SPOTS OUTLINE

  1. Intro
  2. What is myo and what are the oral symptoms exhibited?
  1. Etiologies and co morbidities (SPOTS screening for myo)
  2. Speech
  3. /s, r/ and /d, n, t, l/ most often affected
  4. /g, k, c/ and ( p,b, m/
  5. Abnormal

a)Lateral and AP shifting of mandible

b)Anterior and posterior lisping

c)Molar vs. bicuspid anchoring (quick demo)

(1)“Fronting”

(2)Changes Intonation and resonance

d)Low tongue posturing

  1. Clues to tongue functioning ( group demo)

a)Extend, retract, elevate

b)Lateralize, lateralize/retract, elevate/retract

c)Point, narrow, depress

d)Shape cup, suction, lift lateral borders

e)The more dysfunction =increased mandibular involvement

  1. Posture
  2. Body posture

a)often a clue to airway

(1)sleep and TMD

(2)Forward head posture

(3)Rounded shoulders

(4)“toe standing”

b)Pain symptoms and trigger points

(1)Use of myofascial release

  1. Open mouth posturing

a)Intra oral signs

(1)Soft tissue

(2)Hard tissue

b)Extra oral signs

(1)Mouth breathing/ nasal congestion

(2)Mandibular growth

(3)TMD

  1. Occlusion
  2. Intra oral - Typically seen in myo referrals

a)Narrow, vaulted, cyanotic palate

(1)Lingually tipped dentition, crowding

b)X-bite/open bite

c)Angle’s classifications changes due to altered muscle function

  1. Extra Oral - Facial asymmetries typically seen in myo referrals

a)Cants and rotations

b)Cosmetic line

(1)Excessive vertical growth

(2)Affects temporal bone

c)Gonial angles

  1. TMD and open mouth posture

a)Changes grown patterns

b)Muscles are misused

(1)Lateral pterygoid pain – refers to TMJ

(2)Medial pterygoid pain - refers to infra auricular and posterior mandible areas

(3)Temporal pain – referred to temple, orbits and max. teeth

(4)Masseter pain– refers to ear, TMJ and mandibularTeeth

c)Clicking and deviation seen ( even in children)

  1. Tethered Oral Tissues
  2. Definition
  3. Physical signs
  4. Classification
  5. Implications

a)Speech

b)Swallow

c)posturing

d)TMD

(1)Compensatory actions

  1. Myo and myofascial release before and after to keep scar tissue supple
  1. Swallow
  2. Normal - Oral phase

a)Posterior tongue rises first to seal palate

b)Anterior stability

c)Epiglottis and esophagus

  1. Tongue thrust

a)Mandibular adaptations

b)Soft tissue dysfunctions

(1)Choking and GERD

(2)Myofascial restrictions and TMD

(a)Myofascial pain most often associated with TMD

(b)Most often are the muscles of mastication

(c)Other common etiologies

(i)Parafunctional habits

(ii)Soft palate/uvula

  1. Mastication

a)Rotary vs adaptations

b)Tongue and muscle function for oral stage swallow

  1. Myo treatment
  2. Four phases of treatment

a)Proprioception, toning, neuromuscular repatterning, rest posture

b)Swallow - liquids to dry solids

c)Incorporation in to daily living

d)Habituation

  1. Results
  2. Before and after pics
  3. Usually TMJ clicking goes away and ROM improves
  4. Arch development
  5. Musculature is more mobile and symmetrical
  6. Posture improves
  7. Sleep improves

REFERENCES

Effects of oral motor exercises and laser therapy on chronic temporomandibular disorders: a randomized study with follow-up. Machado BC, Mazzetto MO, DaSilva MA, de Felilcio CM

Orofacial motor functions in pediatric obstructive sleep apnea and implications for myofunctional therapy.DeFelicio CM, da Silva Dias FV, Folha GA, deAlmeida LA, de Souza JF Anselmo-Lima WT, Trawitzki LV, Valera FC

Patients with myogenic temporomandibular disorders have reduced oxygen extraction in the masseter muscle. Ferreira CL, Bellilstri G, Montagna S, deFelicio CM, Sforza C

Impaired orofacial motor functions on chronic temporomandibular disorder. Ferreira CL, Machaod BC, Borges CG, RodriguesDaSilva MA, Sforza C, DeFelicio CM

Orofacial manual therapy improves cervical movement impairment associated with headaches and features of temporomandibular dysfunction: a randomized controlled trial. Von Piekartz, H, Hall, T

Effects of orofacial myofunctional therapy on temporomandibular disorders.De Felicio CM, de Oliveira MM, da Silva MA

Validity of theh protocol of orofacial myofunctional evaluation with scores’ for young and adult subjects. De Felicio CM, Medeiros AP, de Oliveira Melchior M

