A minor surgical intervention can be a life changing experience. “There’s nothing I can say enough, do enough, or give back enough that explains my gratitude to her,” was Dalan Motz’ heartfelt response to Dr. Amy Luedemann-Lazar. The experience a father and mother shared when their son, Mason, who was finally able to speak clearly and articulate his words without difficulty for the first time in his life, after a tongue-tie release surgery, should serve as a testament to that fact.
Mason Motz is a 6 year old boy who until recently lacked the ability to fully enunciate words despite years of speech therapy. The Motz family emphasized that the combination of Mason’s sleep disordered breathing and inability to chew and swallow food without choking was the source of numerous behavioral problems in his life. Mason was diagnosed with Sotos syndrome, a genetic disorder identified by a long, narrow face, overgrowth in childhood, and learning disabilities. Seeking remediation from numerous clinicians, including pediatricians, geneticists, neurologists, and speech pathologists, proved personally frustrating and ineffective in alleviating these symptoms.
Enter Dr. Amy Luedemann-Lazar, a dentist specializing in tongue-tie release who recognizes the virtues of holistic treatment and interdisciplinary treatment modalities. While performing routine dental work, she observed Mason’s tongue-tie. After consulting with his parents, she performed a simple, non-invasive surgical release that permanently changed the course of the entire Motz family. The results were astonishing! Upon returning home, Mason began to speak in full sentences. He is presently not afflicted by obstructive sleep apnea and snoring. Chewing and swallowing food no longer present a daily choking hazard for him. In short, his quality of life has drastically improved.
Points worth considering…
Detecting the presence of tongue-tie should be a priority for our child(ren)! Dr. Luedemann-Lazar advocates, as do I and virtually all the myofunctional therapists I know, for mandatory tongue-tie screening as part of a comprehensive health treatment assessment.
Tongue-tie, medically termed ankyloglossia, which is defined as a short or thickened frenulum restricting the tongue’s range of motion has multiple sequela which even experienced medical professionals may dismiss or overlook. Tongue-tie affects the natural resting posture of the tongue inside the mouth, inhibiting one’s ability to speak, eat, practice nasal breathing, and/or sleep soundly. An aberrant oral resting position can develop multiple pathologies, anatomical, physiological, and behavioral: including malocclusion, mouthbreathing, and altered facial development (such as “long face syndrome”).
Collaborative interdisciplinary treatment modalities are beneficial in diagnosis, assessment, and remediation. Mason’s case teaches us that the more clinical professionals we incorporate in our treatment plans, the higher the odds of achieving optimal health. Mason’s team included pediatricians, geneticists, neurologists, speech therapists, and a caring, attentive dentist who was able to properly diagnose and release his tongue-tie.
Successfully treating orofacial myofunctional disorders (OMDs) through the combination of surgery and myofunctional therapy greatly enhances the patient’s quality of life. Clinical research has demonstrated the effectiveness of myofunctional therapy, both alone and as an adjunct treatment modality to surgical intervention. Repatterning dysfunctional orofacial behaviors (ie. tongue thrust, mouth breathing, etc.) and eliminating harmful habits (ie. finger sucking, nail biting, etc.) are examples of integral behavior modification techniques applied by myofunctional therapists.
In this month’s professional profile, I would like to bring attention to an individual who embodies these traits. Kristie Gatto is not only a successful SLP (speech language pathologist), but she is also a lifelong student, a business owner, and an accomplished author. Ms. Gatto’s career delineates a deliberate and methodical approach to improving oneself. To better understand the nature of the pathological elements that the orofacial myologist must address, Ms. Gatto devoted thousands of hours to reading research materials which identified exactly how dysfunction develops throughout the orofacial region from a physiological and anatomical perspective. She is driven to know, explain, and illustrate the relationships that disparate units of the orofacial complex can have when they are underdeveloped and/or when deleterious behavior negatively impacts anatomical function
The pursuit of continuous education and professional excellence are important pillars, but the foundational stone of orofacial myology is the desire to be prolific in addressing clinical issues that patients bring one’s way. Ultimately, the orofacial myologist’s purpose is to incapacitate the patient’s pain and discomfort by teaching them how to overcome potentially debilitating behaviors/habits which frequently inhibit the execution of vital functions! Maladaptive orofacial behaviors (including non-nutritive sucking, mouth breathing, tongue thrusting, etc.) can significantly alter the musculature, structure, and function of the orofacial complex. A myofunctional therapist must be aware of exactly how to address a patient’s unique condition as there is no universal treatment solution.
