreement. Results: The Sandway^® showed excellent reliability for anterior tongue and lip strength measures (ICC = 0.978). Bland–Altman plots revealed minimal bias and narrow limits of agreement compared to the IOPI^®, indicating strong agreement for both tongue and lip measurements. A high correlation was also observed between Sandway^® and TDS results (r = 0.863, p < 0.001), supporting secondary validation. Conclusions: The Sandway^® manometer demonstrates high reliability and strong agreement with gold standard instruments, representing a valid, accessible alternative for objective assessment of orofacial muscle strength in clinical practice. Full article

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11 pages, 691 KB

Open AccessProtocol

Effect of Orofacial Myofunctional Therapy with Auto-Monitoring on the Apnea–Hypopnea Index and Secondary Outcomes in Treatment-Naïve Patients with Mild to Moderate Obstructive Sleep Apnea (OMTaOSA): A Multicenter Randomized Controlled Trial Protocol

by Harald Hrubos-Strøm, Diana Dobran Hansen, Xin Feng, Hanna Mäkinen, Unn Tinbod, Andres Köster, Heisl Vaher, Ole Klungsøyr, Jose M. Saavedra, Helge Skirbekk, Toril Dammen and Triin Jagomägi

Int. J. Orofac. Myol. Myofunct. Ther. 2025, 51(2), 8; https://doi.org/10.3390/ijom51020008 - 9 Sep 2025

Abstract

Background: The aim of this article is to describe the protocol of a large, multicenter randomized controlled trial evaluating the effects of orofacial myofunctional therapy with auto-monitoring (OMTa) versus auto-monitoring alone on obstructive sleep apnea (OSA) assessed by the apnea–hypopnea index and other [...] Read more.

Background: The aim of this article is to describe the protocol of a large, multicenter randomized controlled trial evaluating the effects of orofacial myofunctional therapy with auto-monitoring (OMTa) versus auto-monitoring alone on obstructive sleep apnea (OSA) assessed by the apnea–hypopnea index and other pre-specified outcomes. Method: The OMTaOSA study protocol was registered at ClinicalTrials.gov (NCT06079073) in August 2023, and data collection ended in January 2025. One hundred and four participants with mild and moderate OSA were included. Randomization was conducted in a 1:1 ratio, using sex-stratified blocks. The intervention was a standardized protocol of OMT exercises previously shown to be effective, auto-monitoring with a Withings scan watch, and feedback from self-reports. Controls received watches and access to the same application without the exercise module. Sleep was measured over three nights at baseline and after three months. The sleep scorer and researchers evaluating other outcomes were blinded to the treatment allocation. Change in the apnea–hypopnea index was defined as the primary outcome. Secondary outcomes are published on Clinicaltrials.gov. Results: The results of the trial are still in preparation. Conclusions: By addressing the limitations of previous OMT studies, this trial may clarify the effectiveness of digitally delivered OMT for patients with mild to moderate OSA. Full article

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20 pages, 777 KB

Open AccessArticle

Multidisciplinary Approaches to Tongue Thrust Management in Australia: An Exploratory Study

by Sharon Smart, Julia Dekenah, Ashleigh Joel, Holly Newman and Kelly Milner

Int. J. Orofac. Myol. Myofunct. Ther. 2025, 51(2), 7; https://doi.org/10.3390/ijom51020007 - 14 Jul 2025

Abstract

Background/Objectives: Tongue thrust (TT) occurs when abnormal tongue movements cause anterior tongue placement with pressure and contact against or between the teeth, potentially affecting the oral phase of swallowing, impacting eating, breathing and speaking. There is limited literature on the diagnostic and treatment [...] Read more.

