International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.3390/ijom52010005

Authors: Shubhangi Mani Rutvi Karia Sameehan Bodas Nandalal Toshniwal Sumeet Mishra

Background: Functional appliance therapy is widely employed for the management of skeletal Class II malocclusion in growing patients. However, treatment outcomes are influenced by multiple biological and behavioural variables, including genetic background, craniofacial growth pattern, neuromuscular adaptability, orofacial resting postures, and patient adherence. These factors often limit direct comparison of different appliance systems. Monozygotic twin studies provide a unique biological model by minimizing genetic and environmental variability, allowing more accurate evaluation of appliance-specific effects. Methods: This case report presents a comparative evaluation of a clear functional jaw corrector and a conventional twin block appliance in two 11-year-old female monozygotic twins at cervical vertebral maturation index stage 3. Both patients exhibited similar skeletal Class II patterns, vertical growth tendencies, proclined maxillary incisors, and convex soft tissue profiles. Twin A was treated with a removable clear functional jaw corrector fabricated using mandibular advancement blocks incorporated into a 1.5-mm Essix retainer sheet, while Twin B received a conventional twin block appliance. Treatment objectives, wear protocol, and duration were identical. Neither patient received orofacial myofunctional therapy. Results: Post-treatment clinical and cephalometric evaluation demonstrated improvement in sagittal jaw relationships, facial profile, and occlusal relationships in both patients. However, differences were observed in the magnitude of skeletal correction, dentoalveolar effects, vertical control, and the extent of molar and canine relationship correction. Conclusions: Both appliance designs were effective in improving sagittal relationships under similar biological conditions, with minor differences favoring the clear functional jaw corrector. However, the findings also highlight that orthodontic appliance therapy alone does not address underlying orofacial myofunctional factors, emphasizing the importance of incorporating functional assessment and adjunctive myofunctional therapy for optimal and stable outcomes.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.3390/ijom52010004

Authors: Rosalba Courtney

Background/Objectives: Breathing efficiency and stability depend on the integrated function of biochemical, biomechanical, and psychophysiological processes across the unified upper and lower airway. Clinical interventions often address these domains in isolation, which may limit treatment outcomes. The primary objective of this article is to present Integrative Breathing Therapy (IBT) as a clinically applicable, multidimensional framework for training unified airway function. A secondary objective is to illustrate how this framework can inform clinical reasoning in orofacial myology and behavioural management of obstructive sleep apnea. Method: This article presents a clinical synthesis of physiological theory, neuroplasticity research, and applied breathing therapy to describe the theoretical and clinical foundations underpinning the Integrative Breathing Therapy (IBT) framework. Multidimensional phenotyping is used to organise dominant biochemical, biomechanical, and psychophysiological contributors to breathing inefficiency, with obstructive sleep apnea presented as a clinical example. Results: This synthesis outlines a unified airway model linking multidimensional phenotyping to targeted intervention selection. The IBT framework provides a structured approach for integrating biomechanical coordination, ventilatory control, and psychophysiological regulation within clinical practice. The obstructive sleep apnea exemplar demonstrates how phenotype-informed mapping can support clinical reasoning and guide individualised intervention strategies within OM and related behavioural approaches. Conclusions: Integrative Breathing Therapy offers a clinically grounded, multidimensional model for functional breathing optimisation that aligns unified airway training with principles of neural adaptation and systems-based clinical reasoning. This framework supports phenotype-guided clinical decision-making and provides a coherent structure for addressing breathing inefficiency and airway instability across a range of clinical populations, including those treated with orofacial myology and behavioural OSA therapies.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.3390/ijom52010003

Authors: Audrey Yoon Shifa Shamsudeen Richard Baxter Caroline Hu Leyli Norouz-Knutsen Reuben Kim Lesley McGovern Kupiec Soroush Zaghi

Background/Objectives: The labial frenum is a variable oral structure with potential impacts on infant feeding, speech development, periodontal health, and aesthetics. Several classification systems have been established, but the age-related natural history and its relationship with midline diastema remain incompletely defined. This study aimed to systematically evaluate age-related changes in maxillary and mandibular labial frenum morphology and tension, and their association with midline diastema across pediatric age groups. Methods: A cross-sectional study was conducted on 1068 patients (ages 1 day–47 years) presenting for routine dental examinations at two pediatric dental clinics. Frenum morphology was classified as mucosal, gingival, papillary, or papillary-penetrating. Palpable tension was assessed by manual lip pulling and recorded as present or absent. Midline diastema was defined as ≥1 mm spacing between the maxillary central incisors, measured at the incisal midline with a periodontal probe. Data were analyzed using Pearson’s chi-square tests with Bonferroni correction for multiple comparisons, and logistic regression was applied to evaluate independent predictors. Inter-examiner agreement was assessed using Cohen’s κ. Results: Among 1068 participants, maxillary frenum morphology varied significantly by age. In children < 3 years, papillary and papillary-penetrating insertions predominated (65.7%), while gingival and mucosal insertions were more frequent in older children and adults (72.8%). Palpable tension declined sharply with age, from 92.5% in infants to <10% in adults. Midline diastema was significantly associated with papillary-penetrating frena (RR = 3.47, 95% CI 2.45–4.91) and with the presence of tension (RR = 1.68, 95% CI 1.34–2.11). Logistic regression confirmed both phenotype (OR = 6.2, 95% CI 3.8–10.1) and tension (OR = 2.1, 95% CI 1.5–2.9) as independent predictors of diastema. In contrast, mandibular frena showed minimal variation by age and limited functional impact. Conclusions: The maxillary labial frenum demonstrates predictable developmental change, migrating apically and losing tension most prominently between 3 and 6 years of age, while the mandibular frenum remains largely stable. Papillary and papillary-penetrating phenotypes with palpable tension carry the greatest risk of midline diastema. These findings emphasize that management should prioritize functional symptoms and growth trajectory rather than appearance alone, with frenectomy reserved for cases of demonstrable impairment.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.3390/ijom52010002

Authors: Siddharth Sonwane Shweta Sonwane

Background/Objectives: Obstructive sleep apnea (OSA) is a prevalent sleep-related breathing disorder characterized by repeated episodes of upper airway obstruction during sleep, leading to intermittent hypoxia and fragmented sleep architecture. Orofacial myofunctional therapy (OMT) has emerged as a promising non-invasive approach to improving airway patency in individuals with mild-to-moderate OSA. However, the role of sleep ergonomics—including sleep posture and pillow support—in enhancing OMT outcomes remains underexplored. This study aimed to evaluate whether ergonomic interventions could augment the therapeutic effects of OMT in adult patients with mild-to-moderate OSA. Methods: A 12-week prospective cohort study was conducted involving 60 adult participants diagnosed with mild-to-moderate OSA. All participants underwent a structured orofacial myofunctional therapy (OMT) program comprising exercises for tongue elevation, lip seal enhancement, and soft palate strengthening. In addition, ergonomic instructions were provided regarding optimal sleeping posture and pillow adjustment. Compliance with ergonomic practices was monitored weekly using infrared night-vision cameras and reviewed by a blinded sleep technician. Pre- and post-intervention assessments included apnea–hypopnea index (AHI), Pittsburgh Sleep Quality Index (PSQI), and Ep-worth Sleepiness Scale (ESS). Results: Statistically significant improvements were observed in all measured parameters following the intervention. AHI scores reduced from 18.2 ± 4.5 to 10.6 ± 3.9 events/hour (p < 0.001), PSQI scores improved from 11.3 ± 2.1 to 6.5 ± 1.8 (p < 0.001), and ESS scores declined from 13.7 ± 2.6 to 7.4 ± 2.0 (p < 0.001). Participants with high adherence to ergonomic recommendations demonstrated significantly greater clinical improvements compared to less adherent individuals. Conclusions: The combination of ergonomic sleep posture interventions with OMT was associated with positive improvements in sleep-related outcomes, comparable to or in some cases better than those reported in previous studies evaluating these interventions independently. As an observational cohort without a control arm, this study cannot establish causality but provides preliminary evidence to guide the design of future randomized clinical trials.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.3390/ijom52010001

Authors: International Association of Orofacial Myology International Association of Orofacial Myology

The International Association of Orofacial Myology (IAOM) held its 2025 Convention in Salt Lake City, UT, USA, from 26 to 28 September with the theme “Summit for Elevated Myofunctional Health.” The Proceedings of the Convention contain abstracts and summaries of each presentation. Podium presentations were available in person and virtually, and poster presentations were posted online.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.3390/ijom51020014

Authors: Elias Ghosein Marilyne El Khoury Georgio El Chamy Mona Nahas Gholmieh

(1) Background/Objectives: Obstructive Sleep Apnea (OSA) in childhood is a significant health concern with potential adverse effects on daytime function, behavior, education, and overall development. Early intervention is crucial to ease these consequences. Myofunctional therapy (MT) has emerged as a treatment modality, particularly in young children, to address OSA. This highlights the importance of early detection and intervention by pediatric dentists and other healthcare providers who frequently interact with the pediatric oral and facial structures. This study aimed to investigate the knowledge, attitudes, and practices of Lebanese pediatric dentists regarding pediatric OSA and MT. (2) Methods: A cross-sectional survey was distributed to 103 Lebanese Pediatric dentists registered with the Lebanese Society of Pediatric Dentistry (LSPD). The survey assessed familiarity with OSA, diagnostic practices, treatment approaches, and utilization of MT. (3) Results: Out of 103 pediatric dentists, 62 responded (60.2%). Most respondents were familiar with OSA (86.8%). However, the number of diagnostic symptoms used varied. MT was not pediatric dentists’ primary choice in treating OSA. (4) Conclusions: Lebanese pediatric dentists demonstrate a good understanding of OSA, but there is potential for improvement in diagnostic comprehensiveness and exploration of MT as a treatment option.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.3390/ijom51020013

Authors: Mariana Pires Comune Biscuola Daniel Mendes Lobato Almiro José Machado Júnior

Background: Mouth breathing and obstructive sleep apnea (OSA) in children are interrelated conditions that can negatively impact neurocognitive development and overall quality of life. This study aimed to critically analyze the available evidence regarding the relationship between these conditions, highlighting their prevalence, clinical consequences, and therapeutic approaches. Methods: To this end, an umbrella review was conducted, including systematic reviews and meta-analyses retrieved from scientific databases, following rigorous inclusion criteria. Results: A total of six systematic reviews met the inclusion and exclusion criteria and were included in the final analysis. These studies explored various aspects of the topic and underwent a thorough assessment of methodological quality. Conclusions: The findings indicated that mouth breathing may act as both a predisposing and aggravating factor for OSA, while OSA itself may contribute to the persistence of this breathing pattern. However, the methodological heterogeneity among the included studies posed a challenge to synthesizing the findings, underscoring the need for more standardized research. It is concluded that early interventions and multidisciplinary approaches are essential for the effective management of these conditions. Furthermore, this review provides a foundation for future research in this area.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.3390/ijom51020012

