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Orofacial Myology: My Personal Journey by Sara Holmes

What is Orofacial Myology?
“The study and treatment of oral and facial muscles as they relate to speech, dentition, chewing/bolus collection, swallowing and overall mental and physical health.”
-Sandra Holtzman

To further break it down, think about the skeletal song we learned as kids, “Your head bone is connected from your neck bone, and your neck bone is connected from your shoulder bone…” and then how all of these muscles relate to each other. Whether you realize it or not, each tiny muscle, ligament and bone within the face and oral cavity are connected to the rest of your body and affect your everyday health. Even as a Speech-Language Pathologist, I did not fully understand how much our anatomy plays into our overall health until I underwent my own orofacial myofunctional treatment program as an adult.

My Personal Journey
As a child, I experienced several orofacial myofunctional disorders (OMD) that went undiagnosed and unexplained throughout my development. As a young child, I did not experience any known feeding or speech issues, so no one fully assessed how my jaw, tongue and teeth worked together. I did however experience headaches, scoliosis, neck/shoulder/low back pain, IBS, and allergies. I also was told by my dentist and orthodontist at the time that my mouth was too small for all of my teeth and that I would need to have permanent teeth prior to braces. Little did I know then that all of these ailments were in some way related to my OMD.

After removing two permanent teeth, I received my first set of braces while I was in my 8th grade year. I wore braces for two years and although my teeth became straighter and my bite was corrected, I later developed a popping/clicking sound when opening my mouth on the right side. At the time, the popping caused no pain so my dentist was not concerned with the TMJ dysfunction.

Years later, after becoming an SLP, I noticed my bite begin to slope upward on one side. I attributed this to getting older until I woke up one day with intense pain on the left side of my jaw joint. I also experienced tension within my neck and shoulders and low back, constantly. I went to see a chiropractor and had my neck and back aligned, in addition to my jaw massaged and moved back into place. While this provided temporary relief, I did not feel that it would progress to permanent relief.

I then decided to contact an orthodontist in the area to determine the cause of my misalignment and pain. Dr. Mary Paula at Zaytoun Orthodontics and I then went on a journey that I previously had limited knowledge on. After a couple of months in my second round of braces, Dr. Mary Paula determined that I had a tongue tie that had never been released. The tongue tie restriction likely attributed to my TMJ pain, bite misalignment and the need to have a second set of braces.

Next, I called Kayla Uhl knowing she was trained in orofacial myofunctional therapy, and began phase 1 of the treatment program. While completing the exercises, I made an appointment with a local ENT to have my tongue tie revised. Unfortunately, the ENT claimed I had a decent range of motion and since I was not experiencing any speech or swallowing issues, he determined I did not need a revision completed. Even after explaining the research and all of my ailments (TMJ pain, neck/shoulder/ low back tension, sleep difficulties, scoliosis, IBS, allergies, etc) his only recommendation was for me to use a nasal spray.

Thankfully, ACT Therapy Services has a great list of release providers in Charlotte that take a more holistic approach and deem revisions necessary based on symptoms and measurements taken. Prior to the release, I was unable to reach my back molars with my tongue, my tongue rested between my teeth, and I was not able to achieve maximum opening. In December of 2022, I finally had my tongue tie revision completed at Queen’s Road Dentistry and immediately felt relief in my neck and shoulder tension. Following the release, I completed phases 2 and 3 of myofunctional therapy, and my orthodontist pulled my palate forward and out to allow it to expand as much as it could with two permanent teeth missing.

Now that I have had my tongue tie revised, completed myofunctional therapy, and finished orthodontia, I have experienced so much pain relief and increased my overall health and well-being. My tongue is now able to rest properly (at the roof of my mouth and behind my front teeth), and I am able to use a correct swallowing pattern that I did not realize was incorrect prior to myofunctional therapy. Correcting my tongue posture at rest has allowed me to breathe better and reduce forward-head rest posture. My tongue tie had been causing my head muscles to tilt low and forward, changing my facial symmetry and structure. This also related to my neck/shoulder and low back tension. Not only is my facial symmetry corrected, but I also have reduced headaches and jaw pain. The corrected tongue resting posture also helped me breathe through my nose better, which led to better sleep patterns.

The photos below are before (left) and after (right) pictures taken by my orthodontist. You can see several changes just by comparing the two without knowing my background history. The following are my results from a tongue tie revision, orthodontia round 2, and myofunctional therapy:

– Facial symmetry- notice how my jaw was shifting to the side before
– Reduced forward head rest posture- notice the straightening and extension in my neck
– Corrected tongue resting posture- notice the skin under my chin in the second photo

-Increased sleep/ reduced brain fog- notice the change in my eyes
– Reduced headaches
– Reduced neck, shoulder, and low back pain
– Reduced TMJ popping and pain
– Increased nasal breathing to decrease allergy symptoms
-Overall increased health and well being

While it was a long journey to determine the cause of my symptoms, I am thankful to have gained this knowledge to help better support my families. Throughout my own treatment process, I became trained in orofacial myology and am better able to guide families through myofunctional therapy. I hope to provide my clients with answers earlier on to increase their overall health as young as possible. The earlier the detection, the easier the habituation into everyday lifestyles.