Background/Objectives: Tongue thrust (TT) occurs when abnormal tongue movements cause anterior tongue placement with pressure and contact against or between the teeth, potentially affecting the oral phase of swallowing, impacting eating, breathing and speaking. There is limited literature on the diagnostic and treatment approaches for TT, as well as involvement of health practitioners in its management. This study aims to examine the current knowledge and practices related to TT diagnosis and treatment among health professionals in Australia. Methods: A two-phase explanatory sequential mixed methods approach was adopted, comprising an online survey that collected participants’ demographic information and details on assessment, diagnosis, management, referral practices, and relevant experience and training. Phase one involved 47 health professionals from various disciplines in Australia who completed an online survey in its entirety. Phase two included in-depth interviews with seven speech-language pathologists (SLPs) to gain further insights into their experiences in managing TT. Survey data were analysed descriptively, and interview data was analysed thematically. Results: Most participants diagnosed TT using clinical assessments, such as general observation and oral motor examinations. Treatment approaches commonly included orofacial myofunctional therapy and the use of myofunctional devices. Interviews with SLPs identified four key themes: tongue thrust as a symptom rather than a diagnosis, facilitators to effective treatment, multidisciplinary approaches to management, and training and education gaps in clinical practice. Conclusions: This study provides valuable insights into how TT is identified, assessed, diagnosed, and managed by health professionals in Australia. It highlights the perspectives of SLPs on treatment approaches, as well as their views on the availability and adequacy of training and education in this field. The findings suggest the need for a broader understanding of TT management, emphasising the importance of multidisciplinary collaboration and professional development. These insights are globally relevant, as they stress the shared challenges and the value of international collaboration in improving TT diagnosis and treatment practices. Full article

(This article belongs to the Special Issue 50 Years of the IJOM: Perspectives and Future Directions in Orofacial Myology and Myofunctional Therapy)

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25 pages, 1824 KB

Open AccessArticle

Orofacial Myofunctional Therapy for Patients with Obstructive Sleep Apnea—A Mixed Methods Study of Facilitators and Barriers to Treatment Adherence

by Diana Dobran Hansen, Unn Tinbod, Xin Feng, Toril Dammen, Harald Hrubos-Strøm and Helge Skirbekk

Int. J. Orofac. Myol. Myofunct. Ther. 2025, 51(2), 6; https://doi.org/10.3390/ijom51020006 - 30 Jun 2025

Abstract

Orofacial myofunctional therapy (OMT) for obstructive sleep apnea (OSA) is a promising, new treatment. We aimed to study patients’ experiences and adherence to OMT. Twelve patients with OSA were included in the study, and they engaged in OMT exercises three times daily for [...] Read more.

Orofacial myofunctional therapy (OMT) for obstructive sleep apnea (OSA) is a promising, new treatment. We aimed to study patients’ experiences and adherence to OMT. Twelve patients with OSA were included in the study, and they engaged in OMT exercises three times daily for 12 weeks. Participants tracked their sleep and OMT exercise activities in an electronic diary. Exercise techniques were guided by a certified therapist. Patients’ experiences with OMT were assessed through semi-structured individual interviews conducted after a 12-week intervention, and the transcripts were analyzed using thematic analysis. The findings revealed an overarching theme that captured both facilitators of and barriers to OMT, organized into three subthemes: (1) motivation, (2) perceived support, and (3) perceived effects. Motivation was driven by a desire to improve general health and avoid continuous positive airway pressure treatment, and was supported by a sense of mastery and perceived effectiveness. Key facilitators included a trusting patient–therapist relationship, as well as developing routines and a sense of control. Barriers involved managing the comprehensive treatment protocol, insecurities around exercise execution and the potential impact of OMT, sickness burden, and previous negative healthcare experiences. These themes were supported by quantitative findings, which demonstrated high treatment adherence, while sleep data indicated modest individual improvements in subjective sleep quality and efficiency. By recognizing facilitators and barriers and addressing the individual differences among OSA patients, healthcare providers can better tailor their approach to meet diverse patient needs. This personalized approach, supported by emerging sleep improvements, may enhance patient engagement and improve adherence to OMT. Full article