Authors: Robert M. Mason

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International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.3390/ijom51020011

Authors: 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 Leyli Norouz-Knutsen

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.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.3390/ijom51020010

Authors: Pedro Contreras Salinas Felipe Inostroza-Allende Cristóbal Caviedes-Ulloa Patricio Soto-Fernández Giédre Berretin-Felix

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.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.3390/ijom51020009

Authors: 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 Carlos O'Connor-Reina

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.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.3390/ijom51020008

Authors: 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 Triin Jagomägi

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.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.3390/ijom51020007

Authors: Sharon Smart Julia Dekenah Ashleigh Joel Holly Newman Kelly Milner

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.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.3390/ijom51020006

Authors: Diana Dobran Hansen Unn Tinbod Xin Feng Toril Dammen Harald Hrubos-Strøm Helge Skirbekk

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.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.3390/ijom51010005

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

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.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.3390/ijom51010004

Authors: Robyn Merkel-Walsh Danielle Carey Ashika Burnside Danyelle Grime Denim Turkich Raymond J. Tseng Sharon Smart

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.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.3390/ijom51010003

Authors: Thea Cook Elliana Nolan Raymond J. Tseng Sharon Smart

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.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.3390/ijom51010002

Authors: Nancy Pearl Solomon

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 [...]

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.3390/ijom51010001

Authors: Clàudia Aunós

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 [...]

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2024.50.2.7

Authors: Raymond Tseng Sharon Smart

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.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2024.50.2.6

Authors: Humera Khatri Iqbal Musani Prashant Udavant Tushar Parikh

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.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2024.50.1.4

Authors: IAOM

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.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2024.50.2.5

Authors: Rebecca Hill

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.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2024.50.2.4

Authors: Sharon Smart Zoe Whitfield Mary Claessen

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.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2024.50.1.3

Authors: 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 Loftin Anthony Seikel

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.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2024.50.2.3

Authors: Sharon Smart Andrea Kittrell Robyn Merkel-Walsh Raymond Tseng

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.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2024.50.2.2

Authors: Robyn Merkel-Walsh Lori Overland

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.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2024.50.1.2

Authors: Donny Mandrawa Mary Bourke Ignatius Bourke

Background: Achondroplasia is a genetic condition that results in several orofacial and physical manifestations that predispose patients to dental, breathing, and sleep issues. Case Description: This report details the case of a 2-year-old girl with achondroplasia, malocclusion, speech and breathing dysfunction, and obstructive sleep apnea (OSA). Treatment involved using a myofunctional device that required chewing twice per day, two simple tongue exercises, speech-language therapy, chiropractic therapy, and continuous positive airway pressure (CPAP) for 24 months. Throughout the treatment period, the patient demonstrated significant improvements in her sleep, breathing, dental occlusion, speech, and overall confidence. Conclusion: This case report highlights how pediatric patients with achondroplasia can improve their OSA symptoms and health with conservative myofunctional therapy interventions.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2024.50.2.1

Authors: International Association of Orofacial Myology

The International Consortium of Ankylofrenula Professionals (ICAP) held its 2024 Conference in Cleveland, Ohio, themed "Collaboration Rocks," from May 2 to 4, 2024. The Conference Proceedings includes abstracts and summaries of plenary, concurrent, and poster presentations.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2024.50.1.1

Authors: Heuiwon Han Mina Jawadi

Purpose: Orofacial myofunctional therapy (OMT) addresses various dental issues and has evolved significantly since its emergence in the early 20th century. Despite its uses and effectiveness, the adoption of OMT among dental practitioners varies with a lack of comprehensive understanding in the field. This scoping review will aim to map the current evidence on OMT in dentistry, with a focus on the perspectives and attitudes of dental practitioners, as well as the barriers to and facilitators of its implementation in clinical practice. Method: The planned scoping review adheres to the JBI methodology for scoping reviews guide, with data sourced from five databases, including MEDLINE, CINAHL, Scopus, Dentistry & Oral Science Source, and Cochrane Library. Inclusion criteria encompass dental practitioners' experiences with OMT, using the PCC mnemonic. Titles and abstracts will be screened by two independent reviewers, followed by full-texts, to identify relevant primary sources. The review will include primary studies of quantitative, qualitative, and mixed-methods nature, and is limited to English-language publications. Data will be extracted by two independent reviewers and combined. The extracted data will be analyzed and displayed in a tabulated format, supplemented with a descriptive summary. Conclusion: This scoping review will provide an understanding of the role of OMT in managing orofacial myofunctional disorders and other dental conditions. It seeks to identify barriers and facilitators in implementing OMT, aiming to guide strategies that encourage its adoption in dental practice. The findings are expected to contribute to integrating OMT into standard dental care as appropriate according to local regulations, enhancing the management of dental conditions and improving overall oral health outcomes.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2023.49.1.3

Authors: Nancy Solomon

In these times of quickly proliferating journals with potentially unscrupulous publishing practices, it is more important than ever to be confident that the journals you rely on for scholarly content and for your own publication needs are legitimate. We are proud to report that the IJOM was thoroughly reviewed by the Committee on Publication Ethics and has been accepted for membership, verifying that the journal maintains a commitment to research and a high level of publication integrity.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2023.49.1.4

Authors: International Association of Orofacial Myology

The International Association of Orofacial Myology (IAOM) held its 2023 Convention in Chandler, Arizona from October 13–15. The Proceedings of the Convention contain abstracts and summaries of podium and poster presentations.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2023.49.1.2

Authors: Hollie-Ann Shortland Gwendalyn Webb Anne Vertigan Sally Hewat

Purpose: Poor oral health is a known predictor of aspiration pneumonia in vulnerable populations such as the elderly and chronically ill. This study examined the feasibility of using myofunctional devices during a 5-week intervention for the management of oral care and dysphagia for residents in a residential aged-care facility. Method: Feasibility was determined through evaluation of study recruitment and retention rates, adherence to intervention, and resident and staff acceptability of the intervention. Thirteen residents, ages 74–99, participated in the intervention and 10 care staff completed feedback on post-intervention questionnaires. Results: Enrolment and retention rates were 61.9% and 92.3%, respectively. Adherence rates for use of the device were 92.6% at 3 weeks, and 89.3% at 5 weeks for the 12 participants who completed the protocol. The device was considered acceptable for ease of use, comfort, and amount of support required. Conclusion: Results indicate that further research exploring device use in an aged care population for the management of dysphagia and oral hygiene is feasible.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2023.49.1.1

Authors: Isabella Summersgill Gloria Nguyen Cullen Grey Leyli Norouz-Knutsen Robyn Merkel-Walsh Christine Katzenmeir Benjamin Rafii Soroush Zaghi

Introduction: Muscle tension dysphonia (MTD) describes a condition affecting the feeling or quality of the voice due to increased muscle tension in and/or around the neck and larynx. Ankyloglossia is a condition of restricted tongue mobility that has been shown to be associated with increased muscle tension. This case series explores outcomes for voice users with MTD who have been treated for ankyloglossia. Methods: Twelve professional or recreational voice users diagnosed with ankyloglossia were surveyed on their symptoms of MTD before and after treatment with lingual frenuloplasty and pre- and post-operative orofacial myofunctional therapy (OMT), a multidisciplinary approach known as functional frenuloplasty. Two investigators independently compiled a list of themes reported by participants and agreed upon common themes. Results: Eleven out of twelve patients (91.6%) reported clinical improvement in the use of their voice after functional frenuloplasty; one patient reported no change. Five primary themes were noted: improved voice quality, improved ease of singing and/or speaking, increased stamina, increased pitch range, and improved breath support. Discussion: OMT with lingual frenuloplasty can be an effective adjunctive intervention for treatment of symptoms of vocal tension and fatigue for singers and professional speakers with ankyloglossia. These findings suggest a possible association between MTD and restricted tongue mobility presumably due to underlying myofascial tension.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2023.49.2.1

Authors: Eduardo Correa Carlos O'Connor-Reina Laura Rodriguez-Alcalá Diego Conti Alberto Rabino Peter Baptista Maria-Teresa Garcia-Iriarte Guillermo Plaza

Purpose: This article presents a narrative review of current recommendations for the clinical evaluation and management of adult patients with obstructive sleep apnea (OSA) to identify points missing from a myofunctional perspective. Methods: The authors reviewed current official guidelines for adult patients with OSA, searching clinical evaluation and treatment recommendations for myofunctional therapy. Results: None of the current guidelines for evaluation of adult OSA recommend performing a myofunctional evaluation. Only two guidelines consider myofunctional therapy (MFT) as a treatment modality for adult patients with OSA. Conclusion: Despite the role of the pharyngeal dilator muscles as an essential contributor to the pathogenesis of OSA, this review has shown that myofunctional assessment is still not a standard recommendation in current guidelines for adult OSA. Recent guidelines occasionally include MFT as a therapeutic tool for OSA. To strengthen the knowledge base and evidence for including MFT treatment for adult patients with OSA, the authors encourage physicians to incorporate myofunctional evaluation into their regular clinical practice.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2022.48.1.7

Authors: Nancy Solomon

An online, open-access, no-fee model of the International Journal of Orofacial Myology and Myofunctional Therapy (IJOM) was established in December 2020 and includes all archived articles back to the journal’s origin in 1975. While aiming to increase content for the journal, the Editorial Review Board (ERB) has also been diligent about maintaining high standards for publication. This note From the Editor highlights recent publications, conference proceedings, and special issues. It also lists updates and challenges in terms of policies and practices. The IJOM remains both a traditional association-supported journal and is on the cutting edge of open-access publishing.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2022.48.1.5

Authors: International Association of Orofacial Myology

The International Association of Orofacial Myology (IAOM) held its 2022 Convention in Kansas City, Missouri from October 21−23. The Proceedings of the Convention contain abstracts and summaries of podium and poster presentations.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2022.48.1.6

Authors: International Consortium of Oral Ankylofrenula Professionals

The International Consortium of Ankylofrenula Professional (ICAP) held its 2022 Conference in Vancouver, Canada from September 1 to 4, 2022, titled ‘Untangling Ankylofrenula: Collaborative Approaches to Best Practice Management’. The Conference Proceedings includes abstracts and summaries of plenary, concurrent, lightning and virtual presentations.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2022.48.1.4

