International Journal of Orofacial Myology and Myofunctional Therapy

Lingual frenotomy is commonly evaluated by release location, wound appearance, or general improvement in tongue mobility; however, an objective measurement-based framework for guiding surgical completeness has not been established. The purpose of this retrospective cohort study was to describe a standardized functional lingual frenotomy technique under general anesthesia and derive the Tool for Optimal Tongue Rest Posture (TOTRP) as a patient-specific surgical guide and intraoperative checkpoint for the attainment of optimal tongue rest posture. A total of 390 patients aged 3.0–52.2 years underwent lingual frenotomy under general anesthesia with intraoperative assessment of tongue protrusion, tongue vertical extent, and tongue resting posture before and after release. Complete passive palatal suction, defined as full-length passive tongue contact against the hard palate, was used as the clinical endpoint of optimal tongue rest posture. Hard palate length was available for 192 patients and served as the patient-specific anatomic reference for TOTRP derivation. Two candidate formulations were evaluated: post-release tongue vertical extent relative to hard palate length, and post-release tongue protrusion relative to hard palate length. All patients demonstrated a non-palatal tongue resting posture before release and complete passive palatal suction after release, regardless of palatal morphology. The vertical extent-based TOTRP constant demonstrated a mean value of 24.20 mm (SD, 4.94), with a 5th percentile lower-bound threshold of 17 mm (bootstrap 95% CI, 16.66–17.34). In contrast, the protrusion-based formulation demonstrated greater variability and less stable lower-bound estimates. The resulting TOTRP formula was defined as measured hard palate length plus 17 mm, representing the minimum post-release tongue vertical extent associated with confirmed complete passive palatal suction in this cohort. Age-stratified analysis demonstrated increasing hard palate length during childhood with relative plateauing in adulthood; however, residual inter-individual variability remained within age groups, supporting direct hard palate measurement rather than age-based estimation. Awake and asleep protrusion measurements were not interchangeable, with asleep protrusion exceeding awake protrusion by a mean of 3.36 mm and wide Bland–Altman limits of agreement. The TOTRP provides a reproducible, measurement-based framework linking surgical technique, patient-specific anatomy, functional release, and post-release tongue vertical extent as an intraoperative surgical adequacy guide for attaining the mobility associated with optimal tongue rest posture under general anesthesia.

Background: Temporomandibular disorders (TMDs) are multifactorial conditions involving the joint, musculature, and associated systems. While physiotherapy commonly addresses the temporomandibular joint and cervical spine, emerging evidence suggests that dysfunction may extend to the shoulder girdle, influencing posture, muscle activity, and functional performance. Despite this, no structured framework exists to guide clinicians in assessing the shoulder girdle in individuals with TMD. Objective: To establish a clinically relevant assessment framework for the shoulder girdle in individuals with TMD using expert consensus via the Delphi method. Methods: A two-round Delphi study was conducted with an international panel of physiotherapy experts experienced in TMD management. Eleven statements relating to subjective and objective shoulder girdle assessment were evaluated using a 5-point Likert scale. Consensus thresholds were set at ≥70% for round one and ≥60% for round two. Data were analyzed using descriptive statistics. Results: Eleven experts participated in round one and nine in round two. Consensus was achieved for nine assessment components, including both subjective (pain, symptoms, injury history, and outcome measures) and objective (trigger points, muscle length, strength testing, and jaw-related influences on muscle performance) domains. Conclusion: This study presents the first known expert-derived framework for assessing the shoulder girdle in individuals with TMD. The findings support a broader, integrative clinical approach that considers regional interdependence.

The Orofacial Myofunctional Evaluation with Scores (OMES) protocol is a standardized clinical instrument developed to assess orofacial myofunctional disorders (OMD); however, diagnostic cut-off values have not previously been established for different age groups. This study aimed to strengthen the validity and psychometric evidence supporting the OMES protocol and to establish diagnostic cutoff values for OMD across different age groups. A cross-sectional observational study based on a retrospective database review was conducted with 302 participants, including children, young adults, and adults with clinical conditions associated with a high probability of OMD or healthy controls matched by age and sex. All participants were assessed using the OMES protocol. Instrument performance was examined using a known-groups approach, internal consistency analysis, and receiver operating characteristic (ROC) curve analysis. Internal consistency was high across all age groups (Cronbach’s alpha: 0.91 for children, 0.87 for young adults, and 0.84 for adults). All OMES categories and the total OMES score discriminated between individuals with and without OMD. ROC analyses demonstrated high diagnostic accuracy. The OMES protocol demonstrated strong psychometric performance and can be applied across different age groups, supporting the identification of OMD, informed clinical decision-making, therapeutic planning, and treatment outcome evaluation.