With an ever growing spotlight on orofacial myofunctional disorders (OMDs) and their impact on overall well being, the orofacial myologist must be committed to continuous education. Research demonstrates that focusing on an isolated behavior, such as tongue thrust, is not nearly as effective a treatment plan as addressing the multiple interrelated factors which arise from and/or precipitate the behavior. Additionally, there are concepts, such as compensation, dissociation, impact of motor reflexes, and congenital neurological conditions that have slowly, but steadily received increasing attention from research in an attempt to illustrate a comprehensive view of the cause and effects behind (OMDs). A successful myofunctional therapist is aware of these advances. Awareness is not circumscribed to the orofacial myologist by any means!
In this day and age, parents are increasingly coming into offices with questions, having done some preliminary investigative work. Iit is incumbent upon the myofunctional therapist to stride over some of the comfortable boundaries he/she may have in respect to being researchers and lifelong students. One of Ms. Gatto’s contributions to the field of orofacial myology is The Orofacial Complex The Evolution of dysfunction. This insightful tool effectively illustrates the various muscles, structures, and co-relational functions of the orofacial complex. With over 170 pages, The Orofacial Complex outlines everything from terminology to the interconnections between the facial/cranial nerves and the specific muscles of each orofacial structure. Detailed pictures of muscles and bones add color and stunning visual cues, in addition to functional significance assessments, and real life implications of abnormalities. This manual is comprehensive in tying together the phenomenon of various organs/muscles and how dysfunction within each potentially leads to OMDs.
After obtaining her certification in Orofacial Myology, administered through the IAOM (International Association of Orofacial Myology), Ms. Gatto dedicated her professional life to improving people’s quality of life. She has been a strong promoter of interdisciplinary relationships ranging between hospital based teams, oral and maxillofacial surgeons, neurologists, otolaryngologists, orthodontists, pediatric dentists, pediatricians, and myofunctional therapists . Orofacial myology encourages a collaborative atmosphere of professionals as a means of addressing not only the noxious habits people have come to practice, but also the anatomical etiologies behind those behaviors. Often times, the habits are merely an individual’s attempt to achieve an acceptable degree of function. Compensation is the result of an individual’s desire to achieve function to the very best of their ability!
The logic behind having a team approach is to ensure that each aspect of pathology is appropriately addressed. Myofunctional therapists for habituation and behavior modification, surgeons for surgical interventions, psychologists for the process of transition and healing, nutritionists for implementation of a balanced and healthy diet, and pharmacists to ameliorate any pain or discomfort after a surgical intervention. The more facets that are covered by the team, the more successful the outcome. The orofacial myologist’s goal is to assist the patients transition into a healed, healthy, and vibrant human being. This is the benchmark of care and what each service provider must strive for.
Often times, it is easy to disregard the significance of a single conversation, never mind the profound impact it can have on an entire profession, a specific medical field, and perhaps even the world. Such an impactful conversation took place in 2009, when two very successful dentists and iconoclastic visionaries, Dr. Gelb and Dr. Hindin, were able to conceive a novel way of looking at dental pathology. They decided to shine light through an entire new prism: Airway Centric®.
The effects of this conversation produced powerful, redounding ripples across the field of dentistry. Ultimately, from the seeds of this conversation sprouted a bountiful harvest including the creation of AirwayCentric® (philosophy, appliances and education), the American Academy of Physiological Medicine and Dentistry (AAPMD), the Foundation for Airway Health, and the book, GASP: Airway Health; The Hidden Path to Wellness, along with the terms “Hidden Airway”, “Connecting the Dots”, White Flag Event” and “Airway for All.”
One of the major tenets established by Dr. Gelb and Dr. Hindin was the imminent need for a paradigm shift in the field of dentistry. Their vision is a recalibration of the focus that medical provider direct: rather than treating the side effects of pathology, one should aim for direct remediation on the pathology itself! In other words, instead of simply fixing the visible symptoms (dental malocclusion, allergy problems, mouth breathing, improper chewing / swallowing, mandibular protrusion, etc.) there must be a recognition that those symptoms are an effect, however significant they may be, of a greater cause; usually an insidious underlying problem. One that traditional medicine often overlooks.
Drs. Gelb and Hindin understood the necessity of directing attention to an open airway, or a patient’s ability to breathe effectively, before anything else. It is only through a patent airway that we can access the essential nutrient for life; oxygen. With myofunctional therapy, much like orthodontics and general dentistry, each provider must realize that, “Without the airway problem ever being discovered by patient or practitioner, interventions produced only symptomatic and temporary relief.”1 When people develop pathology due to a compromised ability to breathe, structural compensation and tissue deformation follow sequentially, as every living organism needs oxygen to live. Breathing is an indispensable function, without equal, as every living creatures need for air supersedes water and food intake; respectively in order of importance. Regardless of the cause of compromised oxygen intake due to: either tongue-tie, habituation of mouth breathing, deformation due to genetic factors, or impaired reflex development, the inability to secure an ample amount of oxygen all the way down to the cellular level destroys, inhibits, and retards our ability to grow and function optimally.