(This article belongs to the Special Issue 50 Years of the IJOM: Perspectives and Future Directions in Orofacial Myology and Myofunctional Therapy)

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10 pages, 5714 KB

Open AccessReview

Clinical Consequences of Ankyloglossia from Childhood to Adulthood: Support for and Development of a Three-Dimensional Animated Video

by Carlos O’Connor-Reina, Laura Rodriguez Alcala, Gabriela Bosco, Paula Martínez-Ruiz de Apodaca, Paula Mackers, Maria Teresa Garcia-Iriarte, Peter Baptista and Guillermo Plaza

Int. J. Orofac. Myol. Myofunct. Ther. 2025, 51(1), 5; https://doi.org/10.3390/ijom51010005 - 23 May 2025

Cited by 1

Abstract

Ankyloglossia causes impairment of normal tongue motility and disrupts the average balance of the muscle forces that form the orofacial complex. Inadequate swallowing from birth can cause long-term anatomical and functional consequences in adult life. Using the video presented herein, we describe the [...] Read more.

Ankyloglossia causes impairment of normal tongue motility and disrupts the average balance of the muscle forces that form the orofacial complex. Inadequate swallowing from birth can cause long-term anatomical and functional consequences in adult life. Using the video presented herein, we describe the current knowledge about the long-term implications of ankyloglossia. After a literature review of the Medline, Google Scholar, and Embase databases on the relations between ankyloglossia and sleep-disordered breathing, we designed and created a three-dimensional (3D) video using Adobe After Effects based on the anatomical and functional changes produced by repeated deglutition, with and without ankyloglossia, from childhood to adulthood. The animated video (Blender 3D, Amsterdam, The Netherlands, 2024) presented herein was based on the most recent literature review of dentition, breathing, posture, and abnormal swallowing, emphasizing the importance of the potential consequences of sleep-disordered breathing. The resulting animated 3D video includes dynamic sequences of a growing child, demonstrating the anatomy and physiology of deglutition with and without ankyloglossia, and its potential consequences for the surrounding structures during growth due to untreated ankyloglossia. This visual instructional video regarding the impacts of ankyloglossia on deglutition/swallowing may help motivate early childhood diagnosis and treatment of ankyloglossia. This instrument addresses the main myofunctional aspects of normal deglutition based on the importance of free tongue motion and can be used by students or professionals training in myofunctional disorders. Full article

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26 pages, 955 KB

Open AccessSystematic Review

Effectiveness of Orofacial Myofunctional Therapy for Speech Sound Disorders in Children: A Systematic Review

by Robyn Merkel-Walsh, Danielle Carey, Ashika Burnside, Danyelle Grime, Denim Turkich, Raymond J. Tseng and Sharon Smart

Int. J. Orofac. Myol. Myofunct. Ther. 2025, 51(1), 4; https://doi.org/10.3390/ijom51010004 - 3 Mar 2025

Abstract

Orofacial myofunctional therapy (OMT) is an intervention approach used to remediate orofacial myofunctional disorders (OMDs). OMDs are abnormal patterns involving the oral and orofacial musculature that can subsequently interfere with the normal growth, development, or function of orofacial structures, including speech production. Historically, [...] Read more.