Authors: Flávia Puccini Marina Gatti Antônio Rodrigues Silmara Rondon-Melo Chao Wen Roberta Martinelli Giédre Berretin-Felix

Objective: This project aimed to develop and update a dynamic three-dimensional (3D) graphic video learning object demonstrating a current knowledge of the anatomy and physiology of sucking and swallowing in newborns during breastfeeding. Method: To build and update the 3D computer graphics iconographies of the “Virtual Baby”, we defined objectives for the learning object, created a literature review-based script, and organized a guide for structural (static) and functional (dynamic) graphical modeling for the designer. Results: Using 3D computer graphics, we produced a video with static images (anatomical structural) and dynamic sequences (most significant physiological and functional aspects and application of transparency to visualize the anatomical correlations between both). The video showed the anatomy and physiology of sucking and swallowing during breastfeeding. Its updates reflected additional scientific evidence as studies were published. Conclusion: Creation of the Virtual Baby provides a learning tool for visualizing the anatomy and physiology of sucking and swallowing in full-term newborns. The tool addresses the significant morphofunctional aspects of the breastfeeding process, supported by scientific literature, and can be used for student or professional training and in primary health care.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2022.48.1.3

Authors: Robyn Merkel-Walsh

The book A Trip to the Land of Funny Animals: Oral Motor and Myofunctional Exercises for Toddlers by Hilit Brown (illustrated by Karin Berenshtein) is reviewed by a Certified Orofacial Myologist®. The review lists several strengths and weaknesses of the book and concludes that it may be a useful addition to a therapist's "toolbox." Parents are cautioned to work with a speech therapist before implementing the exercises for further instruction and guidance. In addition, the activities are more appropriate for children closer to the age of 4 years rather than toddlers (ages 1–3).

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2022.48.1.2

Authors: Rosalba Courtney Roger Engel Sandra Grace Anna Potts Brooke Riordan Kaitlyn Ireland Courtney Osbourne Avinash Sukhtankar

Purpose: Nasal disuse and mouth breathing are associated with negative structural, functional, postural, occlusal, and behavioural changes. While there is some research to suggest that nasal breathing exercises can reduce mouth breathing, clinical protocols have not been extensively investigated. The purpose of this research was to determine the feasibility and effectiveness of a nasal breathing rehabilitation protocol based on Integrative Breathing Therapy principles called Functional Nasal Breathing Rehabilitation (FNBR). Methods: Twenty-three participants with symptoms of nasal obstruction and self-reported mouth breathing completed the 4-week online FNBR training. Outcome measures included the Nasal Obstruction Symptom Evaluation (NOSE) scale, a numeric rating scale (NRS) for nasal breathing difficulty and obstruction, allergy symptoms, self-reported daytime and nighttime mouth breathing, and a composite questionnaire called the Self-reported Nasal Breathing Difficulty Questionnaire (SRNBQ) to compare symptoms of nasal obstruction, allergy and reported mouth breathing pre- and post-trial. A content analysis was performed on qualitative data collected during weekly online interviews. Results: There were statistically significant improvements in the SRNBQ total score (p = 0.002), NOSE scale (p = 0.006), NRS score (p = 0.008), and mouth breathing daytime and night-time (MBDS) score (p = 0.024), but not in allergy symptoms. Participants were highly adherent with the techniques, with 91% of the participants completing formal breathing practice more than four times a week and 96% reporting that they used the practices informally in daily life mostly or all of the time. Conclusion: Functional Nasal Breathing Rehabilitation appears to be a feasible and effective modality for reducing mouth breathing and improving nasal obstruction symptoms in patients with subjective signs of nasal obstruction.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2022.48.1.1

Authors: Erin Kamarunas Sarah Szynkiewicz Lindsay Griffin Teresa Drulia Kelsey Murray

Purpose: Mental practice using motor imagery (MP) improves motor strength and coordination in the upper and lower extremities in clinical patient populations. Its effectiveness as a rehabilitation tool for patients with lingual weakness is not yet well understood, nor are the underlying mechanisms within the context of swallow or lingual MP. Using previously published data on a lingual and MP exercise program, the objective of this study was to explore how MP of lingual exercise affects cortical activation in healthy older adults over time and how neural changes correlate with functional oral pressure outcomes. Method: A prospective randomized controlled study was previously completed; older healthy participants were randomized to one of four treatment groups receiving lingual MP, lingual physical practice, a combination of both, and a sham control. This paper reports descriptive data on cortical activation during both the physical and mental forms of lingual resistance in a subgroup of 13 participants using functional near-infrared spectroscopy at baseline and after 6 weeks of the assigned exercise regimen. Results: Aggregated data indicates that participants who completed 6 weeks of lingual exercise, either in physical or in MP form, had decreased oxygenated hemoglobin when completing a maximal lingual pressure task. Conclusions: Some participants in a lingual resistance MP program demonstrated trends similar to those seen after strength training. Combining MP with physical training may lead to greater changes in oxygenation compared to a physical or mental training program alone, although given the small number of participants, it is important not to overinterpret the results. MP is a promising, innovative approach that may enhance traditional exercise-based swallowing rehabilitation.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2021.47.1.4

Authors: Samantha Washington Jayanti Ray

Background: Breathing, chewing, swallowing, sleep, and speech disorders are known to be associated with malocclusions. Assessment protocols using non-instrumental evaluation of orofacial myofunctional disorders (OMD) in adults with malocclusions are almost nonexistent. Purpose: This scoping review aimed to determine the existence of scientific evidence demonstrating the areas of non-instrumental assessment of OMD in adults with malocclusion. Another purpose was to identify the protocols for assessing the nature of orofacial myofunctional assessments in adults with malocclusion. Methods: An electronic search was performed in the databases: MEDLINE, EBSCOhost, PsycINFO, CINAHL, Cochrane Library, Health & Medical Collection, Medline, Nursing and Allied Health Database, Common Health Complete, PubMed, Consumer Health, and Health Services: Nursing/Academic Edition, for papers published between 2000 and October 2021. This exhaustive search was conducted using the key search terms: oral myofunctional disorders, orofacial myofunctional disorders, malocclusion, assessment protocols, and adults. The articles were selected for inclusion and analysis by two independent researchers. Results: The search strategy with a list of eligibility criteria resulted in the retrieval of 72 peer-reviewed studies. Only 21 were included in the article since they were related to the assessment areas of OMD due to malocclusion. Out of 21, only three articles included information on OMD assessment protocols for adults. Information on assessments from the articles was extracted and analyzed by the authors. The results of this study indicated that published oromyofunctional assessment protocols, specifically for adults with malocclusion, are limited. Conclusions: Though the availability of valid and reliable protocols is limited, OMD assessments must address various orofacial functions and draw from multiple disciplines to initiate appropriate referrals for improving the quality of life of patients with OMD.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2021.47.1.5

Authors: Charlotte Boshart

“Knowing your history can give you the tools to shape your future.” Gloria Feldt’s insightful quote inspires us to delve into the past and learn from those who came before us. This article chronicles the journey of several individuals who shaped the field of orthodontics and influenced the formation of the specialty of orofacial myology. The early years of orthodontics were challenging. In addition to the struggle to elevate the focus of orthodontics beyond mechanics, there was the challenge to convince academia to deem it worthy of post-graduate study. Dr. Edward H. Angle left his indelible mark on orthodontics and planted seeds regarding the mutual relationship of dentition with oral-facial muscles, respiration, and oral habits. In the mid-1900s, Dr. Walter J. Straub picked up the mantle. His stated quest was to identify and rectify dental relapse. His search led him to investigate allergies, oral habits, bottle feeding, and swallowing. There were others, but primarily as a result of these two men, the International Association of Orofacial Myology (IAOM) was created. Over the past 50 years, the IAOM has continued to grow, evolve, and set the gold standard for excellence in the treatment of orofacial myofunctional disorders.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2021.47.1.1

Authors: Nancy Solomon

I am honored to take on the role as Editor-in-Chief (EIC) of the International Journal of Orofacial Myology and Myofunctional Therapy (IJOM). To prepare for my role as EIC, I set two major goals to address today’s quickly evolving publication standards and the expansion and growth of the discipline of orofacial myofunctional disorders. The first was to establish an on-line submission and review process and an on-line archive for all past articles. The second critical goal was to recruit and enlist an international group of highly respected scientists and doctoral-level practitioners who represent diverse topics related to orofacial myofunctional disorders and therapy to serve on the journal’s Editorial Review Board (ERB). I am proud to introduce this new slate of ERB members.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2021.47.1.2

Authors: Christina Osen Nicola Litke Michel Wensing Aline Weis

Purpose: This study aimed to develop a concept for a mobile health application, an app-based exercise tool, to support the treatment of orofacial myofunctional disorders by speech-language therapists. Method: A sequential mixed research design combining qualitative research and user-centered software develop-ment was applied. Qualitative interviews and focus groups were conducted with eight speech-language therapists, one patient and three relatives to gather ideas for an app to support orofacial myofunctional therapy. On the basis of the findings, a paper-based prototype was developed, which was then evaluated by seven end users, to refine the concept of the app. Results: Qualitative data on desirable functionalities were clustered into topics and related subcategories contain-ing general ideas for the app—a control mechanism, a reward system, the visualization of exercises, and pop-up messages for reminders and recommendations. The paper prototype was developed that addressed these func-tionalities. Discussion: An app-based exercise tool is considered to have added value for orofacial myofunctional therapy. A prototype for a mobile application is ready for programming and subsequent testing in the treatment of orofacial myofunctional disorders by conducting additional interviews to ascertain patients’ perceptions.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2021.47.1.6

Authors: Jayanti Ray

The field of myofunctional therapy (MT) is complex, as it covers theoretical and practical information on many topics to effectively assess and treat orofacial myofunctional disorders, also known as myofunctional disorders, including tongue thrust, tongue posture, tongue-tie, orthodontic concepts, oral habits, and more. This review summarizes the strengths and usefulness of the book New Trends in Myofunctional Therapy: Occlusion, Muscles and Posture (Saccomanno & Paskay, 2020). The review informs the audience about various important features of the book, chapter materials, and the overall usefulness of the content for professionals working in MT. Providing cuttingedge information, the book draws substantive support from various interdisciplinary journal articles and clinical textbooks. Overall, the book is beneficial to leading professionals in MT as a resource for assessing and treating orofacial myofunctional disorders.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2021.47.1.8

