Research

Publication trends and levels of evidence in orofacial myofunctional therapy literature

Bibliography by topic with graded levels of evidence

OMT For Articulation

Bigenzahn W, Fishchman L, Mayrhofer-Krammel U (1992). Myofunctional therapy in patients with orofacial dysfunctions affecting speech. Folia Phoniatrica et Logopaedica, 44(5):238-44.

· Level 4

· Case series; 45 subjects

· “Myofunctional therapy is highly instrumental also in phoniatrics as a special form of treatment for disorders of articulation.”

Ferreira TS, Mangilli LD, Sassi FC, Fortunato-Tavares T, Limongi SC, Andrade CR (2011). Speech and myofunctional exercise physiology: a critical review of the literature. Jornal da Sociedade Brasileira de Fonoaudiologia, Sep;23(3):288-96.

· Level 3

· Limited literature review 2000-2010

· “There is a lack of knowledge about the effects of the myofunctional exercises used by clinicians. Also there is a lack of scientific evidence to determine the frequency at which they should be performed.”

Kent, R. D. (2015). Nonspeech oral movements and oral motor disorders: a narrative review. American Journal of Speech-Language Pathology, 24(4), 763-789. doi: 10.1044/2015_AJSLP-14-0179

· Level 5

· Literature review of quasispeech, paraspeech, speechlike, and nonspeech oral movements.

· “Nonspeech movements have a broad spectrum of clinical applications, including developmental speech and language disorders, motor speech disorders, feeding and swallowing difficulties, obstructive sleep apnea syndrome, trismus, and tardive stereotypies. “

Lee AS, Gibbon FE (2015). Non-speech oral motor treatment for children with developmental speech sound disorders. Cochrane Database of Systematic Reviews, Mar 25;(3):CD009383. doi: 10.1002/14651858.CD009383.pub2.

· Level 3

· Literature review of 3 “biased” randomized controlled studies considered

· “Currently no strong evidence suggests that nonspeech oral motor therapies are an effective treatment or an effective adjunctive treatment for children with developmental speech sound disorders. “

McCauley RJ, Strand E, Lof GL, Schooling T, Frymark T (2009). Evidence-Based Systematic Review: Effects of Nonspeech Oral Motor Exercises on Speech. American Journal of Speech Language Patholology, 18(4), 343-360. doi: 10.1044/1058-0360(2009/09-0006).

· Level 3

· Literature review of 15 studies between 1960 and 2007

· “Insufficient evidence to support or refute the use of oral motor exercises to produce effects on speech was found in the research literature. “

Ray, J (2002). Orofacial myofunctional therapy in dysarthria: a study on speech intelligibility. International Journal of Orofacial Myology, Nov;28:39-48.

· Level 4

· Case series; 12 subjects

· “Post-therapy measures indicated significant improvements in the stated goals as well as in speech intelligibility for single words.”

Ray J (2003). Effects of orofacial myofunctional therapy on speech intelligibility in individuals with persistent articulatory impairments. International Journal of Orofacial Myology, Nov;29:5-14.

· Level 4

· Case series; 6 subjects

· “Speech intelligibility increased significantly in all clients except the one diagnosed with developmental apraxia of speech.”

Ruscello DM (2008). Nonspeech oral motor treatment issues related to children with developmental speech sound disorders. Language, Speech, and Hearing Services in Schools Jul;39(3):380-91. doi: 10.1044/0161-1461(2008/036).

· Level 5

· Expert opinion

· “There is no substantive evidence to support nonspeech oral motor treatments as interventions for children with developmental speech sound disorders.”

Van Lierde KM, Luyten A, D’haeseller E, Van Maele G, Becue L, Fonteyne E, Corthals P, DePauw G (2015). Articulation and oromyofunctional behavior in children seeking orthodontic treatment. Oral Diseases, May;21(4):483-92. doi: 10.1111/odi.12307. Epub 2015 Feb 2.

· Level 3

· Case controlled study; 56 subjects

· “Children seeking orthodontics have articulatory and oromyofunctional disorders. To what extent a combined orthodontic and logopaedic treatment can result in optimal oral health is subject for further multidisciplinary research.”


OMT For Dysphagia, Oral Stage Swallow, Feeding

Arvedson J, Clark H, Lazarus C, Schooling T, Frymark T (2010). Evidence-based systematic review: effects of oral motor interventions on feeding and swallowing in preterm infants. American Journal of Speech Language Pathology, Nov;19(4):321-40. doi: 10.1044/1058-0360(2010/09-0067). Epub 2010 Jul 9.

· Level 3

· Literature review 1960-2007 oral motor interventions on feeding and swallowing; 6 studies of lesser quality research reviewed

· “Although some oral motor interventions show promise for enhancing feeding/swallowing in preterm infants, methodological limitations and variations in results across studies warrant careful consideration of their clinical use.”

Burkhead LM, Sapienza CM, Rosenbek JC (2007). Strength-training exercise in dysphagia rehabilitation: principles, procedures, and directions for future research. Dysphagia, Jul;22(3):251-65. Epub 2007 Apr 25.

· Level 5

· Expert opinion

· “Explore the overriding principles of neuromuscular plasticity with regard to strength training.”

Byeon H (2016). Effect of orofacial myofunctional exercise on the improvement of dysphagia patients’ orofacial muscle strength and diadochokinetic rate. Journal of Physical Therapy Science, Sep; 28(9): 2611–2614. doi: 10.1589/jpts.28.2611.