Orofacial myofunctional therapy (OMT) is an intervention approach used to remediate orofacial myofunctional disorders (OMDs). OMDs are abnormal patterns involving the oral and orofacial musculature that can subsequently interfere with the normal growth, development, or function of orofacial structures, including speech production. Historically, articulation therapy is used to remediate speech sound disorders (SSDs). Currently, there is a dearth of literature on the use of OMT to treat non-developmental (organic) SSDs in children. The aim of this systematic review is to examine the effectiveness of OMT in treating organic SSDs in children and adolescents between 4 and 18 years of age. A search of five electronic databases (ProQuest, Scopus, Ovid, CINAHL, and Embase) was conducted, including backward (identifying and reviewing references from earlier studies from sources) and forward searching (reviewing newer studies that have cited a source). Only primary research including OMT with post-treatment outcome measures for speech production were included. Thirteen studies were reviewed, including a total of 397 participants between 4 and 17 years of age. A range of study designs, diagnoses, and intervention approaches were discussed. Studies yielded mixed results on the effectiveness of OMT to treat organic SSDs. OMT alone, and in combination with articulation therapy, was not found to be more effective than articulation therapy alone. The methodological quality of the studies ranged from limited to strong. Findings from high quality studies showed no improvement to speech that could be directly attributed to OMT, and lower quality studies yielded mixed results. This review found no conclusive evidence supporting the use of OMT as a standalone treatment for the effective remediation of SSDs. This is attributed to significant variability in speech outcomes, small sample sizes, limited comparison groups, diverse participant diagnoses, and inconsistent methodologies and treatment protocols, yielding mixed results. In addition, while the term OMT was used in the papers to designate treatment methodology, an analysis of the exercise descriptions revealed that some reported OMT exercises were non-speech oral motor exercises (NSOMEs) and oral motor therapies. Overall, many of the techniques utilized across studies did not provide speech-like movements in their therapeutic interventions based on their description. Finally, traditional articulation therapy, including speech drills to work on articulation disorders, was not included in many of the included studies. SLPs using OMT as a modality would typically combine this with articulation practice to treat the SSD. This study highlights the need for robust future studies including prospective cohort studies to compare OMT, combined OMT and articulation therapy, and articulation therapy alone to provide clearer guidance for future clinical practice. Full article

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16 pages, 470 KB

Open AccessArticle

Pre- and Post-Operative Care Protocol for Infants with Tongue-Tie: Clinical and Caregiver Perspectives

by Thea Cook, Elliana Nolan, Raymond J. Tseng and Sharon Smart

Int. J. Orofac. Myol. Myofunct. Ther. 2025, 51(1), 3; https://doi.org/10.3390/ijom51010003 - 27 Feb 2025

Abstract

Purpose: Ankyloglossia or tongue-tie (TT) occurs when the lingual frenulum is visually altered and accompanied by restricted tongue mobility causing feeding and other difficulties for infants. Pre- and post-operative stimulation techniques are known to be effective in preventing tissue reattachment and ensuring [...] Read more.

Purpose: Ankyloglossia or tongue-tie (TT) occurs when the lingual frenulum is visually altered and accompanied by restricted tongue mobility causing feeding and other difficulties for infants. Pre- and post-operative stimulation techniques are known to be effective in preventing tissue reattachment and ensuring feeding success. The aim of this study was to gather feedback from parents and health professionals for an experimental evidence-based pre- and post-operative care protocol for breastfeeding infants undergoing surgical management for TT. Methods: A qualitative approach was used to evaluate an experimental pre- and post-operative care protocol for infants with TT, through virtual semi-structured interviews with clinicians and parents of children with TT. Five parents and eight current practicing clinicians were interviewed to obtain feedback on the protocol in development. The results were analyzed using thematic analysis. Results: Four themes were generated from participants: (1) parental confidence and competence, (2) the need for individualized and adaptable instruction; (3) supporting the parent and infant equally; and (4) regular and periodic support and adjustment to protocol. Conclusions: The findings from the qualitative interviews highlighted the importance of fostering parental confidence and education, adaptability and flexibility in care, and clinician reassurance throughout the process. The participants suggested these factors would contribute to greater adherence to care protocols and improved outcomes for both infants and their families. This research emphasizes the importance of providing care that extends beyond logistics of oral stimulation techniques and instead recommends a mindful, family-centered approach that empowers and motivates families throughout the process. Full article

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2 pages, 208 KB

Open AccessEditorial

Advancing Research in Orofacial Myology and Myofunctional Therapy with a New Publishing Partnership

by Nancy Pearl Solomon

Int. J. Orofac. Myol. Myofunct. Ther. 2025, 51(1), 2; https://doi.org/10.3390/ijom51010002 - 15 Jan 2025