Authors: IAOM

The International Association of Orofacial Myology (IAOM) held its 50th Anniversary Convention virtually in 2021. The Proceedings of the Convention contain abstracts and summaries of the presentations. Topics include: history of orofacial myology, mastication, palatal expansion, temporomandibular disorder, clinical research methods, tethered oral tissues, frenuloplasty, case report, nasal breathing rehabilitation, sleep disordered breathing, parasomnias, evolution and comparative zoology, reticent children, orofacial myofunctional therapy.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2021.47.1.3

Authors: Heidi VanRavenhorst-Bell Lucy Cook

Purpose: The Iowa Oral Performance Instrument (IOPI) is commonly used to measure tongue strength and endurance. The tongue, however, is reported to periodically move from its intended placement on the IOPI bulb during measurement. This study sought to determine one’s perception of tongue-to-bulb slippage with and without two anti-slip patches (Patch1 – flexible fabric, Patch2 – hypoallergenic micropore fabric) and whether measures of tongue strength and endurance differed across the three IOPI bulb conditions. Method: 40 healthy adults were randomly assigned to perform tongue strength and endurance procedures by elevating either the anterior (n = 22) or posterior (n = 18) portions of the oral tongue. Three IOPI bulb conditions (bulb alone, bulb+Patch1, bulb+Patch2) were used for tongue strength (5 trials per condition) and endurance (3 trials per condition) assessments. A survey to assess comfort level, stability, and preference followed. Results: The bulb+Patch1 was perceived to maintain placement and significantly reduce tongue-to-bulb slippage, F (2,76) = 43.557, p < 0.0001; F (2,76) = 45.451, p < 0.0001, compared to bulb alone and bulb+Patch2, respectively. Tongue strength [anterior: F (2, 42) = 1.467, p = 0.242; posterior: F (1.41, 24.004) = 0.374, p = 0.619] and endurance [anterior: F (2, 42) = 3.738, p = 0.032; posterior: F (2, 34) = 1.399, p = 0.261] did not differ across conditions. Conclusion: The findings suggest that healthy adults preferred using the bulb+Patch1 rather than a bare bulb or the bulb+Patch2 due to perceived stability of tongue-to-bulb contact. Given that lingual assessments of maximal performance did not differ across the IOPI bulb conditions, the use of a flexible fabric patch when adhered to the bulb may be helpful for positional stability without impacting testing validity.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2021.47.1.7

Authors: Amanda Chastain

The 50th Anniversary Address delivered by the President of the International Association of Orofacial Myology at the Annual IAOM Convention held online October 22–24, 2021.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2020.46.1.2

Authors: Nancy Solomon Heather Clark

Purpose: Instrumental assessments of tongue strength have provided clinicians with the ability to obtain quantitative measures to document lingual weakness. A technical challenge with a common instrument is that the surface of the of the bulb-shaped sensor is smooth and can be slippery when contacted by the tongue. This study evaluated whether adding a textured layer to the bulb leads to enhanced strength measures in neurologically normal adults. Methods: Maximum-effort maneuvers for anterior and posterior tongue elevation, right and left tongue lateralization, and tongue protrusion were available from 62 healthy adults using the Iowa Oral Performance Instrument (IOPI). The IOPI tongue bulb was either bare or covered with a single layer of gauze. The maximum pressure (Pmax) exerted on the bulb from three trials was used as the outcome variable for each task. Results: In addition to significant main effects for both bulb-cover and task, there was a significant interaction between the use of gauze and the direction of the tongue-strength maneuver. Pmax was significantly greater when a gauze-covered bulb was used for tongue lateralization and protrusion but not for tongue elevation maneuvers. Conclusion: Using a singlelayer of gauze on the smooth tongue-bulb helped reduce slippage of the tongue and resulted in greater Pmax values when evaluating tongue strength in the lateral and protrusive directions, but not for tongue elevation. Efforts to develop a more permanent solution to texturizing the bulb’s surface are needed.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2020.46.1.3

Authors: Robyn Merkel-Walsh

Purpose: The purposes of this paper are to 1) define variations in terminology and treatment methodology for orofacial myofunctional disorders (OMDs) in children 0–4 years of age and in special populations, and 2) compare and contrast service delivery models for children ages 0–4 and individuals with special needs versus older children and children who are neurotypical. Method: A literature review of scholarly articles, professional presentations, poster presentations, blogs, and social media were analyzed using three tiers of evidence-based practice to include: 1) clinical expertise/expert opinion; 2) external and internal evidence and 3) client/patient/caregiver perspectives. Results: Professional texts and publications used consistent language when discussing treatment of OMDs in young children and children with special needs. Terminology and treatment approaches for young children and/or children with special needs who present with OMDs were inconsistent in social media and professional presentations. Discussion: The treatment modalities used in orofacial myofunctional therapy to stimulate oral motor responses depend upon age and cognitive status. OMDs should certainly be treated in infants, young children and individuals with special needs according to the methods of the pediatric feeding specialist. Orofacial myofunctional therapy requires volitional control and self-monitoring; as such, it is contraindicated for infants and toddlers as well as those individuals who cannot actively engage in therapeutic techniques.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2020.46.1.5

Authors: Hope Reed

COVID-19 has forced educational institutions to increasingly rely on technology to provide appropriate clinical experiences for students. Simulations and case studies have been used for decades, but COVID-19 thrust these resources into the forefront of clinical education. Clinical simulation (CS) is the use of alternative methods in the clinical preparation of students (American- Speech-Language-Hearing Association [ASHA], 2020). Forms of CS include simulators, standardized patients, virtual patients, digital mannequins, immersive reality, task trainers, and computer-based interactive experiences and often incorporate case studies (ASHA). This article draws upon clinical education in the primary certification fields for those who practice orofacial myofunctional therapy: speech-language pathology and dentistry. It is designed to be a CS primer for these clinicians by presenting types of simulation-based learning, experiences specific to orofacial myofunctional disorders (OMDs), advantages and disadvantages, supporting evidence, best practices, and enhancement of critical thinking skills. There is a need to increase the representation of OMD-related content in CS experiences.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2020.46.1.7

Authors: Patricia Taylor

One of the unique and interesting things that happens when putting together an issue of the International Journal of Orofacial Myology (IJOM) is that often times connections between articles emerge [...]

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2020.46.1.6

Authors: Charlotte Boshart Sarah James Patricia Fisher

Purpose: Since the advent of COVID-19, online services within most healthcare fields have become ubiquitous. This article investigates the research regarding the feasibility and effectiveness of delivering online services and provides a tutorial of ideas and information to successfully implement online orofacial myofunctional therapy. Method: This article is a compilation of evidence-based results on the topic of online service delivery and perspectives and experiences shared by three service delivery providers. Results: It is possible to compensate for the interactive differences between in-person and online myofunctional therapy. It is believed that online therapeutic services are an efficient and effective mode of service delivery. Discussion: Although online service delivery is not new, the current world-wide pandemic has brought telehealth to the forefront. In a time of increased demand for distance treatment, the orofacial myologist must rapidly develop competency and comfort within the new assessment and treatment online paradigm. It is positive to know that research to date indicates that clients within associated fields benefit from the accessibility, ease, and convenience of online service delivery. This article summarizes legal considerations, technology, treatment preparation, client motivation, and the implementation of online therapy.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2020.46.1.4

Authors: Robert Mason Honor Franklin Patricia Grant Ellen Role

The purpose of this article is to explain the importance of evaluating and documenting the freeway space (interdental rest position), in initial examinations and at the completion of therapy in patients exhibiting an open mandibular resting position. The freeway space measurements obtained can be shared with parents, patients, and referral sources. To this end, the muscular, neural, and sensory components related to the freeway space are discussed, as well as airway, dental eruption patterns, tactile feedback, and orthodontic relapse considerations. An extraoral method for evaluating the dimensions of the anterior freeway space is proposed.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2020.46.1.1

Authors: Luiza Ferrer Adriana Tessitore Almiro Machado Júnior Eulalia Sakano

Purpose: The objective of this study is to observe the efficacy of orofacial myofunctional therapy in children who breathe through their mouths “mouth breathers” using a clinical assessment and surface electromyography. Method: 30 nasal breath (control group) and 30 mouth breathers (study group) were evaluated initially, and the study group was re-evaluated after 12 sessions of orofacial myofunctional therapy. Assessments involved the MBGR protocol and surface electromyography. Results: The control group had significantly better scores on all nasal breathing tests compared to mouth breathers both before and after therapy. However, mouth breathers demonstrated statistically significant improvements over time with therapy. Conclusion: After twelve orofacial myology therapy sessions, the mouth breathers improved but not to normal levels. Inadequate muscular strength remained for the required tasks suggesting that additional therapeutic intervention is needed or that therapeutic success is inhibited by a vertical craniofacial growth pattern.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2019.45.1.4

Authors: Miki Mizukami Takeshi Kikutani Miwa Matsuyama Keigo Nagashima Tomoko Isoda Fumiyo Tamura

Down syndrome (DS) has the highest prevalence of any chromosomal abnormality identified in newborns. DS children have specific eating and swallowing difficulties such as poor tongue control, mouth opening, swallowing food without chewing, and both facial and occlusal abnormalities. DS children are also at high risk of aspiration, and swallowing food without chewing is considered to be a factor associated with increased risk of aspiration and eating problems. This study aimed to identify factors preventing the acquisition of masticatory function in DS children. The subjects were 75 outpatient DS children (44 males, age range 12 to 36 month-old, mean age 33.0 ± 7.0 monthold; 31 females, age 12 to 36 month-old, mean age 20.8 ± 8.0 month-old), who had not yet acquired masticatory function, out of 319 who visited the clinic between October 2012 and October 2017. The information necessary for assessment was retrospectively extracted from the medical records of the subjects. The items examined included age, birth weight, nutritional intake, picky eating, tactile hyperesthesia, cognitive development assessed by Ohta stage, gross motor function, occlusal condition by Hellman’s dental age, and tongue thrust/lip closure/mastication while eating. The relationships between the acquisition of masticatory function and these items were investigated after one year of rehabilitation. The revealed age, low birth weight, picky eating, and gross motor function to be relevant factors. Among these, gross motor function was found to be the factor most strongly associated with acquisition of masticatory function.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2019.45.1.2

Authors: Mariana Amaral Ranata Furlan Guilherme Santana Clarice Figueiredo Estevam Barbosa de Las Casas Andréa Motta