· Level 3

· Case controlled study; 50 subjects

· “Orofacial myofunctional exercise is effective in the rehabilitation of swallowing function in the oral phase in dysphagia patients by improving orofacial muscle strength and response rate.”

Cho Y-S, Oh D-H, Paik Y-R, Lee J-H, Park J-S (2017). Effects of bedside self-exercise on oropharyngeal swallowing function in stroke patients with dysphagia: a pilot study. Journal of Physical Therapy Science, 29(10):1815-1816. doi:10.1589/jpts.29.1815.

· Level 4

· Case series; 9 subjects

· “This study demonstrated that bedside self-exercise is a positive method to improve oropharyngeal swallowing function in patients with dysphagia after stroke.”

Crary MA, Carnaby GD. (2014) Adoption into clinical practice of two therapies to manage swallowing disorders: exercise based swallowing rehabilitation and electrical stimulation. Current Opinion in Otolaryngology and Head and Neck Surgery, 22(3):172-180. doi:10.1097/MOO.0000000000000055.

· Level 3

· Narrative literature review

· “Current efforts indicate that exercise based therapies should incorporate multiple principles of exercise physiology and document physiologic change within the impaired swallowing mechanism. “

Guica MR, Pasini M, Pagano A, Mummolo S, Vanni A (2008). Longitudinal study on a rehabilitative model for correction of atypical swallowing. European Journal of Paediatric Dentistry, Dec;9(4):170-4.

· Level 4

· Case series; 57 subjects

· “The results show the benefits of myofunctional therapy in the treatment of children with abnormal swallowing.”

Hagg M, Anniko M (2008). Lip muscle training in stroke patients with dysphagia. Acta Otolaryngoligica, Sep;128(9):1027-33. doi: 10.1080/00016480701813814.

· Level 3

· Retrospective Study; 30 subjects

· “Training with an oral screen can improve lip force and swallowing capacity in stroke patients with oropharyngeal dysphagia.”

Kang JH, Park RY, Lee SJ, Kim JY, Yoon SR, Jung KI (2012). The effect of bedside exercise program on stroke patients with dysphagia. Annals of Rehabilitation Medicine, Aug;36(4):512-20. doi: 10.5535/arm.2012.36.4.512. Epub 2012 Aug 27.

· Level 3

· Case controlled study; 50 subjects

· “Bedside exercise program showed an improvement of swallowing function and exhibited a positive secondary effect, such as mood state and quality of life, on subacute stroke patients with dysphagia.”

Kays S, Robbins J (2006). Effects of sensorimotor exercise on swallowing outcomes relative to age and age-related disease. Seminars in Speech and Language, Nov;27(4):245-59.

· Level 5

· Expert opinion

Kim HD, Choi JB, Yoo SJ, Chang MY, Lee SW, Park JS (2017). Tongue-to-palate resistance training improves tongue strength and oropharyngeal swallowing function in subacute stroke survivors with dysphagia. Journal of Oral Rehabilitation, Jan;44(1):59-64. doi: 10.1111/joor.12461.

· Level 2

· Prospective therapeutic controlled study

· “This study demonstrated the effectiveness of tongue-to-palate resistance training in increasing tongue muscle strength and improving swallowing function in patients with post-stroke dysphagia.”

Kim KD, Lee HJ, Lee MH, Ryu HJ (2015). Effects of neck exercises on swallowing function of patients with stroke. Journal of Physical Therapy Science, Apr;27(4):1005-8. doi: 10.1589/jpts.27.1005. Epub 2015 Apr 30.

· Level 1

· Randomized control study; 26 subjects

· “The study results suggest the effectiveness of proprioceptive neuromuscular facilitation-based short neck flexion exercises as a treatment for swallowing disorders in stroke patients.”

Koyama Y, Sugimoto A, Hamano T, Kasahara T, Toyokura M, Masakado Y (2017). Proposal for a Modified Jaw Opening Exercise for Dysphagia: A Randomized, Controlled Trial. Tokai Journal of Experimental and Clinical Medicine, Jul 20;42(2):71-78.

· Level 1

· Case controlled study; 16 subjects

· “Modified jaw opening exercise is feasible without any adverse events in post-stroke patients, and it promotes anterior hyoid displacement during swallowing.”

Langmore SE, Pisegna JM (2015). Efficacy of exercises to rehabilitate dysphagia: A critique of the literature. International Journal of Speech-Language Pathology, Jun;17(3):222-9. doi: 10.3109/17549507.2015.1024171. Epub 2015 Mar 31.

· Level 4

· Literature review of 5 studies

· “Although some oral motor interventions show promise for enhancing feeding/swallowing in preterm infants, methodological limitations and variations in results across studies warrant careful consideration of their clinical use.”

Logeman JA (2007). Swallowing disorders. Best Practice and Research. Clinical Gastroenterology, 21(4):563-73.

· Level 5

· Expert opinion


Malandraki GA, Kaufman A, Hind J, Ennis S, Gangnon R, Waclawik A, Robbins J (2012). The effects of lingual intervention in a patient with inclusion body myositis and Sjogren’s syndrome: a longitudinal case study. Archives of Physical Medicine and Rehabilitation, Aug;93(8):1469-75. doi: 10.1016/j.apmr.2012.02.010. Epub 2012 Feb 27.