Abstract

The International Journal of Orofacial Myology and Myofunctional Therapy (IJOM), the official journal of the International Association of Orofacial Myology (IAOM), has just celebrated its 50th continuous year of publication [...] Full article

1 pages, 233 KB

Open AccessEditorial

Publisher’s Note: A New Chapter for the International Journal of Orofacial Myology and Myofunctional Therapy (IJOM)—Continued Publication by MDPI

by Clàudia Aunós

Int. J. Orofac. Myol. Myofunct. Ther. 2025, 51(1), 1; https://doi.org/10.3390/ijom51010001 - 15 Jan 2025

Abstract

The International Journal of Orofacial Myology and Myofunctional Therapy (IJOM) has been an important part of the orofacial myology field since its establishment in 1975 [...] Full article

2 pages, 243 KB

Open AccessEditorial

Capturing a Moment in an Evolving Landscape: Contemporary Management of Ankyloglossia

by Raymond J. Tseng and Sharon Smart

Int. J. Orofac. Myol. Myofunct. Ther. 2024, 50(2), 1-2; https://doi.org/10.52010/ijom.2024.50.2.7 - 1 Dec 2024

Abstract

This special issue on ‘Contemporary Approaches to Collaborative Management in Ankyloglossia’ contains a collection of scholarly papers that address the assessment, diagnosis, treatment, and follow-up care of tethered oral tissues (TOTs). In this column, the editors summarize the content of the issue and [...] Read more.

This special issue on ‘Contemporary Approaches to Collaborative Management in Ankyloglossia’ contains a collection of scholarly papers that address the assessment, diagnosis, treatment, and follow-up care of tethered oral tissues (TOTs). In this column, the editors summarize the content of the issue and reflect upon its relevance at the current time in the evolution of research and clinical care of TOTs. Full article

20 pages, 1668 KB

Open AccessReview

Gastrointestinal Symptom Improvement in Infants After Restrictive Tethered Oral Tissue Release: A Systematic Review and Meta Analysis

by Humera Khatri, Iqbal Musani, Prashant Udavant and Tushar Parikh

Int. J. Orofac. Myol. Myofunct. Ther. 2024, 50(2), 1-20; https://doi.org/10.52010/ijom.2024.50.2.6 - 1 Dec 2024

Abstract

Purpose: The purpose of this systematic review was to systematically explore improvements in gastrointestinal symptoms 1 week and 1 month following the frenotomy procedure, compared to before the procedure for infants under 12 months of age using meta-analysis calculations. Methods: Studies were selected [...] Read more.

Purpose: The purpose of this systematic review was to systematically explore improvements in gastrointestinal symptoms 1 week and 1 month following the frenotomy procedure, compared to before the procedure for infants under 12 months of age using meta-analysis calculations. Methods: Studies were selected that presented data on breastfed infants under 12 months of age, with gastrointestinal symptoms and reflux, who underwent surgical correction for restricted maxillary labial frenum and/or ankyloglossia, and/or maxillary buccal frena. Case reports, letters to editors, previous systematic reviews, in vitro and animal studies, and only abstracts were excluded. An integrative literature review was carried out in MEDLINE via PubMed, EBSCOhost, Scopus Embase, Web of Science & Cochrane Library from April 2016 to March 2023. Risk of bias was evaluated using the Modified Newcastle‐Ottawa Scale. GRADE profiler (GRADEpro) was used to rate the quality of evidence. We conducted meta-analysis using random effects modelling with the RevMan Software 5.4. Results: Out of the 90 studies identified, nine studies were included, seven were prospective cohort studies, one was a prospective randomized trial, and one was a retrospective analysis. Gastroesophageal reflux symptoms showed statistically significant improvement in I-GERQ-R scores after 1 week (effect size = 3.40, p < 0.00001) and 1 month (effect size = 6.37, p < 0.00001) as compared to before release. Kotlow Class 3 and Class 4 lip tie, Coryllos Type 3 and Type 4 tongue tie showed maximum symptoms and the greatest improvement after release. Conclusion: Tethered oral tissues should be considered as a potential etiology in the differential diagnosis of gastrointestinal reflux in infants. Full article