Effect of speech-language therapy after low-level therapy in patients with TMD: a descriptive study. Melchior MO, Machado BC, Magri LV, Mazzetto MO

Effects of oral motor exercises and laser therapy on chronic temporomandibular disorders: a randomized study with follow-up. Machado BC, Mazzetto MO, DaSilva MA, de Felicio CM

Does low intensity laser therapy reduce pain and change orofacial myofunctional conditions?. Melchior Mde O, Venezian GC, Machado BC, Borges RF, Mazzetto MO

The effects of orofacial myofunctional therapy combined with an occlusal splint on signs and symptoms in a man with TMD-hypermobility: case study. DeFelicio CM, Freitas RL, Bataglion C.

Otologic symptoms of temporomandibular disorder and effect of orofacial myofunctional therapy.deFelicio CM, Melchior Mde O, Ferreira CL, Da Silva MA

Efficacy of treatment with hard and soft occlusal appliance in TMD. Littner D, Perlman-Emodi A, Vinocuor E

Therapeutic jaw exercises and interocclusal appliance therapy, A comparison between two common treatments of temporomandibular disorders, Magnusson T, Syren M

Sleep cycles, TMD, fibromyalgia, and their relationship to orofacial myofunctional disorders. Green S

Long term effect on tinnitus by treatment of temporomandibular disorders: a two;-year follow-up by questionnaire. Tullberg M, Emberg M

TMJ, eating and breathing.Cheynet F

Global body posture and plantar pressure distribution in individuals with and without temporomandibular disorder: a preliminary study.Sosuza JA, Pasinato F, Correa EC, daSilsva AM

Frequency of oral habits, dysfunctions and personalty traits in bruxing and nonbruxing children: a comparative study.Cortese SG, Fridman DE, Farah CL, Bielsa F, Grinberg J, Biondi AM

Tongue surgeries for pediatric obstructive sleep apnea: a systematic review and meta-analysis.Carnacho M, Noller MW, Zaghi S, Reckley LK, Fernandez-Salvador C, HoE, Dunn B, Chan D

Toward a functional definition of ankyloglossia: validating current grading scales for lingual frenulum length and tongue mobility in 1052 subjects. Yoon A, Azghi S, Weitzman R, HaS, Law CS, Guilleminault C, Liu SY

Tonsillectomy for adult obstructive sleep apnea: A systematic review and meta-analysis.Carnacho M, Li D, Kawai M, Zaghi S, Teixeira J, Senchak AJ, Brietzke SE, Frasier S, Certal V

Maxillary expansion and maxillomandibular expansion for adult OSA: A systematic review and meta-analysis.Abdullataif J, Certal V, Zaghi S, Sonsg SA, Chang ET, Gillespie MB, Carnacho M

Maxillomandibular advancement for treatment of obstructive sleep apnea: A meta-analysis.Zaghi S, Hooty JE, Cartal V, Abdullatif J, Guilleminault C, Powell NB, Riley TW, Camacho M

Is it just attention-deficit hyperactivity disorder…or is it? Won DC, Guilleminaulta C, Koltai PJ, Quo SD, Steint MT, Loe IM

A frequent phenotype for paedeatric sleepapnoea: short lingual frenulum. Guilleminault C, Huseni S, Lo L

Passive myofunctional therapy applied on children with obstructive sleep apnea: A 6-month follow-up. Chuang LC< Lian YC, Hervy-Auboiron M, Guillemionault C, Huang YS

Pediatric sleep-disordered breathing: New evidence on its development. Guilleminault C, Akhtar F

Myofunctional Therapy: A novel treatment of pediatric Sleep-disordered Breathing. Moeller J, Cociani Paskay L, Gelb M

Myofunctional Therapy to treat obstructive sleep apnea: A systemic review and meta-analysis. Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R, Kushida CA

The theoretical substantiation of myofunctional correction of sagittal occlusion abnormalities and temporomandibular joint dysfunction. Danilova MA, Ishmurzin PV, Zakharov SV

Myofunctional Therapy combined with Occlusal Splint in treatment of temporomandibular joint dysfunction-pain syndrome. Felicio CM, Rodriguesda Silva MA, Mazzetto MO, Centola AL

Tongue –Tie: morphogenesis,m impact, assessment and treatment. Hazelbaker, AK

Tongue Tie - from confusion to clarity: a guide to the diagnosis and treatment of ankyloglossia. Fernando C

Marchesan, I. (2013). Lingual Frenum Protocols and Researches. International Association of Orofacial Myology. Washington D.C.: CEFAC.

American Academy of Pediatrics, Summer 2004 Edition.

International Affiliation of Tongue-Tie Professionals (IATP)

pain and healing with laser is better