· Level 5

· Case study

· “Isometric lingual strengthening was effective in maintaining posterior tongue lingual pressure and Penetration-Aspiration Scale scores during the treatment periods. “

Morgan AT, Dodrill P, Ward EC (2012). Interventions for oropharyngeal dysphagia in children with neurological impairment. Cochrane Database of Systematic Reviews, Oct 17;10:CD009456. doi: 10.1002/14651858.CD009456.pub2.

· Level 2

· Meta-analysis of 3 lesser quality randomized controlled studies

· “There is currently insufficient high-quality evidence from randomised controlled trials or quasi-randomised controlled trials to provide conclusive results about the effectiveness of any particular type of oral-motor therapy for children with neurological impairment.”

Namasivayam-MacDonald AM, Burnett L, Nagy A, Waito AA, Steele CM (2017). Effects of tongue strength training on mealtime function in long-term care. American Journal of Speech Language Pathology, Nov 8;26(4):1213-1224. doi: 10.1044/2017_AJSLP-16-0186.

· Level 4

· Case series; 7 subjects

· “Anterior and posterior tongue strength increased significantly with therapy. There were no changes in mealtime function.”

Oh DH, Won JH, Kim YA, Kim WJ (2017). Effects of jaw opening exercise on aspiration in stroke patients with dysphagia: a pilot study. Journal of Physical Therapy Science, Oct;29(10):1817-1818. doi: 10.1589/jpts.29.1817. Epub 2017 Oct 21.

· Level 5

· Case study; 3 subjects

· “Jaw opening exercises can be effective in reducing aspiration in dysphagia patients after stroke.”

Oh JC (2016). A pilot study of the head extension swallowing exercise: new method for strengthening swallowing-related muscle activity. Dysphagia, Oct;31(5):680-6. doi: 10.1007/s00455-016-9732-8. Epub 2016 Jul 26.

· Level 4

· Case series; 15 subjects

· “Jaw opening exercise can be used to reduce aspiration in patients with dysphagia after stroke. The head extension swallowing exercise appears effective in exercising and strengthening the suprahyoid muscles and tongue muscles in healthy subjects.”

Park T, Kim Y (2016). Effects of tongue pressing effortful swallow in older healthy individuals. Archives of Gerontology and Geriatrics, Sep-Oct;66:127-33. doi: 10.1016/j.archger.2016.05.009. Epub 2016 Jun 3.

· Level 4

· Case series; 27 subjects

· “The tongue pressing effortful swallow had statistically significant and positive effects on increasing maximum tongue pressure.”

Robbins J, Kays SA, Gangnon RE, Hind JA, Hewitt AL, Gentry LR, Taylor AJ (2007). The effects of lingual exercise in stroke patients with dysphagia. Archives of Physical Medicine and Rehabilitation, Feb;88(2):150-8.

· Level 4

· Case series; 10 subjects

· “Lingual exercise enables acute and chronic dysphagic stroke patients to increase lingual strength with associated improvements in swallowing pressures, airway protection, and lingual volume.”

Steele, CM (2012). Exercise-based approaches to dysphagia rehabilitation. Nestle Nutrition Institute Workshop Series, 72:109-17. doi: 10.1159/000339999. Epub 2012 Sep 24.

· Level 4

· Literature review

· “Exercise-based approaches to swallowing rehabilitation do succeed in changing muscle strength and function, but generalization to true swallowing tasks may be somewhat limited.”

Steele CM, Bayley MT, Peladeau-Pigeon M, Nagy A, Namasivayam AM, Stokely SL, Wolkin T (2016). A Randomized Trial Comparing Two Tongue-Pressure Resistance Training Protocols for Post-Stroke Dysphagia. Dysphagia, Jun;31(3):452-61. doi: 10.1007/s00455-016-9699-5. Epub 2016 Mar 2.

· Level 1

· Randomized controlled study; 6 subjects

· “Improved penetration-aspiration does not necessarily accompany improvements in tongue strength, however tongue-pressure resistance training does appear to be effective for reducing thin liquid vallecular residue.”

Steele CM, Bailey GL, Polacco REC, Hori SF, Molfenter SM, Oshalla M, Yeates EM (2013). Outcomes of tongue-pressure strength and accuracy training for dysphagia following acquired brain injury. International Journal of Speech-Language Pathology. 2013;15(5):492-502. doi:10.3109/17549507.2012.752864.

· Level 3

· Case controlled study; 6 subjects

· “Improvements were seen in post-treatment measures of tongue pressure and penetration–aspiration. No improvements were seen in pharyngeal residues, indeed worsening residue was seen in some patients.”

Wada S, Tohara H, Iida T, Inoue M, Sato M, Ueda K (2012). Jaw-opening exercise for insufficient opening of upper esophageal sphincter. Archives of Physical Medicine and Rehabilitation, Nov;93(11):1995-9. doi: 10.1016/j.apmr.2012.04.025. Epub 2012 May 10.

· Level 4

· Case series; 8 subjects

· “The jaw-opening exercise is an effective treatment for dysphagia caused by dysfunction of hyoid elevation and upper esophageal sphincter opening.”

Wakabayashi H, Matsushima M, Momosaki R, Yoshida S, Mutai R, Yodoshi T, Murayama S, Hayashi T, Horiguchi R, Ichikawa H (2018). The effects of resistance training of swallowing muscles on dysphagia in older people: A cluster, randomized, controlled trial. Nutrition, Apr;48:111-116. doi: 10.1016/j.nut.2017.11.009. Epub 2017 Nov 27.