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17 pages, 1181 KB

Open AccessConference Report

Proceedings of the 2024 IAOM Convention

by IAOM

Int. J. Orofac. Myol. Myofunct. Ther. 2024, 50(1), 1-11; https://doi.org/10.52010/ijom.2024.50.1.4 - 30 Oct 2024

Abstract

The International Association of Orofacial Myology (IAOM) held its 2024 Convention in Raleigh, North Carolina, from September 27–29. The Proceedings of the Convention contain abstracts and summaries of each presentation. Full article

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11 pages, 805 KB

Open AccessArticle

Feeding and Gastrointestinal Symptomatology: Comparing Infants Without Oral Restriction to Those with Treated and Untreated Tethered Oral Tissues

by Rebecca R. Hill

Int. J. Orofac. Myol. Myofunct. Ther. 2024, 50(2), 1-11; https://doi.org/10.52010/ijom.2024.50.2.5 - 10 Oct 2024

Abstract

Objectives: The aims of this study were to (1) evaluate if there were any significant differences in gastrointestinal (GI) and/or feeding symptoms for infants with tethered oral tissues (TOTs) pre-frenotomy compared to infants with untreated TOTs and infants without TOTs, and (2) evaluate [...] Read more.

Objectives: The aims of this study were to (1) evaluate if there were any significant differences in gastrointestinal (GI) and/or feeding symptoms for infants with tethered oral tissues (TOTs) pre-frenotomy compared to infants with untreated TOTs and infants without TOTs, and (2) evaluate if treatment via frenotomy led to improvements in symptoms that more closely align with GI and/or feeding symptoms in infants with untreated TOTs and/or infants without (TOTs). Methods: This study utilized a pretest-only control group design. The Infant Eating Assessment Tool (InfantEAT) and Gastrointestinal and Gastroesophageal Reflux (GIGER) Scale were used to evaluate infant feeding and GI symptoms, respectively. Multiple linear regression was used to compare scores between the three groups at baseline, controlling for age and gestational age at birth. Treatment group’s average score after intervention was compared to the mean baseline score of the other two groups. For the treatment group, paired t-test was used to evaluate changes in scores before and after the treatment. Results: All subscales of both the InfantEAT and GIGER demonstrated statistically significant differences for infants with TOTs before intervention when compared with infants with TOTs who did not undergo treatment and infants without TOTs. Conclusion: This study demonstrates the importance of considering structure along with function for infants with tongue- and/or lip-tie. Clinicians must evaluate maternal symptoms alongside infant factors. The decision to treat TOTs via frenotomy is multifactorial and is not necessary in every mother-infant dyad. Full article

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17 pages, 952 KB

Open AccessArticle

Global Perspectives on Tongue-Tie Assessment of One to Ten Year-Old Children in Speech-Language Pathology

by Sharon Smart, Zoe Whitfield and Mary Claessen

Int. J. Orofac. Myol. Myofunct. Ther. 2024, 50(2), 1-17; https://doi.org/10.52010/ijom.2024.50.2.4 - 30 Sep 2024

Abstract

Purpose: Speech-language pathologists (SLPs) are essential in evaluating tongue structure and function. Due to limited psychometrically validated assessment tools, evidence-based practitioners often rely on clinical expertise to inform their assessment and clinical decision-making. This study aimed to explore how SLPs assess tongue structure [...] Read more.