PURPOSE: To investigate the motivation and the effects of: tongue movement direction; resistance force level; repetition number; and sustained tongue contraction duration on tongue motor performance in healthy pre-teen children using computer games. METHODS: An analytical observational cross-sectional study was conducted with 15 healthy 11–13 year-old children with normal lingual strength. The participants played six computer games using a tongue-controlled joystick. The series varied the time for continuous force application on the target (3 and 5 s) and the target force level (0.5, 1 and 2 N). After the tests, the participants answered a questionnaire about their impressions and reactions to the game. The variables analyzed were number of attempts to score (NAS), time for which the target force was maintained (TTFM), and the time spent for scoring (TSS). RESULTS: Of 43 normally developing candidates screened for the study, 15 (35%) were included for having entirely normal tongue structure and function and for being able to complete all of the study tasks. Of the 15 participants, 11 (73.3%) said that it was easy to play, three (20.0%) found it a bit hard to play, and only one (6.6%) considered it difficult to play. The results suggest that healthy individuals with normal lingual structure and function are able to successfully perform the games, but those with longer durations of sustained contraction (5 s) and the most required force (2 N) are the most difficult. Leftward and upward movements were more difficult than rightward and downward movements. CONCLUSION: All of these carefully selected participants were able to perform all of the study tasks, indicating that this method is feasible for pre-teens with normal lingual structure and function. The joystick device encouraged the participants to perform tongue movements that may be part of the typical orofacial myofunctional treatment exercises for tongue function. Results indicated that this game has the potential to be highly motivating for pre-teen children who are able to perform the tasks.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2019.45.1.1

Authors: Hope Reed

The purpose of this article is to stimulate research in orofacial myology. The research-to-practice gap may be reduced by highlighting concepts relating to evidence-based practice. Information is also presented on the International Association of Orofacial Myology Institutional Review Board process.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2019.45.1.3

Authors: Tomoko Isoda Fumiyo Tamura Takeshi Kikutani Miki Mizukami Hiroyuki Yamada Kimiko Hobo

Children with Down Syndrome (DS) show developmental retardation of gross motor function including acquisition of oral movements related to eating and swallowing. To characterize the process of development/acquisition of eating/swallowing function of children with DS, interlabial pressure (IP) during taking food into the mouth was assessed. This study included 99 children with DS (birth to 4 year-old), and 112 age-matched control children showing typical development. IP during taking food into the mouth was measured as an objective index of lip closing function. The system for measuring IP during taking food into the mouth consisted of a strain gauge-pressure sensor connected to a strain-measuring device, which sent data to a personal computer installed with electromagnetic oscillograph software to display pressure waveforms. The DS and typically developing children were grouped into each age group and the data were compared between matched-age groups. IP during taking food into the mouth, pressuretime (PT), variation coefficient (VC) of IP during taking food into the mouth and VC of PT were analyzed using the unpaired t-test. Analyses showed a significantly higher IP during taking food into the mouth in the DS population than in the typically developing children in the 2 and 3 year old (p = 0.042 and 0.049, respectively) groups. No significant difference was observed between the DS and typically developing groups with respect to PT, VC of IP during taking food into the mouth or VC of PT for any age group. Children with DS showed a process of acquisition of lip closing function during taking food into the mouth similar to the process found in typically developing children, even though children with DS experience developmental retardation in gross motor and cognitive functions.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2019.45.1.5

Authors: Patricia Taylor

The International Journal of Orofacial Myology is the only professional journal dedicated specifically to related OMD clinical topics [...]

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2018.44.1.2

Authors: Diego Oliveira Rafael Pinto Larissa Reis Isabela Dias Isabel Leite Fabíola Leite

Myofascial pain is considered a type of muscular TMD, being common in patients with musculoskeletal pain associated with active or latent trigger points. Among the therapeutic options, there are low-intensity laser therapy and dry needling. The aim of this study was to compare the efficacy of these two therapies in the masseter muscles of patients with myofascial pain. Ten patients diagnosed with myofascial pain, with or without limitation of mouth opening, were randomly divided into two groups for treatment with low intensity laser therapy (G1) (n = 5) or dry needling (G2) (n = 5). The pain symptomatology and the mouth opening measurement were evaluated weekly before the start of treatment, and one week after the final treatment. The comparison between G1 and G2 in relation to the improvement in mouth opening was not statistically significant (p > 0.05). However, dry needling (G2) has shown numerically to be more effective than laser therapy in a shorter period comparing initial and final mouth opening. Regarding the pain symptomatology, both therapies were effective comparing the initial and final evaluations of patients with myofascial pain (p < 0.05).

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2018.44.1.1

Authors: Kliss Moulton John Seikel Joni Loftin Nancy Devine

Oropharyngeal dysphagia (OPD) involves difficulty during one or more of the stages of swallowing, resulting in difficulty moving the bolus from the mouth to the stomach. A deficit in tongue mobility, such as that found with ankyloglossia, may affect the oropharyngeal transit time of the bolus and predispose a person to OPD. This study was conducted to examine the possible relationship between tongue tie and oropharyngeal dysphagia. Data were gathered on 8 participants (5 females, 3 males) between the ages of 12–43 years. The Lingual Frenulum Protocol (Marchesan, 2012) was used to determine tongue tie. An Iowa Oral Performance Instrument (IOPI) measured tongue tip, tongue dorsum, and lip strength, and a combination of electromyography, and the five-finger palpation method measured laryngeal timing. Measurements were compared with normative data from Holzer (2011). Results revealed that participants with ankyloglossia had signs of oral stage dysphagia, including reduced articulator strength (tongue tip and dorsum, and lips) and reduced masseter activity. Oropharyngeal transit times were not significantly different from the norms.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2018.44.1.5

Authors: Tainara Bastos Rafael Pinto Isabela Dias Isabel Leite Fabíola Leite

Objective: To evaluate self-care efficacy on reduction of pain and wakefulness bruxism before the treatment with the stabilization splint. Methods: Sixty patients were divided into two groups: 30 belonging to the group that received the self-care guide (G1) and 30 belonging to the control group (G2) who were advised to wait for the beginning of the treatment with the stabilization splint. G1 received a self-care guide for immediate application before any intervention for bruxism treatment. The instructions were given as tips to follow every day for 1 month. Before being given to the patient, the guide was read aloud and clearly by the researcher and clarifying any patients doubts or questions. To evaluate the evolution of each group, the evaluation of physical symptoms occurred at 2 times (M1 and M2). G1 the efficacy of the self-care guide was tested through patient's report of pain sensation before and after the use of the guide. The control group (G2) was evaluated at M1 and M2, in order to obtain a parameter of pain evaluation in patients not previously subjected to the treatment. Results: The Self-care group presented statistical significance in relation to the group that did not receive self-care. Conclusion: According to the results obtained it can be verified that the patient's awareness about this problem and the application of a conservative therapy based on self-care was effective reducing the pain level of patients with wakefulness bruxism.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2018.44.1.3

Authors: Jéssica Avelar Marcio José da Silva Campos Raphaella Fernandes Sérgio Luiz da Mota Júnior Marcelo Fraga Robert Vitral

Despite the fact that the advances in surgical techniques have contributed to the reduction in the number of complications associated with orthognathic surgery, problems resulting from different phases of treatment, treatment planning, and postoperative period may occur. This paper presents a case of facial soft tissue lesion, burn in the lower lip region, in a patient with Class III malocclusion during orthognathic surgery. A 22-year, 3-month-old male patient with Class III malocclusion was burned in the paramedian region of the lower lip due to unnoticed overheating of the low-speed handpiece during sagittal osteotomy of the left mandibular ramus. The injury to the patient could have resulted in legal repercussions against the dental surgeon. However, that did not occur. The satisfaction with the aesthetic and functional results, from the standpoint of both dental and facial aspects, was more important for the patient than the aesthetics of the burn sequelae. Although orthognathic surgery is a safe and widely used procedure in association with orthodontic treatment, the risk of complications always exists. No matter how skilled and self-confident the surgeon is, careful attention to the variables that can be controlled should be taken into account in order to reduce the chance of complications that may result in irreversible damages.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2018.44.1.6

Authors: Patricia Taylor

Orofacial myology and the treatment of individuals experiencing orofacial myofunctional disorders (OMD) is an international topic which is addressed in a variety of ways [...]

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2018.44.1.4

Authors: Pritesh Ruparelia Oshin Verma Vrutti Shah Krishna Shah

Juvenile Dermatomyositis is the most common inflammatory myositis in children, distinguished by proximal muscle weakness, a characteristic rash and Gottron's papules. The oral lesions most commonly manifest as diffuse stomatitis and pharyngitis with halitosis. We report a case of an 8 year old male with proximal muscle weakness of all four limbs, rash, Gottron's papules and oral manifestations. Oral health professionals must be aware of the extraoral and intraoral findings of this rare, but potentially life threatening autoimmune disease of childhood, for early diagnosis, treatment, prevention of long-term complications and to improve the prognosis and hence, the quality of life for the patient.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2017.43.1.6

Authors: Patricia Taylor

While there is a great deal of research related to orofacial myology and the positive effects of myofunctional therapy, we continue to have a need for some basic research to be conducted [...]

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2017.43.1.3

Authors: Rachel Marques Marcio Campos Raphaella Fernandes Bernardo Peralva Luiz Ribeiro Robert Vitral

Objective: To develop a computerized method to assess the mandibular lateral deviation pattern during mastication. Method: 44 videos of masticatory processes were analysed using the algorithm developed. The individuals were instructed to perform a specific pattern of mastication: only on the left or the right side (group 1), alternating five bites on one side and two on the opposite side (group 2), alternating 3 bites on each side (group 3). The computerized method identified, frame by frame, the lateral displacement of the chin and determined the amplitude and the percentage of mandibular lateral deviation to each side. Results: The groups 1 and 2 showed significantly higher number of cycles on the side of chewing compared to the opposite side and there was no difference between two sides in group 3. The amplitude of cycles showed similar results. In groups 1 and 2, the method identified the preferred chewing side, however, the percentage of the identified cycles in the chewing side was significantly lower than the percentage of cycles required (p < 0.001). Conclusion: The proposed computerized method was effective in identifying the bilateral masticatory pattern and recognizing the existence of preference to use one of the sides during the masticatory cycles.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2017.43.1.5

Authors: Renata Migliorucci Dagma Abramides Raquel Rosa Marco Bresaola Hugo Filho Giédre Berretin-Felix

