In Support of Myofunctional Therapy and Functional Frenuloplasty as a promising collaborative therapeutic approach to addressing tongue-tie and Obstructive sleep apnea

Recently, our practice, our Medical Director, and several of our dedicated colleagues have been the target of some rather slanderous blogging by a fellow leader in the field of sleep medicine. His article questioned our approach, and ultimately our integrity. Although we appreciate the opportunity to learn from others perspectives, we are disappointed anytime someone (especially in the medical arena) refuses to exercise their own right to maintain an open mind and possibly learn something new that could have a positive impact on our field in a meaningful way.

In essence, what we do here at The Breathe Institute is simple; We promote and facilitate a healthy roadmap to natural and exclusive nasal breathing. Our whole focus is on helping our patients optimize their health by restoring lip competency, exclusive nasal breathing and improving tongue resting posture to the roof of the mouth. We have learned and seen that some patients with sleep apnea have low resting tongue posture, and in some cases this is associated with restrictions in tongue mobility due to a restricted lingual frenulum. We have also learned that restoring the tongue to its natural biological position at the roof of the mouth helps improve CPAP compliance, helps reduce snoring, and can reduce the severity of obstructive sleep apnea indices as measured by many sleep studies. We stand by our experience thus far of 2+ years specifically dedicated to a functional approach to sleep medicine.  We have successfully treated hundreds and hundreds of patients locally as well as many who fly in from all over the world specifically for our unique approach of patients using our functional approach. Based on our experience, including 350 cases specifically of functional frenuloplasty that we have documented to date, we proudly endorse a satisfaction rate of 88% or more in regards to post-treatment health as well as a reported improved quality of life. 

We firmly believe that patients deserve to be offered an alternative to aggressive surgeries. If surgery ends up being the best option for a patient, then that would indeed be the recommendation of our practitioners, and Dr. Zaghi is a brilliantly skilled surgeon who practices conventional surgeries as well.  But we are of the mind that less invasive, more holistic modalities ought to be considered when appropriate. We are fortunate to have recruited Dr. Zaghi to be our Medical Director because of not only his demonstrated commitment to individualized patient care, but his passion for driving research and growing and sharing the compendium of medical knowledge. Dr. Zaghi is dedicated to presenting patients with an entire roadmap of different surgical and non-surgical treatment options - our patients are offered both conservative and functional approaches and we do see benefits to both of these individualized approaches depending on the patient.

Working alongside Dr. Zaghi, our Myofunctional Therapy Director, Sanda Valcu-Pinkerton has also extensively studied and researched both the scientific work of our colleagues abroad as well as those actively teaching content in the States including, but not limited to; AOMT/Joy Moeller, IAOM, Sandra Coulson, Mary Billings, Linda D'onofrio and Diane Bahr to name a few. After witnessing numerous amazing emotional, dare we say almost spiritual releases from our patients, we have even started delving deeper into research and information from the 1800’s and even further discussing the significance and health benefits of nasal breathing. In many ancient cultures, children were trained to breathe through their nose so not to become mouth breathers. Thousands of years ago, Vedic Yogi’s discussed the benefits of “Kechari Mudra” which is a breathing mudra involving touching the tip of the tongue to the uvula, and other such orofacial and nasal breathing exercises. Some of these practices reach back many thousands of years and are continued to this day.

We agree completely on one thing with the author of the piece that sparked this one: We need the standardization of protocols, scientifically rigorous research, university-based programs and institutional accreditation, so that what we are working diligently to produce alongside AAMS, and many other great organizations, educators and practitioners in the field.

Dr. Zaghi, Sanda and our entire team continue to dedicate ourselves and our time to refining our treatment protocol that incorporates a specific set of myofunctional exercises aimed at achieving lingual palatal suction and floor of mouth/jaw disassociation and awareness which we believe to be key elements of our therapy success.

We fully support the field of myofunctional therapy and wish to thank the thousands of myofunctional therapists from Boston to Brisbane, to Brazil who are pushing this field forward, and as a result seeing legitimate improvements in sleep and breathing issues in their patients (Often this is the first thing to improve after tongue-tie release).

We would love to hear from more of you, so that we can learn from your experiences as well.

It has been said that curiosity killed the cat, but in reality it's often a lack of curiosity that kills (or fails to help) patients. How are new approaches to anything tested if no one ever conducts the research required to fully determine efficacy?