· Level 1

· Randomized controlled study; 91 subjects

· “Resistance training of swallowing muscles did not improve dysphagia in this study.”

Yeates EM, Molfenter SM, Steele CM (2008). Improvements in tongue strength and pressure-generation precision following a tongue-pressure training protocol in older individuals with dysphagia: Three case reports. Clinical Interventions in Aging, 3(4):735-747.

· Level 5

· Case studies; 3 subjects

· “Tongue-pressure training was beneficial for improving both instrumental and functional aspects of swallowing.”

OMT For the Elderly & Special Populations

Argolo N, Sampaio M, Pinho P, Melo A, Nobrega AC (2013). Do swallowing exercises improve swallowing dynamic and quality of life in Parkinson’s disease? NeuroRehabilitation, 32(4):949-55. doi: 10.3233/NRE-130918.

· Level 4

· Case series; 15 subjects

· “Motor swallowing exercises may reduce swallowing disorders in Parkinson’s disease patients without lingual pumping and dental absence and impact positively quality of life and swallowing complaints in individuals with Parkinson’s disease.”

Cai ZG, Shi XJ, Lu XG, Yang ZH, Yu GY (2010). Efficacy of functional training of the facial muscles for treatment of incomplete peripheral facial nerve injury. Chinese Journal of Dental Research, 13(1):37-43.

· Level 3

· Case controlled study; 92 subjects

· “The recovery rate of the treatment group was superior to the control group in the first year after severe nerve injury.”

Cardoso Jr, Teixeira EC, Moreira MD, Favero FM, Fontes SV, Bulle de Oliveira AS (2008). Effects of exercises on Bell's palsy: systematic review of randomized controlled trials. Otology and Neurotology, Jun;29(4):557-60. doi: 10.1097/MAO.0b013e31816c7bf1.

· Level 1

· Meta-analysis of Level 1 research; 4 studies

· “Because of the small number of randomized controlled trials, it was not possible to analyze if the exercises, associated either with mirror or electromyogram biofeedback, were effective.”

Inal O, Serel Arslan S, Demir N, Tunca Yilmaz O, Karaduman AA (2017). Effect of Functional Chewing Training on tongue thrust and drooling in children with cerebral palsy: a randomized controlled trial. Journal of Oral Rehabilitation, Nov;44(11):843-849. doi: 10.1111/joor.12544. Epub 2017 Jul 28.

· Level 3

· Case controlled study; 32 subjects

· “Functional chewing training is an effective approach on the severity of tongue thrust and drooling in children with cerebral palsy.”

Kraaijenga SAC, Molen LV, Stuiver MM, Takes RP, Al-Mamgani A, Brekel MWMVD, Hilgers FJM (2017). Efficacy of a novel swallowing exercise program for chronic dysphagia in long-term head and neck cancer survivors. Head & Neck, Oct;39(10):1943-1961. doi: 10.1002/hed.24710. Epub 2017 Aug 2.

· Level 4

· Case series; 17 subjects

· “Some objective and subjective effects of progressive load on muscle strength and swallowing function could be demonstrated.”

Kraaijenga SA, van der Molen L, Stuiver MM, Teertstra JH, Hilgers FJ, van den Brekel MW (2015). Effects of strengthening exercises on swallowing musculature and function in senior heathy subjects: a prospective effectiveness and feasibility study. Dysphagia, Aug;30(4):392-403. doi: 10.1007/s00455-015-9611-8. Epub 2015 Apr 4.

· Level 4

· Feasibility study; 10 subjects

· “This prospective effectiveness/feasibility study on the effects of chin tuck against resistance and jaw opening against resistance isometric and isokinetic strengthening exercises on swallowing musculature and function shows that senior healthy subjects are able to significantly increase swallowing muscle strength and volume after a 6-week training period.”

Lazarus C (2006). Tongue strength and exercise in healthy individuals and in head and neck cancer patients. Seminars in Speech and Language, Nov;27(4):260-7.

· Level 5

· Expert opinion

· “The effects of skeletal muscle strengthening programs on muscle physiology are discussed, as are the effects of tongue strengthening exercise programs on tongue strength and swallowing.”

Lazarus CL, Husaini H, Falciglia D, DeLacure M, Branski RC, Kraus D, Lee N, Ho M, Ganz C, Smith B, Sanfilippo N(2014). Effects of exercise on swallowing and tongue strength in patients with oral and oropharyngeal cancer treated with primary radiotherapy with or without chemotherapy. International Journal of Oral and Maxillofacial Surgery, May;43(5):523-30. doi: 10.1016/j.ijom.2013.10.023. Epub 2013 Dec 11.

· Level 1

· Randomized controlled study

· “Tongue strengthening did not yield a statistically significant improvement in either tongue strength or swallowing measures in this patient cohort.”

Logemann JA, Pauloski BR, Rademaker AW, Colangelo LA (1997). Speech and swallowing rehabilitation for head and neck cancer patients. Oncology, May;11(5):651-6, 659; discussion 659, 663-4.

· Level 4

· Prospective comparative study

· “Pilot data support the use of range of motion exercises for the jaw, tongue, lips, and larynx in the first 3 months after oral or oropharyngeal ablative surgical procedures, as patients who perform range of motion exercises on a regular basis exhibit significantly greater improvement in global measures of both speech and swallowing, as compared with patients who do not do these exercises.”