Introduction: Some proposals of myofunctional therapy directed to individuals undergoing orthognathic surgery have been presented which promote the orofacial myofunctional balance, enhancing the treatment stability. Objective: To verify the effect of myofunctional therapy on orofacial functions and quality of life in individuals undergoing orthognathic surgery. Method: A total of 24 individuals, with mean age of 26.5 years, participated in the study. They were divided into two groups, namely with myofunctional therapy (N = 12) and without myofunctional therapy (N = 12). Breathing, chewing, swallowing, and speech were evaluated from tests established by the MBGR Orofacial Myofunctional Evaluation, using the scores specified in the protocol. The quality of life (QL) was evaluated using the Oral Health Impact Profile-OHIP-14 questionnaire, which comprises 14 questions that measure the individual´s perception of the impact of their oral conditions on their well-being in recent months. The evaluations were carried out before and 3 months after orthognathic surgery. The myofunctional therapy was initiated 30 days after surgery, with exercises aimed at improving orofacial mobility, tone and sensitivity, as well as the training of normal physiological patterns of orofacial functions. The comparisons between orofacial functions and the study groups were verified by the Mann-Whitney test, using a significance level of 5%. Results: After surgery, the individuals without myofunctional therapy presented with an improvement in breathing and oral health-related quality of life (p < 0.05), while in the group undergoing myofunctional therapy there was improvement in all aspects investigated (p < 0.05). Comparison between the study groups showed better performance in breathing (p = 0.002), chewing (p = 0.012), swallowing (p = 0.002) and speech (0.034) in individuals who underwent myofunctional therapy. Conclusion: The orthognathic surgery alone improved breathing and quality of life. However, the surgical procedure associated with myofunctional treatment, besides improving all oral functions investigated and quality of life, provided better functional performance in breathing, chewing, swallowing and speech. This study’s participants demonstrated the effectiveness of the orofacial myofunctional intervention.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2017.43.1.1

Authors: Natalie Douglass Peter Iltis Jens Frahm Dirk Voit Arun Joseph Patricia Fisher

This study uses real-time (cine) MRI to examine how orofacial myofunctional disorders (OMDs) affect muscle function during speech and horn playing. Dynamic MRI images were captured of an OMD subject and control subjects reciting a speech task and sustaining a note on an MRI-compatible horn. A following visual feedback session allowed the OMD subject to view and react to their (cine) MRI next to the image of an elite subject. Profile lines created in MATLAB allowed analysis of muscle function and changes in oral cavitation between the OMD and control subjects. In both the speech and horn films, the OMD subject consistently utilized maladaptive muscle movements, resulting in low and forward tongue position against the front teeth. Both control subjects had tongue placement free of the front teeth, and the horn control subject could elevate the tongue to narrow the air stream and play higher pitches. The MRI films suggest a connection between speech disorders and compromised horn-playing technique. OMDs limit the ability of the tongue to make the changes in oral cavitation used to play different pitches on the horn.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2017.43.1.2

Authors: Naif Bindayel Moshabab Asiry Georgios Kanavakis

Aim: To investigate the association between mid-line deviation of the mandible, as determined by upper to lower labial frena, and signs and symptoms of Temporomandibular Disorders (TMDs). Materials and Methods: The current study was original research conducted on a sample of 439 medical records of TMD patients treated at Tufts University. All patients underwent a clinical examination revealed a detailed information regarding temporomandibular joints, history of pain, and comprehensive intra-oral findings. Subjects were divided into three groups: 1. No frenal deviation, 2. Deviation to the right, and 3. Deviation to the left. Results: Signs and symptoms of TMD tend to occur more likely on the side of the frenum deviation. The signs and symptoms that were significantly associated to frenum position were TMJ crepitation sounds and locking, right muscles pain on palpation (medial pterygoid and sternocleidomastoid), and “reported locking on the left TMJ”. Subjects with aligned frena showed a statistically significant increase in the range of motion to the right side. The results also revealed a highly significant association between maxillary plane canting and mandibular frenum position. Left posterior cross bite was significantly more prevalent in the left frenum deviation group. Conclusion: Expression of TMD signs and symptoms was more prevalent on the side of frenum deviation. TMD population showed a higher prevalence of left mandibular frenum deviation. Several signs and symptoms were significantly associated to frenum position.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2017.43.1.4

Authors: Yamazaki Terumi Kameoka Ryo Shionoya Yoshiki Matsuzaki Yuki Ide Yoshiaki Uchikawa Yoshimori

We report the case study of a 17-year-old boy with cerebral-hemorrhage sequelae including intellectual disability, who presented with a severe, submerged first deciduous molar in his mandibular alveolar bone. It was believed that his condition was caused by biting on a tracheal tube during hospitalization after a fall that he experienced at the onset of a cerebral hemorrhage when he was 6 years old. His school dentist referred him to us, but he did not notice the submerged deciduous molar at that time. We found that the patient had 26 permanent teeth, with two congenitally missing lateral mandibular incisors, and there was some space with a small groove between his left first and second premolars. Panoramic radiography revealed the crown of his deciduous first molar lodged in the mandibular alveolar bone. Oral surgery to extract this tooth was performed under general anesthesia, with an additional aim of improving his oral hygiene. Additionally, a part of his extracted tooth was examined histopathologically, and was found to have no sign of ankylosis around its root. This case suggests that medical staff should pay attention to patients’ teeth in the hospital, especially because a tracheal tube has the potential to affect the teeth. This case also confirms the importance of dental treatment for people with special needs to improve their oral hygiene and quality of life.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2016.42.1.2

Authors: Nancy Solomon Matthew Makashay Benjamin Munson

Bite blocks are used to stabilize the jaw and to isolate tongue and lip movements from that of the mandible during speech and nonspeech activities. Ten normally speaking young adults produced sentences with an unconstrained jaw and with unilateral placement of 2-mm and 5-mm bite blocks. Six listeners rated sentences spoken without either bite block as the most natural sounding. Spectral characteristics of /s/, /J/ and /t/ (sibilant frication and stop bursts) differed significantly with than without bite blocks, such that mean spectral energy decreased, and variation and skew of spectral energy increased. Spectral kurtosis did not change for the group, but 2 participants exhibited highly kurtotic /s/ spectra without a bite block that normalized with bite blocks. The second formant frequency for the high vowel /i/ was lower with bite blocks; there was no systematic difference in F2 slope for diphthongs. Segmental and suprasegmental timing of speech articulation was not affected significantly by these small bite blocks. This study provides support for using small bite blocks to isolate the tongue from the jaw without large effects on speech, but cautions that speech is likely to sound less natural than when produced with an unconstrained jaw.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2016.42.1.5

Authors: Roberta Martinelli Irene Marchesan Giédre Berretin-Felix

Rest position of the infants' tongue with and without lingual frenulum alteration is poorly reported in the literature. The present study aims to verify the rest position of the tongue in infants with and without lingual frenulum alteration. A cross-sectional study was conducted with 324 infants. While the infant was sleeping, deep sleep, the SLP, facing the baby, opened the infant's mouth by pushing down the infant's chin with their thumbs, and at the same time, elevated the upper lip using their index fingers. The maneuver provided the visualization of the infant's tongue position at rest: elevated or down. The Chi-square test was used for statistical treatment of the data at 5% level of significance (p < 0.05). The variables included in the Chi-square analyses were: (a) tongue elevated, (b) tongue down-positioned, (c) normal lingual frenulum, and (d) altered lingual frenulum. The statistical analysis demonstrated that there was an association between the tongue position at rest and the characteristics of the lingual frenulum. When the lingual frenulum was altered, the infant's tongue rest position tended to be down in the oral cavity (p < 0.001). In infants with lingual frenulum alteration, the tongue at rest tended to be down-positioned, between the gum pads. In infants with normal lingual frenulum, the tongue at rest tended to be elevated.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2016.42.1.8

Authors: Lucia Paskay

In recent years many studies on the anatomy and neurophysiology of muscles of the face and mouth have revealed a much more complex ability of muscles to "multitask". Apart from being involved in sucking, swallowing, chewing and speaking, some muscles are also involved in the patency of the airways during sleep, the postural position of the jaw during physical activities, the promotion of nasal breathing, or stress relief, just to name a few functions. In this brief review, some additional properties of the genioglossus (GG), the palatoglossus (PG), the masseters (MM) and the orbicularis oris (OO) will be reviewed.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2016.42.1.10

Authors: Dana Surena-Mattson

I have always considered myself to be an avid research enthusaist [...]

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2016.42.1.3

Authors: Benjamin Munson Nancy Solomon

The phonetic characteristics of words are influenced by lexical characteristics, including word frequency and phonological neighborhood density (Baese-Berke & Goldrick, 2009; Wright, 2004). In our previous research, we replicated this effect with neurologically healthy young adults (Munson & Solomon, 2004). In research with the same set of participants, we showed that speech sounded less natural when produced with bite blocks than with an unconstrained jaw (Solomon, Makashay, & Munson, 2016). The current study combined these concepts to examine whether a bite-block perturbation exaggerated or reduced the effects of lexical factors on normal speech. Ten young adults produced more challenging lexical stimuli (i.e., infrequent words with many phonological neighbors) with shorter vowels and more disperse F1/F2 spaces than less challenging words (i.e., frequent words with few phonological neighbors). This difference was exaggerated when speaking with a 10-mm bite block, though the interaction between jaw positioning and lexical competition did not achieve statistical significance. Results indicate that talkers alter vowel characteristics in response both to biomechanical and linguistic demands, and that the effect of lexical characteristics is robust to the articulatory reorganization required for successful bite-block compensation.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2016.42.1.4

Authors: Hope Reed

Including orofacial myofunctional disorders (OMDs)-related content in Communication Sciences and Disorders (CSD) curricula is vital to meeting the demands of the profession. The author was prompted to investigate this issue further as a result of her own observations of the resulting benefits from the past 12 years. Student training continues to evolve in order to address this need. This article seeks to substantiate the importance of this content and offer methods for inclusion and possible benefits. The investigation revealed the important role OMDs can play in the preparation of speech-language pathologists. University programs are encouraged to consider including the fundamentals of OMDs in order to best meet the needs of public school students and patients, as well as university students who are the future professionals. Appendices containing related data and an outline of content that could be featured in a course or workshop are provided.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2016.42.1.1

Authors: Roberta Martinelli Irene Marchesan José Lauris Heitor Honório Reinaldo Gusmão Giédre Berretin-Felix