Purpose: Speech-language pathologists (SLPs) are essential in evaluating tongue structure and function. Due to limited psychometrically validated assessment tools, evidence-based practitioners often rely on clinical expertise to inform their assessment and clinical decision-making. This study aimed to explore how SLPs assess tongue structure and function in children aged 1 to 10 years suspected of having a tongue-tie by examining global practice patterns. Methods: A total of 194 practicing, English-speaking SLPs participated in a global online survey. The survey gathered information on participant demographics, classification tools used, and methods for assessing tongue structure and function, oral motor function and speech production in children with suspected tongue-tie. Results: Participants reported using various measures, including case history, oral examination, and clinical assessment. These measures encompassed evaluation of tongue structure, oral motor tasks and functional measures, including observation of speech, feeding, and swallowing. Notably, 40% of participants indicated they did not use any published assessment tool. While over 90% of participants evaluated feeding skills through parent questionnaires, only 55% observed feeding during mealtimes. Additionally, SLPs in the United States reported using different classification tools for tongue-tie compared to their counterparts in Australia, the United Kingdom and other countries. Conclusion: There is a global trend of limited use of published tongue-tie assessment tools in clinical practice. Most clinicians rely on various measures to evaluate tongue structure and function in children with suspected tongue-tie. These findings highlight the need for a specialized assessment tool that is designed and validated for evaluating tongue structure and function in children beyond infancy. Full article

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11 pages, 1278 KB

Open AccessArticle

Tongue Strength and Swallowing-Related Masseter Activity and Oropharyngeal Timing Across the Lifespan

by Alicia Martin-Cowger, Dianna Evers, Christy Osterhout, Katie Small, Shelly Ashbocker, Eric Astel, Rebecca Burke, Natalie Dahl, Rebecca Fish, Jeanette Fountain, Sandra Frickey, Elizabeth Holbrook, Carmen Ives, Cassie Dallaserra, Leigha Juravich, Savannah Leckington, Ashley Purser, Heather Randolph, Catherine Reed, David Ross, Kristine Sedlezky, Chad Seibold, Erin Sholes, Amanda Sisneros, Blake Tanner, Casey Ulrich, Joni Grey Loftin and Anthony Seikel Show full author list Hide full author list

Int. J. Orofac. Myol. Myofunct. Ther. 2024, 50(1), 1-36; https://doi.org/10.52010/ijom.2024.50.1.3 - 28 Aug 2024

Abstract

Purpose: This study examined lifespan changes in maximum tongue strength, swallowing time, and masseter activity during swallowing. It provides normative data with which to compare clinical assessments of orofacial myofunctional disorders (OMD) and oropharyngeal dysphagia (OPD). Method: 409 healthy participants without identified OMD [...] Read more.

Purpose: This study examined lifespan changes in maximum tongue strength, swallowing time, and masseter activity during swallowing. It provides normative data with which to compare clinical assessments of orofacial myofunctional disorders (OMD) and oropharyngeal dysphagia (OPD). Method: 409 healthy participants without identified OMD or OPD (ages 5–79 years) provided instrumental measures of tongue strength and electromyographic measurements for oropharyngeal transit time and masseter activity during swallows of four boluses. Participants were placed in three broad age groups (5–15, 16–59, 60–79) for cross-sectional analysis. Results: Differences were found between age groups for tongue strength, such that the youngest group had significantly lower anterior tongue strength than the other groups, and lower posterior tongue strength than the 16–59 age group. Anterior tongue strength was significantly greater for males than females; posterior tongue strength did not differ significantly between the sexes. The youngest group had longer oropharyngeal transit times than either of the two older groups for most boluses. Swallowing transit time decreased in duration across the age groups, from youngest to oldest, for the 2.5 cc pudding bolus. Both right and left masseters differed in activation among tasks and age groups. The oldest age group had consistently greater levels of activation of the right masseter, and all groups had greater activation for the cracker bolus. Spearman rank-order correlations largely confirmed the inferential statistics and provided evidence of a relationship between tongue weakness and increased oropharyngeal transit time. Conclusion: Maximum tongue pressure generation and oropharyngeal timing measures support a developmental hypothesis, with lower tongue strength and longer swallowing transit times for children ages 5 through 15. The smaller pudding bolus provided the greatest differentiation among the age groups, which may prove to be a functional indicator for clinical evaluation. These results are largely consistent with existing data for tongue strength and oropharyngeal swallowing transit times. Full article