Mackenzie C, Muir M, Allen C (2010). Non-speech oro-motor exercise use in acquired dysarthria management: regimes and rationales. International Journal of Language and Communication Disorders, Nov-Dec;45(6):617-29. doi: 10.3109/13682820903470577

· Level 5

· Questionnaire on oral motor exercise use for dysarthria

· “Non-speech oro-motor exercises are a frequent component of dysarthria management in the UK.”

Pauloski BR, Rademaker AW, Logemann JA, Colangelo LA (1998). Speech and swallowing in irradiated and nonirradiated postsurgical oral cancer patients. Otolaryngology Head and Neck Surgery, May;118(5):616-24.

· Level 4

· Case series; 9 subjects

· “Increased use of tongue range-of-motion exercises during and after radiation treatment may reduce the formation of fibrotic tissue in the oral cavity and may improve pharyngeal clearance by maintaining adequate tongue base-to-pharyngeal wall contact.”

Pereira LM, Obara K, Dias JM, Menacho MO, Lavado EL, Cardoso JR (2011). Facial exercise therapy for facial palsy: systematic review and meta-analysis. Clinical Rehabilitation, Jul;25(7):649-58. doi: 10.1177/0269215510395634. Epub 2011 Mar 7.

· Level 1

· Literature review of 6 randomized controlled studies; Meta-analysis of 1 study

· “Facial exercise therapy is effective for facial palsy for the outcome functionality.”

Perry A, Lee SH, Cotton S, Kennedy C (2016). Therapeutic exercises for affecting post-treatment swallowing in people treated for advanced-stage head and neck cancers. The Cochrane Database of Systematic Reviews, Aug 26;(8):CD011112. doi: 10.1002/14651858.CD011112.pub2.

· Level 1

· Meta-analysis of 6 studies with small subject numbers found to have high bias

· “No evidence that undertaking therapeutic exercises before, during and/or immediately after HNC treatment leads to improvement in oral swallowing.”

Ray J(2001). Functional outcomes of orofacial myofunctional therapy in children with cerebral palsy. International Journal of Orofacial Myology, Nov;27:5-17.

· Level 4

· Case series, 16 subjects

· “Post-therapy measures indicated significant improvement in functioning of lips, tongue, and jaw. Speech intelligibility of words also improved significantly.”

Robbins J, Gangnon RE, Theis SM, Kays SA, Hewitt AL, Hind JA (2005). The effects of lingual exercise on swallowing in older adults. Journal of the American Geriatrics Society, Sep;53(9):1483-9.

· Level 4

· Case series; 10 subjects

· “Lingual resistance exercise is promising not only for preventing dysphagia due to sarcopenia, but also as a treatment strategy for patients with lingual weakness and swallowing disability due to frailty or other age-related conditions.”

Russell JA, Ciucci MR, Connor NP, Schaller T (2010). Targeted exercise therapy for voice and swallow in persons with Parkinson's disease. Brain Research, Jun 23;1341:3-11. doi: 10.1016/j.brainres.2010.03.029. Epub 2010 Mar 15.

· Level 4

· Literature review of voice and swallowing exercises specific to Parkinson’s disease

· “Targeted training for voice and swallow is a promising but under-studied intervention for cranial sensorimotor deficits associated with Parkinson’s disease.”

Saccomanno S, Martini C, D’Alatri L, Farina S, Grippaudo C (2018). A specific protocol of myo-functional therapy in children with Down syndrome. A pilot study. European Journal of Paediatric Dentistry, Sep;19(3):243-246. doi: 10.23804/ejpd.2018.19.03.14.

· Level 5

· Case Study

· “In addition to the functional results, such as the correction of the atypical swallowing, restoration of lip competence, breathing improvement and reduction of nasal rhinorrhea, there were also aesthetic results.”

Sjogreen L, Tulinius M, Kiliaridis S, Lohmander A (2010). The effect of lip strengthening exercises in children and adolescents with myotonic dystrophy type 1. International Journal of Pediatric Otorhinolaryngology, Oct;74(10):1126-34. doi: 10.1016/j.ijporl.2010.06.013. Epub 2010 Jul 16.

· Level 3

· Case controlled study; 8 subjects

· Increased lip strength did not automatically lead to improved function.

Sugiyama T, Ohkubo M, Honda Y, Tasaka A, Nagasawa K, Ishida R, Sakurai K (2013). Effect of swallowing exercises in independent elderly. Bulletin of Tokyo Dental College, 54(2):109-15.

· Level 4

· Case series; 29 subjects

· “Analyses demonstrated significant increases in diadochokinesis rate (/ta/ and /ka/) and unstimulated whole saliva flow rate, suggesting that the swallowing exercises promote the maintenance and improvement of oral function in the independent elderly.”

Swider K, Matys J (2018). Complete dentures for a patient after a stroke by means of orofacial myofunctional therapy: a clinical report. Journal of Prosthetic Dentistry, Mar 15. pii: S0022-3913(17)30723-0. doi: 10.1016/j.prosdent.2017.10.023.

· Level 5

· Case study

· Positive outcome incorporating orofacial myofunctional therapy.

Varjao, FM (2012). Myofunctional therapy as an aid to prosthodontic treatment after hemiglossectomy: a clinical report. Journal of Prosthetic Dentistry, May;107(5):284-7. doi: 10.1016/S0022-3913(12)60076-6

· Level 5

· Case study

· “Myofunctional therapy improved the posture and function of the remaining tongue, providing acceptable mastication and increased stability of the mandibular denture.”