At The Breathe Institute, we whole-heartedly believe that:

1. In order to advance any field of medicine or science, research must be undertaken that sheds light on previous unknowns. 
2. If hypotheses are supported by evidence and further investigation, a researcher has a good reason to continue researching.
3. “First, Do No Harm”, is the first consideration. After that a doctors goal should be to learn more, and to be and do better for his/her patients.
4. When possible and appropriate, the least invasive, and most effective approach should be considered first before invasive surgeries are attempted.
5. ​Making accusations that someone is doing harm (or is likely to cause harm) without proof or any complaints, is irresponsible and slanderous.
   
   

It should be made clear here that our practice has never claimed that a functional frenuloplasty “is the cure for sleep apnea”. Our position is that the procedure, when completed effectively, enables a patient to perform and adhere to their myofunctional exercises more readily, as well as correct physiological issues related to tethered oral tissues. Myofunctional Therapy and our Functional Frenuloplasty surgery are two collaborative tools that we have found to be remarkably effective in facilitating the elimination of disordered breathing through increased compliance and patient awareness when implemented together appropriately.

We wouldn’t ask anyone to just take our word for it. In that light, we are happy to here share a link to a collection of some of our patient testimonials and we very much look forward to releasing the findings of our ongoing study for you, the good readers of this post to review for yourselves and make up your own minds. Meanwhile we at The Breathe Institute shall continue to work diligently at treating our wonderful patients, and finishing our research publications.

We will continue to do what we can to propel the research forward, building upon the work of Dr. Christian Guilleminault whose research has been cited well over 51,800 times, as well as other leaders from Europe, Brazil and the US who are dedicating so much of their time, energy and ability to the field of myofunctional therapy. We will always strive to be patient-centered in that pursuit, even if it means questioning or venturing outside the warmth of the status quo.  We can not refute the wonderful results we are seeing in our practice - especially as we continue to get thank you card after thank you card from patients and families whose lives are being positively impacted and changed for the better.

At one point in history the majority of people were calling Galileo a heretic for having the audacity to suggest that indeed the Earth might be round. Today it seems a small number of others, seem disinclined to consider that perhaps, there could be something they don't know. Perhaps out of genuine concern for patients, or perhaps out of fear that if patients realize there may be an alternative to highly invasive surgery in some cases, they might choose to explore a more conservative treatment approach first. While some practitioners who claim to be innovators are balking at anyone who suggests more tolerable and accessible alternatives to the methods they've been proselytizing for years (entire careers in some cases), we always reserve the right to get smarter. 

We now have experience and data from 350+ cases to support specifically our functional approach to treatment of sleep and breathing issues as helpful adjuncts and honestly are honored to be singled out and identified as pioneers and leaders in this approach. Furthermore we are grateful for the continued requests from many outstanding institutions, organizations and practitioners for us to lecture, teach and share our methodologies and protocols worldwide. As awareness is rapidly spreading about the benefits of our functional approaches to frenuloplasty and sleep medicine, we are seeing our own in-house courses in Los Angeles filling up as well. This is surely an indicator that the zeitgeist is on the side of health and progress.

A series of research publications on our experiences will be available soon. For more information, please do not hesitate to reach out to us at anytime.  We do hope that our research will plant the seeds of a more positive, curious and collaborative perspective moving forward.

What is needed now is a united front, pushing for awareness and undertaking investigative studies to give us more tools to use in helping all of our patients better!

We want to hear from you:

Child development and craniosacral therapists who understand the importance of establishing nasal breathing, a normal swallowing pattern, and an adequate tongue position in growing children. the interaction between orofacial structural growth and muscle activity starts early in development, and the physiologic functions of suction, mastication, swallowing and nasal breathing in infancy play an important role in developing healthy oral habits and craniofacial development, and in stimulating subsequent growth.

Dentists who understand how low tongue resting posture causes the maxilla not to fully develop from the oral habit of resting the tongue on the floor of the mouth (rather than the palate), as well as causing improper deglutination/swallow habits. Narrow palatal vaults restrict the airway, and left untreated lead to sleep disordered breathing symptoms.

Myofunctional therapists and speech and language pathologists (SLP’s) who understand that a low tongue position can contribute to improper muscle functioning and that Increased labial muscle tone, proper positioning of the tongue on the anterior palate, and labial seal at rest contributed to the development of nasal breathing.

ENT’s and Sleep MD’s who are treating patients in a myriad of ways and understand that myofunctional therapists can be a great ally in identifying and treating patients that may have not otherwise been referred to an ENT due to obstructions present in breathing.

In the words of Thomas Jefferson, “Be bold in the pursuit of knowledge, never fearing to follow truth and reason to whatever results they lead.”