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11 pages, 875 KB

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International Consortium of Oral Ankylofrenula Professionals (ICAP) Practice Guidelines for Ankylofrenula Management

by Sharon Smart, Andrea Kittrell, Robyn Merkel-Walsh and Raymond J. Tseng

Int. J. Orofac. Myol. Myofunct. Ther. 2024, 50(2), 1-11; https://doi.org/10.52010/ijom.2024.50.2.3 - 27 Aug 2024

Cited by 2

Abstract

This document contains Practice Guidelines developed by the International Consortium of oral Ankylofrenula Professionals (ICAP) Consensus Committee and accepted by the Board of Directors to delineate the roles and responsibilities of healthcare professionals involved in caring for individuals with ankylofrenula. These Practice Guidelines [...] Read more.

This document contains Practice Guidelines developed by the International Consortium of oral Ankylofrenula Professionals (ICAP) Consensus Committee and accepted by the Board of Directors to delineate the roles and responsibilities of healthcare professionals involved in caring for individuals with ankylofrenula. These Practice Guidelines apply to practitioners serving individuals across all age groups, from infants to adults. It aims to standardize healthcare practices concerning ankylofrenula definition, diagnosis, assessment, and management. The purpose of these Practice Guidelines is twofold: firstly, to communicate ICAP’s stance on the standardization of healthcare practices for health professionals engaging with patients and families affected by ankylofrenula. Secondly, it serves as an educational resource and advocacy tool for ICAP in interactions with external stakeholders, such as multidisciplinary team members, healthcare management, government bodies, researchers, funding agencies, patients, caregivers, and their families. Full article

13 pages, 1121 KB

Open AccessPerspective

Clinical Perspectives on Post-Operative Care for Tethered Oral Tissues (TOTs)

by Robyn Merkel-Walsh and Lori L. Overland

Int. J. Orofac. Myol. Myofunct. Ther. 2024, 50(2), 1-13; https://doi.org/10.52010/ijom.2024.50.2.2 - 6 Jul 2024

Cited by 2

Abstract

Introduction: Post-operative frenectomy care is often focused on active wound management (AWM) and followed by neuromuscular re-education (NMR). The standard practices of AWM are varied amongst providers. AWM is often expected to be performed by caregivers who have little to no experience with [...] Read more.

Introduction: Post-operative frenectomy care is often focused on active wound management (AWM) and followed by neuromuscular re-education (NMR). The standard practices of AWM are varied amongst providers. AWM is often expected to be performed by caregivers who have little to no experience with AWM. In contrast, NMR is individualized to patient needs and has been emerging in external evidence as a beneficial modality for the functional implications of tethered oral tissues (TOTs). It is guided by licensed professionals but is not often accessible or recommended. New Perspective: AWM and NMR often are similar in execution but differ in goals. AWM is focused on wound debridement and avoiding scarring or reattachment of the frena, whereas NMR is focused on airway, sleep, feeding, swallowing, speech, and optimal orofacial growth. AWM has little consensus or external evidence compared to NMR which has both internal and external evidence. AWM for oral care is also limited by scope of practice (SOP) which few licensed professionals have. NMR has a broader range of professionals such as International Board-Certified Lactation Consultants (IBCLCs), speech-language pathologists (SLPs), physical and occupational therapists (PT/OT) and registered dental hygienists (RDHs). Conclusions: NMR has multiple benefits post-operatively, is individualized and performed by multiple professionals. It is suggested that release providers consider gentle, functionally directed post-operative NMR techniques that are individualized, and research the impact these approaches have on wound care goals. Full article

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International Journal of Orofacial Myology and Myofunctional Therapy

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