Virani A, Kunduk M, Fink DS, McWhorter AJ (2015). Effects of 2 different swallowing exercise regimines during organ-preservation therapies for head and neck cancers on swallowing function. Head and Neck, Feb;37(2):162-70. doi: 10.1002/hed.23570. Epub 2014 Mar 17.

· Level 3

· Case controlled study; 50 subjects

· “Findings indicate significant benefits of the exercise group's exercise regimen in reducing PEG dependence and oral intake difficulties."

OMT For Non-nutritive sucking and chewing habits

Aizenbud D, Gutmacher Z, Teich ST, Oved-Peleg E, Hazan-Molina H (2014). Lip buccal mucosa traumatic overgrowth due to sucking habit - a 10-year follow-up of a non-surgical approach: a combination of behavioural and Myofunctional therapy. Acta Odontologica Scandinavica, Nov;72(8):1079-83. doi: 10.3109/00016357.2014.913308. Epub 2014 Jun 16.

· Level 5

· Case study

· Positive outcome incorporating orofacial myofunctional therapy.

Borrie FRP, Bearn DR, Innes NPT, Iheozor-Ejiofor Z. Interventions for the Cessation of Non-nutritive sucking habits in children. Cochrane Database of Systematic Reviews, 3:CD008694. doi: 10.1002/14651858.CD008694.pub2

· Level 2

· Meta-analysis of 6 studies of lesser quality research

· “There was insufficient evidence to recommend a treatment to stop non-nutritive sucking habits in children.”

Green, S (2013). Case history: improved maxillary growth and development following digit sucking elimination and orofacial myofunctional therapy. International Journal of Orofacial Myology, Nov;39:45-53.

· Level 5

· Expert opinion

· Positive outcome incorporating orofacial myofunctional therapy.

Van Norman RA (1997). Digit-sucking: a review of the literature, clinical observations and treatment recommendations. International Journal of Orofacial Myology, 23:14-34.

· Level 5

· Expert opinion

· Positive outcome incorporating orofacial myofunctional therapy.

OMT For Occlusion & Orthodontic Retention

Alvarado-Faysse C (2014). Dento-facial orthopedics and kinesthetic therapy: partners in patient management. L’Orthodontie Francaise, Sep;85(3):275-85. doi: 10.1051/orthodfr/2014012. Epub 2014 Aug 28.

· Level 5

· Expert opinion

· Positive outcome incorporating orofacial myofunctional therapy.

Asiry MA (2015). Anterior open bite treated with myofunctional therapy and palatal crib. Journal of Contemporary Dental Practice, Mar 1;16(3):243-7.

· Level 5

· Case study

· “The importance of myofunctional therapy in adopting normal tongue position and in maintaining the stability of open bite correction is emphasized.”

Aristizabal JF, Smit RM (2014). Orthodontic treatment in a patient with unilateral open-bite and Becker muscular dystrophy: A 5-year follow-up. Dental Press Journal of Orthodontics, 19(6):37-45. doi:10.1590/2176-9451.19.6.037-045.oar

· Level 5

· Case study

· “After 36 months, open bite was corrected. The case remains stable after a 5-year post-treatment retention period.”

Benkert, KK (1997). The effectiveness of orofacial myofunctional therapy in improving dental occlusion. International Journal of Orofacial Myology, 23:35-46.

· Level 5

· Expert opinion

· Positive outcome incorporating orofacial myofunctional therapy.

Celli D, Gasperoni E, Deli R (2007). Long-term outcome in a patient with dentoskeletal open-bite malocclusion treated without extraction. World Journal of Orthodontics, Winter;8(4):344-56.

· Level 5

· Case study

· Positive outcome incorporating orofacial myofunctional therapy.

Celli, D, Manente A, DeCarlo A, Deli R (2014). Long-term stability of anterior open bite correction in mixed dentition with a new treatment protocol. European Journal of Paediatric Dentistry, Jun;15(2):158-62.

· Level 5

· Case study

· Positive outcome incorporating orofacial myofunctional therapy.

Daglio SD, Schwitzer R, Wüthrich J, Kallivroussis G (1993). Treating orofacial dyskinesia with functional physiotherapy in the case of frontal open bite. International Journal of Orofacial Myology, Nov;19:11-4.

· Level 4

· Case series; 75 subjects

· “Oral myofunctional therapy was found to be successful, in a group of 75 patients, ages six to 22 all with anterior open bites.”

Doual A, Besson A, Cauchy D, Aka A (2002). Retraining in dento-facial orthopedics. An orthodontist’s viewpoint. L’Orthodontie Francaise, Dec;73(4):389-94.

· Level 5

· Expert opinion

· Positive outcome incorporating orofacial myofunctional therapy.

Farret MM, Farret MM, Farret AM (2012). Skeletal Class III and anterior open bite treatment with different retention protocols: a report of three cases. Journal of Orthodontics, Sep;39(3):212-23. doi: 10.1179/1465312512Z.00000000025

· Level 5

· Case study

· Long-term follow-up revealed a stable outcome.

Fournier M, Girard M (2013). Acquisition and sustainment of automatic reflexes in maxillofacial rehabilitation. L’Orthontie Francaise, Sep;84(3):287-94. doi: 10.1051/orthodfr/2013059. Epub 2013 Sep 3.