Introduction: In Brazil, the law 13.002/2014 states that all newborns in the country must undergo lingual frenulum assessment before hospital discharge. Objective: To validate the Lingual Frenulum Protocol for Infants. Material and Methods: The study used data from 100 infants assessed at 30 days of life at Santa Therezinha Hospital, in Brotas, SP, Brazil. The LFPI was administered to the 30-day-old infants and all assessments were registered in patient records and videotaped. Live exams, assessments and re-assessments using images of the infants were performed by two examiners experienced in Orofacial Myofunctional Disorders. The study included healthy full-term infants of both genders, who were being breastfed exclusively. Prematurity, perinatal complications, craniofacial anomalies, neurological disorders, and visible genetics syndromes were the exclusion criteria. The validation process included the analysis of content validity, criterion validity, construct validity, reliability, sensitivity, specificity, positive predictive value, and negative predictive value. Results: Concerning content validity, the percentage of agreement was 100%. The criterion validity was measured by comparing the common items of the LFPI and BTAT. The agreement percentage for the analyzed items was 100%. The construct validity was analyzed by comparing the partial and total scores from the assessment of infants with and without lingual frenulum alteration at 30 and 75 days of life. Results demonstrated similarity of scores between the control group and the group that underwent frenotomy. The results from the inter-rater and intra-rater agreement analysis indicated perfect agreement. The values of sensitivity, specificity, positive predictive value, and negative predictive value were 100%. Conclusions: The study concluded that the LFPI was a valid and reliable assessment too that ensures accuracy when diagnosing lingual frenulum alterations within the investigated parameters.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2016.42.1.7

Authors: Zuleica Camargo Luciana Oliveira Maria Svicero Irene Marchesan Sandra Madureira

Introduction: Subjects with altered lingual frenulum may have difficulty speaking, chewing, and swallowing. Acoustic analysis allows for inferring the mechanisms of speech production, such as the tongue position on the horizontal and vertical axes and the jaw position. Aim: The aim is to compare formant frequencies (F1 and F2) for seven oral vowels in Brazilian Portuguese (BP), when produced by individuals who had a lingual frenectomy, pre- and post-surgical periods (a minimum six-month interval). Methods: There were seven subjects ranging in age from 6y3m to 14y7m, who were assessed and diagnosed with lingual frenulum alteration and the need for frenectomy was indicated, were selected and participated in two collections of speech data: (a) pre- surgery and (b) post-surgery. The speech samples consisted of words containing the seven vowels of BP which were acoustically analyzed in the software PRAAT, and the F1 and F2 measures were taken. The data were statistically analyzed (ANOVA) for the different vowels in the moments (a) and (b). Results: Acoustic measurements revealed significant differences between the pre-and post-surgical period (six months) when compared to F1 for vowels [a] (p = 0.018), [e] (p = 0.018) and [u] (p = 0.049) and F2 for vowels [e] (p = 0.026) and [u] (p < 0.001). Conclusions: F1 and F2 values indicated that the movement of the tongue improved after lingual frenectomy, revealing greater anterior mobilization but limited height range.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2016.42.1.6

Authors: Roberta Martinelli Irene Marchesan Giédre Berretin-Felix

Introduction: The literature refers to ankyloglossia as anterior, when the lingual frenulum is visible, and posterior, when the frenulum is not visible. Posterior ankyloglossia is sometimes referred to as a submucosal tongue-tie. The anatomical variations of the posterior ankyloglossia and its interference with tongue movements are poorly described in the literature. Aim: The aim of this study is to verify the occurrence of posterior lingual frenulum in infants and its interference with sucking and swallowing during breastfeeding. Methods: This clinical study included 1084 newborns, who were assessed at 30 days of life, using the Lingual Frenulum Protocol for Infants (LFPI). This study included healthy full-term infants, who were being exclusively breastfed. Prematurity, perinatal complications, craniofacial anomalies, neurological disorders, and visible genetics syndromes were the exclusion criteria. The LFPI was administered to the infants, and the assessments were registered and videotaped. Tongue movements, sucking rhythm, sucking/swallowing/breathing coordination, nipple chewing, and/or tongue clicking were assessed during nutritive and non-nutritive sucking evaluations. Descriptive statistics were performed. Results: Of the 1084 newborns, 479 (44.2%) had normal lingual frenulum; 380 (35%) had posterior lingual frenulum; and 225 (20.8%) had lingual frenulum alterations. Infants with posterior lingual frenulum did not have any restrictive tongue movement during sucking and swallowing. Conclusions: The occurrence of posterior frenulum in this sample was 35%. The posterior frenulum did not interfere with sucking and swallowing during breastfeeding; therefore, surgery was not recommended for any of the subjects in this sample.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2016.42.1.9

Authors: Shari Green

In the past few years, new research has emerged regarding the significance of ankyloglossia and it's potential for a myriad of oral muscular and growth concerns [...]

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2015.41.1.6

Authors: Patricia Taylor

The keys to any successful organization are leadership and membership [...]

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2015.41.1.5

Authors: Anita Weinfield

Orofacial Myology is more than a tongue up swallow. There are many functional components to successful treatment. This article will focus on eating and drinking. It is important to evaluate the eating and drinking pattern. The process of chewing, gathering solid foods correctly and then swallowing those solids and liquids are significant steps to a complete Orofacial Myofunctional Therapeutic program. Successful therapy begins with understanding the entire eating process. Once this process is understood then diagnostic therapeutic evaluation of dysfunctional eating can be addressed.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2015.41.1.2

Authors: Kimiko Hobo Fumiyo Tamura Keiichiro Sagawa Hisaharu Suzuki Takeshi Kikutani

This study was conducted to clarify the actual status of oral symptoms related to the systemic and eating/swallowing functions, and the effect of ageing for those conditions in patients with Rett syndrome. The subjects were 38 females aged from 4 to 63 years diagnosed with Rett syndrome. The examination items were age, nutritional status, gross motor functions, history of epileptic seizures, antiepileptic drugs use, history of pneumonia, respiratory status (apnea, hyperventilation, and aerophagia), ingested food type, eating/swallowing functions, dysphagia symptom, occlusal condition, eating independence level, palate shape, and bruxism. Using Pearson's correlation coefficient, no significant correlation between age and nutritional status was observed (Rohrer index: p = 0.12, BMI: p = 0.22). When the other inter-item relationships were evaluated by the x square test and Fisher's exact test, a significant correlation was recognized between gross motorl functions and oral functions (p < 0.01), between gross motor functions and swallowing function (p <0.05), and between respiratory status and oral functions (p <0.05). The investigation of the characteristics of patients with Rett syndrome suggested that decreased gross motor functions, such as gait function, and the appearance of respiratory status might herald the development of eating/swallowing dysfunction.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2015.41.1.3

Authors: Asuka Fujiwara Fumiyo Kuroyanagi Atsushi Kawabata Atsushi Fujiwara Wakato Tome Noriyuki Kitai

The purpose of the present study was to investigate the relationship between multidirectional lip­closing force and the three-dimensional morphology of perioral soft tissue in adults. Twenty-three Japanese adults with straight facial profiles participated in this study. The signals of directional lip­closing force (DLCF) were investigated in 8 directions. Three-dimensional morphology of perioral soft tissue was recorded using a 30 surface-imaging device. Correlations between lip-closing force and the three-dimensional morphology of the perioral soft tissue were analyzed statistically. Upper lip-closing force significantly correlated with the anteroposterior, vertical, transverse morphology of the upper lip, while lower lip-closing force did not correlate with the anteroposterior, vertical, or transverse morphology of the lower lip. In adults with straight facial profiles, associations were found between upper lip-closing force and upper lip morphology. There were no associations between lower lip-closing force and lower lip morphology.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2015.41.1.1

Authors: Tais Grechi Carla Itikawa Fernanda Gallarreta Fabiana Valera Wilma Anselmo-Lima Roberto Dantas Luciana Trawitzki

The purpose of this research was to determine the effect of respiratory obstruction due tonsils hypertrophy on bolus organization, lip posture, bolus propulsion, and on associated head and mandible movements during the preparatory oral and oral phases of swallowing in children. This is a transversal study in children with tonsils hypertrophy (Group 1 − n = 21, 8 girls and 13 boys; mean age 4.5 years) and nasal breathers children without tonsils hypertrophy (Group 2 − n = 10, 4 girls and 6 boys; mean age 4.6 years). The groups were evaluated for respiratory patterns (oroscopy, anterior rhinoscopy and nasopharyngoendoscopy), dental evaluation and videofluoroscopy of swallowing, for liquids and paste food. No significant differences were detected (p > 0.05) between groups regarding liquid volume ingested, bolus organization, lip posture, bolus propulsion, or the presence of associated head and mandible movements. The results indicate that respiratory obstruction caused by tonsil hypertrophy in children with normal occlusion did not influence the variables studied regarding the preparatory oral and oral phases of swallowing for both consistencies.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2015.41.1.4

Authors: Moacyr Filho Alexandra Araújo Márcia Ribeiro

With respect to the stomatognathic system, as a rule, speech therapy used to be restricted to the function of deglutition. At present, the importance of chewing and breathing for both the development and growth of the stomatognathic system is better understood. This study investigates the safety of PRELI DAEMON (AD) in healthy adults and children (i.e., showing no symptoms, signs or complaints of acute illness), and collects impressions on AD use and safety. Method: this is an intervention study with a convenience sample of 10 adults and 20 children. Exclusion criteria: lesions in the oral cavity, and use of orthodontic appliances. Subjects kept prototype device AD in the mouth for 30 uninterrupted minutes while performing routine activities. Participants and trained observers filled in questionnaires about the use of the device. A descriptive analysis with frequency distribution, measures of central tendency and of dispersion were carried out; qualitative data were assessed by reading all responses to the questionnaire, identifying core themes, and categorizing. Results: all volunteers kept AD in their mouths for 30 uninterrupted minutes; no adverse effects occurred during or after use. Discomfort at use was found in 40% of adults and 20% of children. Hypercontraction and lip sealing, lateralization and suction were observed during the use of the device. Conclusions: The device was safe in both age groups.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2014.40.1.3

Authors: Adriana de Figueiredo Alfredo Halpern Marcio Mancini Cintia Cercato

Masticatory performance is determined not only through the speed of mastication, or by the quantity of food ingested; it also depends on the structures and functional integration of the stomatognathic system (SS). Objectives: this study investigated differences in the SS and orofacial motricity between obese and normal-weight women. Method: a total of 18 obese women, with an average age of 28 ± 7.3 years and an average body mass index (BMI) of 37.4 ± 5.1 kg/m2, and 18 normal-weight women, with an average age of 26 ± 7.6 years and an average BMI of 20.7 ± 1.8 kg/m2, took part in the study. During the speech therapy evaluation, chewing, the number of chewing strokes, and swallowing were observed. The posture, mobility and tonus of lips and tongue, morphology, mobility and tonus of cheeks were designated as normal or altered. The electrical activity of the anterior temporalls, the masticatory muscle was evaluated for both groups using surface electromyography (EMG), which was expressed in microvolts (μV) and registered as Root Mean Squares. Results: significant differences were found between the two groups in clinical evaluation. In surface EMG, the obese group showed asymmetry of electrical activity of the anterior temporalis. Conclusion: this study suggests that speech therapist investigation of the SS should be combined with interdisciplinary obesity management.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2014.40.1.4

