Orofacial Myofunctional Therapy before and after Laser Frenectomy

What is orofacial myofunctional therapy (OMT)?

·       Orofacial myofunctional therapy (OMT) is a program of specific exercises that target the facial muscles for chewing and swallowing.  These exercises help to strengthen the tongue muscles after the frenectomy procedure. 

Why is orofacial myofunctional therapy necessary before & after laser frenectomy?

·       Karen Wuertz, D.D.S. and Brooke Pettus, COMS are authors of the article published in Laser focus in DSP, fall 2018 wrote, “The removal of oral restrictions is necessary to attain optimal orofacial function and must be combined with regular pre- and post-frenectomy orofacial myofunctional therapy (OMT).”

·       OMT helps re-educate the tongue and orofacial muscles during movement and at rest to create new neuromuscular patterns for proper oral function, including chewing, swallowing, speaking, and breathing. 5,6

5. Guilleminault C. Huang YS, Monteyrol PJ, Sato R, Quo S, Lin CH.  Critical role of myofascial reeducation in pediatric sleep-disordered breathing. Sleep Med. 2013 Jun; 14(6): 518-25.  Doi: 10,1016/j.sleep.2013.01.013.

6. Guimaraes KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G. Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2009 May 15;179 (10):962-6. Doi:10.1164/rccm.200806-981OC.

*Case example by Karen Wuertz, D.D.S. & Brooke Pettus, COMS

Patient: 29 year old female

Clinical exam & symptoms:

·       Temporomandibular Disorder (TMD) symptoms with jaw deviation, clicking/popping on the right side

·       Neck pain and frequent headaches

·       Low facial muscle tone, a short upper lip

·       Mouth breathing all night, regular night time drooling, restless sleep

·       Complained of daytime fatigue & never waking well rested

·       Frequent congestion

·       Forward head/neck and forward rolled shoulder posture

·       Tension in the neck and shoulders

·       Tongue thrust during swallowing

·       Dry, chapped lips and the habits of lip licking, cheek biting and clenching

Intraoral examination:

·       Narrow, high palate

·       Tight upper labial frenum and attached gingiva

·       Tongue is short and wide with a tight, restrictive lingual frenum

·       Range of Motion (ROM) was 28mm from tongue tip to incisive papilla

Laser Surgery:

·       CO2 laser frenectomy was performed to release lip and tongue restrictions

·       Patient was asked to lift, extend, and lateralize the tongue

·       ROM was measured at 47mm.  Patient gained 19mm in the ROM with tongue tip to incisive papilla (gum tissue between upper 2 front teeth).

Postoperative care and healing:

·       Almost immediately, patient reported less neck and shoulder tension

·       Could stand up straighter

·       Her airway felt more open when breathing

·       Able to close her mouth without straining on her upper lip

·       Able to elevate the middle and posterior portions of the tongue to the palate

·       800mg ibuprofen was taken twice the day of and once the day after

·       Soft, bland diet for 48 hours

·       Continue orofacial myofunctional therapy (OMT) regimen after the revisions

-OMT helped the patient retrain and re-pattern neuromuscular movements that had been foreign to her and helped her integrate them into her everyday life

Results:

·       Proper oral posture (tongue to palate)

·       Lip (no open mouth posture at rest)

·       Nasal breathing got increasingly easier

·       Better posture, more energy, eats less, feels rested in the morning

·       Sleeps through the night

·       Tongue thrust eliminated

·       No more night time drooling

·       Decreased in clenching and biting the sides of her tongue at night

Summary:

Optimal orofacial functions in adult patients can be achieved through laser lip and tongue frenectomy procedures and regular pre- and post-frenectomy orofacial myofunctional therapy.

*“The Importanace of Orofacial Myfunctional Therapy Before and After CO2 Laser Frenectomy in Achieving Optimal Orofacial Function” by Karen M. Wuertz, DDS, ABCDSM, ABLS, FOM, and Brooke Pettus, RDH, BSDH, COMS

Dr. Anna Lee is a general & cosmetic dentist in Glendora, CA.  Dr. Anna Lee is an experienced provider for laser frenectomy.  If you have any questions about lip and tongue ties, please visit us at www.annaleedds.com or call for a consultation at 626-335-5114.