· Level 5

· Expert opinion

· Positive outcome incorporating orofacial myofunctional therapy.

Gracco A, Siviero L, de Stefani A, Bruno G, Stellini E (2016). Anterior open-bite orthodontic treatment in an adult patient: a clinical case report. International Orthodontics, Jun;14(2):171-83. doi: 10.1016/j.ortho.2016.03.011. Epub 2016 Apr 11.

· Level 5

· Case study

· “Non-surgical open-bite treatment could offer a valid alternative to orthognanthic surgery when cephalometric evaluation shows no vertical growth pattern; patient compliance is essential to prevent relapse.”

Homem MA, Vieira-Andrade RG, Falci SGM, Ramos-Jorge ML, Marques LS (2014). Effectiveness of orofacial myofunctional therapy in orthodontic patients: a systematic review. Dental Press Journal of Orthodontics, 19(4):94-99. doi:10.1590/2176-9451.19.4.094-099.oar

· Level 3

· Meta-analysis of 4 low level studies

· “The findings of the present systematic review demonstrate the scarcity of consistent studies and scientific evidence supporting the use of orofacial myofunctional therapy in combination with orthodontic treatment to achieve better results in the correction of dentofacial disorders in individuals with orofacial abnormalities.”

Jónsson T (2016). Orofacial dysfunction, open bite, and myofunctional therapy. European Journal of Orthodontics, June;38(3):235-236. doi: 10.1093/ejo/cjv091

· Level 2

· Randomized control study of lesser quality research

· “The results after 6 months of OMT and another 6 months of follow-up confirmed a significant improvement in tongue posture and anterior occlusal relationship.”

Maffei C, Garcia P, de Biase NG, de Souza Camargo E, Vianna-Lara MS, Gregio AM, Azevedo-Alanis LR (2014). Orthodontic intervention combined with myofunctional therapy increases electromyographic activity of masticatory muscles in patients with skeletal unilateral posterior crossbite. Acta Odontologica Scandinavica, May;72(4):298-303. doi: 10.3109/00016357.2013.824606. Epub 2013 Nov 21.

· Level 4

· Case series; 14 subjects

· “Orthodontic intervention combined with myofunctional therapy in patients with skeletal unilateral posterior crossbite provided an increase in the electromyographic activity of the masseter and temporalis muscles during mandibular rest and habitual mastication, with predominantly bilateral mastication.”

Moschik CE, Pichelmayer M, Coulson S, Wendl B (2015). Influence of myofunctional therapy on upper intercanine distance. Journal of Dental Health, Oral Disorders & Therapy, 3(1):1-7. doi: 10.15226/jdodt.2015.00135

· Level 3

· Retrospective study; 141 subjects

· “The results indicate that tooth position can be changed by muscle therapy, eve in non-growing subjects.”

Padovan BA (1995). Neurofunctional reorganization in myo-osteo-dentofacial disorders: complementary roles of orthodontics, speech and myofunctional therapy. International Journal of Orofacial Myology, Nov;21:33-40.

· Level 5

· Expert opinion

· Positive outcome incorporating orofacial myofunctional therapy.

Palencar AJ (2016). Dilemmas in treatment of recurrent recalcitrant dental anterior open bite. International Journal of Orthodontics Milwaukee, Spring;27(1):19-24.

· Level 5

· Expert opinion

· “The orthodontic treatment should be augmented with the orofacial myofunctional therapy.”

Saccomanno S, Antonini G, D’Alatri L, A’Angelantonio M, Fiorita A, Deli R (2012). Causal relationship between malocclusion and oral muscles dysfunction: a model of approach. European Journal of Paediatric Dentistry, Dec;13(4):321-3.

· Level 4

· Case series; 23 subjects

· “Orthodontic therapy, in the presence of bad habits, is not enough to solve orthodontic issues, it must be combined with a myofunctional treatment.”

Saccomanno S, Antonini G, D’Alatri L, D’Angeloantonio M, Fiorita A, Deli R (2014). Case report of patients treated with an orthodontic and myofunctional protocol. European Journal of Paediatric Dentistry, Jul;15(2 Suppl):184-6.

· Level 5

· 3 Case studies

· “The aim of this study is to report three cases that needed myofunctional and orthodontic treatment and the good results achieved after the therapy.”

Saccomanno S, Antonini G, D’Alatri L, D’Angelantonio M, Fiorita A, Deli R (2012). Patients treated with orthodontic-myofunctional therapeutic protocol. European Journal of Paediatric Denistry, Sep;13(3):241-3.

· Level 5

· 3 Case studies

· “Orthodontic treatment alone, in presence of bad habits, is not enough to solve the orthodontic issues, so it needs to be combined with myofunctional treatment.”

Smithpeter J, Covell D Jr (2010). Relapse of anterior open bites treated with orthodontic appliances with and without orofacial myofunctional therapy. American Journal of Orthodontics and Dentofacial Orthopedics, May;137(5):605-14. doi: 10.1016/j.ajodo.2008.07.016

· Level 3

· Case controlled study; 76 subjects

· “Orofacial myofunctional therapy in conjunction with orthodontic treatment was highly effective in maintaining closure of anterior open bites compared with orthodontic treatment alone.”