Authors: Lorraine Frey Shari Green Paula Fabbie Dana Hockenbury Marge Foran Kathleen Elder

The origins of Orofacial Myofunctional Therapy began in the early 1960's by orthodontists who recognized the importance of functional nasal breathing, proper swallowing, and more ideal oral rest postures. Re-patterning these functions through myofunctional therapy assisted with better orthodontic outcomes and improved stability. Experts in orofacial myology have concluded that improper oral rest postures and tongue thrusting may be the result of hypertrophy of the lymphatic tissues in the upper airway. Orthodontists are aware of the deleterious effects these habits have on the developing face and dentition. Sleep disordered breathing is a major health concern that affects people from infancy into adulthood. Physicians who treat sleep disorders are now referring patients for orofacial myofunctional therapy. Researchers have concluded that removal of tonsils and adenoids, along with expansion orthodontics, may not fully resolve the upper airway issues that continue to plague patients' health. Sleep researchers report that the presence of mouth breathing, along with hypotonia of the orofacial muscular complex, has been a persistent problem in the treatment of sleep disordered breathing. Orofacial myofunctional disorders (OMDs) coexist in a large population of people with sleep disordered breathing and sleep apnea. Advances in 3D Cone Beam Computed Tomography (CBCT) imaging offer the dental and medical communities the opportunity to identify, assess, and treat patients with abnormal growth patterns. These undesirable changes in oral structures can involve the upper airway, as well as functional breathing, chewing and swallowing. Leading researchers have advocated a multidisciplinary team approach. Sleep physicians, otolaryngologists, dentists, myofunctional therapists, and other healthcare professionals are working together to achieve these goals. The authors have compiled research articles that support incorporating the necessary education on sleep disordered breathing for healthcare professionals seeking education in orofacial myology.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2014.40.1.5

Authors: Monalise Berbert Vivian Brito Renata Furlan Tatiana de Castro Perilo Amanda Valentim Marcio Barroso Estevam de Las Casas Andréa Motta

In clinical speech-language pathology practice, tongue force is usually evaluated qualitatively. Perception and practical experience are used to classify this force. The Biomechanical Engineering Group from the Federal University of Minas Gerais developed an instrument to quantify tongue force. The purposes of this study were to quantify maximum tongue protrusion force in Brazilian subjects with normal tonque strength and to compare force values between gender groups. In total, 105 subjects, 43 men and 62 women, aged from 18 to 29 years, with normal tongue strength according to qualitative evaluation, underwent quantitative evaluation by using the instrument. The mean of the maximum tongue force values of all participants was 17.58 ± 7.95 N. There were significant differences in the median values for maximum tongue forces between the genders, with higher values observed for men. In intersubject comparisons, high variation coefficients were evident due to the variability among individuals. However, the study suggested that the instrument could be an interesting tool for intrasubject comparisons, especially during the follow-up.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2014.40.1.2

Authors: Mohammed Safi Wilhelmia Wright-Harp Jay Lucker Joan Payne Ovetta Harris

Background. Lingual, labial and buccal weakness (LLBW) is a widespread consequence of several neurological insults. LLBW impact on oral motor functions such as speech production and swallowing is well documented in the literature. Therefore, it is important for the speech-language pathologists to have access to evidence-based approaches for treatment. Thus, it is imperative that the speechlanguage pathology field search for effective treatment approaches and explore new treatment modalities that can improve therapy outcomes. One relatively new modality in this field is neuromuscular electrical stimulation (NMES). Aims. The purpose of this paper is fivefold: (a) to provide an overview of the general effects of NMES on skeletal muscles; (b) to review the effect of NMES on orofacial musculature evaluating the potential appropriateness of NMES for use in strengthening lingual, labial and buccal muscles; (c) to identify future directions for research with consideration of its potential role in improving speech intelligibility and the oral preparatory phase of swallowing in patients with oral motor weakness; (d) to provide a brief anatomic and physiologic bases of LLBW; (e) to provide background information for orofacial myologists who may encounter Individuals with LLBW. Main Contribution. NMES is a modality that Is commonly used In physical therapy and occupational therapy fields that assists in treating several motor and sensory muscular disorders including muscular weakness. The literature reviewed demonstrate that very limited data related to the use of NMES on orofacial muscles exist despite the fact that these muscles can be easily accessed by electrical stimulation from the surface. Conclusions. This review of the research using electrical stimulation of muscles highlights the need for experimental treatment studies that investigate the effect of NMES on orofacial weakness.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2014.40.1.1

Authors: Christine Mills

This article presents an historical account of the International Journal of Orofacial Myology from its inception to the present. Highlights from individuals involved and perspectives are included.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2013.39.1.2

Authors: Angela Dietsch Carmen Cirstea Ed Auer Jeff Searl

Fine control of orofacial musculature is necessary to precisely accelerate and decelerate the articulators across exact distances for functional speech and coordinated swallows (Amerman & Parnell, 1990; Benjamin, 1997; Kent, Duffy, Slama, Kent, & Clift, 2001). Enhanced understanding of neural control for such movements could clarify the nature of and potential remediation for some dysarthrias and other orofacial myofunctional impairments. Numerous studies have measured orolingual force and accuracy during speech and nonspeech tasks, but have focused on young adults, maximum linguapalatal pressures, and upright positioning (O’Day, Frank, Montgomery, Nichols, & McDade, 2005; Solomon & Munson, 2004; Somodi, Robin, & Luschei, 1995; Youmans, Youmans, & Stierwalt, 2009). Patients’ medical conditions or testing procedures such as concurrent neuroimaging may preclude fully upright positioning during oral motor assessments in some cases. Since judgments about lingual strength and coordination can influence clinical decisions regarding the functionality of swallowing and speech, it is imperative to understand any effects of body positioning differences. In addition, sex differences in the control of such tasks are not well defined. Therefore, this study evaluated whether pressures exerted during tongue movements differ in upright vs. supine body position in healthy middle-aged men and women. Twenty healthy middle-aged adults compressed small air-filled plastic bulbs in the oral cavity at predetermined fractions of task-specific peak pressure in a randomized block design. Tasks including phoneme repetitions and nonspeech isometric contractions were executed in upright and supine positions. Participants received continuous visual feedback regarding targets and actual exerted pressures. Analyses compared average pressure values for each subject, task, position, and effort level. Speech-like and nonspeech tongue pressures did not differ significantly across body position or sex groups. Pressure matching was significantly less accurate at higher percentages of maximum pressure for both tasks. These results provide preliminary comparative data for the clinical assessment of individuals with orofacial myofunctional and neurological disorders.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2013.39.1.3

Authors: Sujata Mohanty Ujjwal Gulati

As the angle is a weak region in the continuity of mandible, so it is more prone to fracture. It has been proven time and again that coronoid fracture results from a strong sudden contraction of temporalis. Muscular forces influence the remodeling of bones. Orofacial dystonia is a centrally mediated disease in which there is an uncontrolled spasmodic contraction of facial and masticatory muscles. This continuous force applied over a long period of time has the potential to unfavorably remodel or weaken bone. A case is presented in which the dystonic action of facial musculature gradually resorbed the bone to such an extent that there was spontaneous fracture at the right angle of mandible as well as the contra lateral coronoid. Management of this fracture posed a challenge at every step eventually leading to resection of the ramus-condyle unit. No case has been reported so far in the literature where dystonic movements have resulted in fracture of the mandible.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2013.39.1.7

Authors: Almiro Machado Junior Agricio Crespo

Head posture has been related to pharyngeal space, especially in the syndrome of obstructive sleep apnea (OSA) in adults. However no studies were found that evaluated the possible correlation between head posture and pharyngeal airway space measured in children with atypical swallowing. The purpose of this study was to evaluate the possible correction between head posture and the measurement of pharyngeal space on radiographs of children who were in the period of mixed dentition who demonstrated atypical swallowing and in children with normal deglutition. A retrospective clinical study, using cephalometric analysis of lateral radiographs to obtain measures of the antero-posterior dimension of the pharyngeal airway space (PAS) and the angle formed between the base of the skull and the odontoid process (CC1) between two groups: the 55 radiographs experimental group (with atypical swallowing) and 55 radiographs of the control group (normal swallowing). The Spearman Coefficient of Correlation was used to evaluate the possible relationship between PAS and CC1 was used. Results indicated a positive correlation between measures of CC1 and PAS (r = 0357) only in the control group (normal swallowing). Conclusions: There is positive correlation between head posture and measure pharyngeal airway space (PAS) in the group of normal swallowing. This correlation was not observed in the experimental group (atypical swallowing).

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2013.39.1.1

Authors: Heather Clark Natalia Shelton

The purpose of the current investigation was to explore how intra-oral negative pressure and submental muscle activity vary across sips from straws varying in internal diameter and across conditions of low versus high effort. Healthy adults took discrete sips from four straws varying in internal diameter. Sips were performed under normal and high effort conditions. Submental surface electromyography (sEMG) and negative intra-oral pressure were recorded during sips. Significant main effects of straw condition were observed for negative intra-oral pressure. A non-significant trend for increased muscle activity associated with smaller straw diameter was also observed. Significant main effects of effort condition were observed for both submental sEMG and negative intra-oral pressure. The findings are interpreted as supporting the clinical hypothesis that high resistance drinking straws varying in diameter may offer systematic overload to the oral musculature. The findings also support encouraging maximum effort to achieve even further overload.

International Journal of Orofacial Myology and Myofunctional Therapy doi: 10.52010/ijom.2013.39.1.4

Authors: Alana Mantie-Kozlowski Kevin Pitt

The purpose of this study was to determine if electropalatography (EPG) would be a useful adjunct and feasible option for those conducting clinical assessments of individuals with suspected nonspeech orofacial myofunctional disorders (NSOMD). Three females (two adults, one child) were referred by their orthodontist for assessment of suspected NSOMD. Three adults and one child without NSOMD were recruited for the purpose of evaluating methodological construct, and to provide comparisons for participants with NSOMD. Using EPG, lingual-palatal timing and contact patterns of 105 saliva swallows (45 with NSOMD, 60 without NSOMD) were analyzed by compartmentalizing the sensor display and tracking the order and duration of activation. Lingual-palatal contact patterns were compared in terms of four stages: prepropulsion, propulsion, postpropulsion, release. Coding the lingual-palatal activation in an operationalized manner was a valuable adjunct for describing lingual-palatal timing and contact patterns. Participants with NSOMD showed unique lingual-palatal contact patterns that differed from the patterns of the participants without NSOMD, and from each other. EPG is a potential adjunct to the non-instrumental assessment of NSOMD. Larger scale investigations using EPG should proceed.