In Speech Therapy

Definition

Orofacial myofunctional disorders (OMD). That’s a mouthful! Let’s start by breaking down those words. Oro = mouth. Facial = face. Myo = muscle. Therefore, orofacial myofunctional disorders can be simplified as a malfunction of the muscles of the mouth and face. With more details considered, this group of disorders centers around malfunctioning facial muscles that create unhealthy behaviors or patterns, and typically affect speech, chewing, swallowing, oral hygiene, and facial appearances.

Common OMDs

Orofacial Myofunctional Disorders are a category of diagnoses. Here is a brief list of specific types of OMDs:

  • Tongue Thrust is probably the most common variation, where the tongue is too far forward in the mouth, causing disruptions to speech and swallowing. The average person swallows up to 1000 times a day, so improper muscle patterns could impose a variety of implications on the body.
  • Lip Incompetence (Open Mouth Posture) is another well known OMD, where the lips are apart, causing an open mouth and mouth breathing.
  • Oral Habits like nail biting, thumb sucking, etc.
  • Chewing Disorders.
  • Atypical Swallowing.
  • Tongue tie, where the lingual frenum, which connects the bottom of the tongue to the mouth, is shortened.
  • Temporomandibular Joint Disease (TMJ), a condition where there is pain where the jaw attaches to the skull near the ear, and difficulty opening and closing the jaw.
  • Speech Mis-articulation such as a lisp.
  • Sleep Apnea, or other sleep disorders.
  • Bruxism, which is grinding of the teeth.
  • Macroglossia, also known as an abnormally large tongue.

 

Prevalence

Recent statistics rate that roughly 38% of the general population and nearly 81% of children with an existing speech problem have an OMD.

Symptoms and Side Effects

Children with OMD may incorrectly pronounce certain sounds incorrect, such as “th” instead of “s” (like saying “thumb” instead of “some”). The most affected sound is the letter s, while others include “sh”, “zh”, “ch”, “j”, s, z, t, d, n, or l. Lisps and speech impediments are also common side effects. If not treated, OMD may lead to TMJ, airway obstructions, headaches, obstructive sleep apnea, or snoring.

Improper tongue placement can even play a role in dental issue, such as crooked teeth, delayed growth of adult teeth through the gums, or an abnormal bite. Each of those could further influence biting, chewing, and swallowing food, and therefore affect the entire digestive system. Swallowing muscles also play a role in facial features. A slack, open mouth with loose lips suggests a lazy and dull facial appearance and is usually accompanied with mouth breathing. A pursed mouth with a knobby chin is known as a facial grimace due to the overuse of muscles. Both of these expressions signal the possibility of an OMD.

 

Causes

As previously mentioned, an OMD centers around an unhealthy pattern or behavior of the orofacial muscles, making it difficult to pinpoint a specific cause. However, these things could contribute:

  • Nail biting
  • Grinding of teeth
  • Thumb sucking
  • Extended use of a pacifier or bottle
  • Mouth breathing, often caused by constricted nasal passages (due to enlarged tonsils/adenoids or allergies)
  • Abnormally large tongue
  • A shortened lingual frenum (the flap of skin connecting the bottom of your mouth to the underside of your tongue)
  • Mental or developmental delays

Diagnosis and Treatment

A physician, dentist, orthodontist, speech-language pathologist (SLP), psychologist, educator, or orofacial myologist may all play a role in OMD treatment. Physicians discover the root of the malfunction, such as allergies or enlarged tonsils/adenoids, and make sure that the nasal or air passageways do not become blocked. Dentists and orthodontists are concerned with the alignment of teeth and jaws, as well as the breakthrough of new teeth through the gums. Speech-language therapists carry out treatment for speech, swallowing, relaxed postures, and muscle re-training. Details about SLP’s treatment of OMD can be found here in section 38 and 39.

Treatment typically emphasizes awareness of facial muscles, mouth and tongue positions, swallowing patterns, and speech. Continually focusing on improving the strength and coordination of muscles is done by teaching particular exercises and having the patient practice them daily. A multidisciplinary approach and a 6-12 month period of therapy is common. Recent studies rate OMD treatments as 80-90% effective with retention for years following therapy.

After successful treatment of OMD, a patient will breathe, speak, swallow, and even sleep or eat better. Often their facial features will improve, thus boosting self-esteem. Speech will no longer be a concern and relationships may improve.

 

How To Help Your Child With OMD

Here are a few ways to observe your child and help reduce the effects of an OMD.

  1. Does my child do this as a reaction or habit? For example, ask your child to breathe through their nose for two minutes straight. Was it easy? Good! Was it difficult? There may be something else going on that is blocking their airways.
  2. Is your child allergic to anything? The big three areas are dust, dairy, and dander. Either eliminate these things for 30 days to see if symptoms change. For the most definitive answer, consult a specialist for an allergy test.
  3. Does your child have visibly large tonsils? If so, they may be constricting the airway and causing your child to breathe, swallow, and rest their tongue in unnatural positions. Large tonsils also may mean large adenoids, which are globs of tissue behind that nasal passage that cannot be viewed through the mouth. Visit and ENT (ear, nose, and throat doctor) to discuss next steps.
  4. Where does your child’s tongue rest? The proper placement is on the roof of the mouth with the tip placed behind (but not pushing) on the front teeth.
  5. Try to unblock their nose. Typically a stuffed nose will cause your child to breathe through their mouth. Use medications, a dehumidifier, netti pot, or breathing exercises in attempts to clear out their nasal passages.
  6. Consult a myofunctional therapist for home exercises and muscle re-training exercises.

Additional Research

  • Children with cerebral palsy who engaged in OMD therapy improved overall function of their lips, tongue, and jaw, and their speech was easier to understand.
  • Patients aged 3-30 were given myofunctional therapy, which resulted in greater lip strength, tongue placement, closing of lips, swallowing patterns, breathing, and speech articulation.
  • Orofacial myofunctional treatment proved to alleviate the severity and frequency of symptoms in patients with TMJ.
  • Older adolescents with speech impairments engaged in 6 weeks of orofacial myofunctional therapy. The outcomes revealed a significant increase in sound productions, speech intelligibility, and oral postures.
  • If your child is having speech difficulties, learning to play a wind instrument may be a helpful hobby to build up their facial muscles.

 

Sources/References

 

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