Sugawara Y, Ishihara Y, Takano-Yamamoto T, Yamashiro T, Kamioka H (2016). Orthodontic treatment of a patient with unilateral orofacial muscle dysfunction: the efficacy of myofunctional therapy on the treatment outcome. American Journal of Orthodontics and Dentofacial Orthopedics, Jul;150(1):167-80. doi: 10.1016/j.ajodo.2015.08.021

· Level 5

· Case study

· “These results suggest that orthodontic treatment with orofacial myofunctional therapy is an effective option for a patient with orofacial muscle dysfunction.”

Van Dyck C, Dekeyser A, Vantricht E, Manders E, Goeleven A, Fieuws S, Willems G (2016). The effect of orofacial myofunctional treatment in children with anterior open bite and tongue dysfunction: a pilot study. The European Journal of Orthodontics. June;38(3):227-234. doi:10.1093/ejo/cjv044

· Level 1

· Randomized controlled study; 22 subjects

· “Orofacial myofunctional therapy can positively influence tongue behaviour. However, further research is recommended to clarify the success of OMT as an adjunct to orthodontic treatment and to identify possible factors influencing the outcome.”

OMT For Oral Function & Chewing

Arakawa I, Koide K, Takahashi M, Mizuhashi F (2015). Effect of the tongue rotation exercise training on the oral functions in normal adults - Part 1 investigation of tongue pressure and labial closure strength. Journal of Oral Rehabilitation, Jun;42(6):407-13. doi: 10.1111/joor.12271. Epub 2015 Jan 9.

· Level 4

· Case series

· “These results might be suggested that the tongue rotation exercise training was effective for the recovery of the activity of the stomatognathic system.”

Bacha SM, Rispoli Cde F (2000). Mastication in the oral myofunctional disorders. International Journal of Orofacial Myology, Nov;26:57-64.

· Level 5

· Expert opinion

· Positive outcome incorporating orofacial myofunctional therapy.

Campaign SM, Fontes MJ, Camrgos PA, Freire LM (2010). The impact of speech therapy on asthma and allergic rhinitis control in mouth breathing children and adolescents. Jornal de Pediatria, May-Jun;86(3):202-8.doi:10.2223/JPED.1995. Epub 2010 May 6.

· Level 2

· Randomized control study; 24 subjects

· Improved outcome versus breathing therapy alone.

Das UM, Beena JP (2009). Effectiveness of circumoral muscle exercises in the developing dentofacial morphology in adenotonsillectomized children: an untrasonographic evaluation. Journal of the Indian Society of Pedodontics and Preventative Dentistry, Apr-Jun;27(2):94-103. doi: 10.4103/0970-4388.55334.

· Level 3

· Case controlled study; 30 subjects

“Significant changes in the muscle thickness were noticed in the experimental group after 6 months of prescribed lip seal therapy and exercises with oral screen.”

Kumar TV, Kuriakose S (2004). Ultrasonographic evaluation of effectiveness of circumoral muscle exercises in adenotonsillectomized children. Journal of Clinical Pediatric Dentistry, Fall;29(1):49-55.

· Level 5

· Expert opinion

· “Definite changes in muscle thickness were noted in subjects, who were given muscle exercises.”

Landouzy JM, Sergent Delattre A, Fenart R, Delattre B, Claire J, Bioecq M (2009). The tongue: deglutition, orofacial functions and craniofacial growth. International Orthodontics, Sep;7(3):227-56. doi: 10.1016/S1761-7227(09)73500-4. Epub 2010 Jan 30.

· Level 5

· Expert opinion

· Positive outcome incorporating orofacial myofunctional therapy.

Matsubara M, Tohara H, Hara K, Shinozaki H, Yamazaki Y, Susa C, Nakane A, Wakasugi Y, Minakuchi S (2018). High-speed jaw-opening exercise in training suprahyoid fast-twitch muscle fibers. Clinical Interventions in Aging, Jan 22;13:125-131. doi: 10.2147/CIA.S152821. eCollection 2018.

· Level 4

· Case series; 21 subjects

· “High-speed jaw-opening exercise resulted in increased elevation velocity of the hyoid bone during swallowing, indicating its role in effectively strengthening the fast-twitch muscle fibers of suprahyoid muscles.”

Mew J (2015). The influence of the tongue on dentofacial growth. Angle Orthodontist, Jul;85(4):715. doi: 10.2319/angl-85-04-715-715.1.

· Level 5

· Expert opinion

Meyer PG (2000). Tongue lip and jaw differentiation and its relationship to orofacial myofunctional treatment. International Journal of Orofacial Myology, Nov;26:44-52.

· Level 3

· Narrative review

· Positive outcome incorporating orofacial myofunctional therapy.

Perry ES, Potter NL, Rambo KD, Short R (2011). Effects of strength training on neuromuscular facial rehabilitation. Developmental Neurorehabilitation, 14(3):164-70. doi: 10.3109/17518423.2011.566595.

· Level 5

· Case study

· “With intensive facial exercise, muscle weakness resulting from facial nerve damage sustained during childhood can be improved years after injury.”

Rumbach AF, Rose TA, Cheah M (2018). Exploring Australian speech-language pathologists' use and perceptions ofnon-speech oral motor exercises. Disability and Rehabilitation, Jan 29:1-10. doi: 10.1080/09638288.2018.1431694.

· Level 5

· Survey; 124 subjects

· “The majority of speech-language pathologists reported that they did not use non-speech oral motor exercises when working with paediatric or adult clients with speech sound difficulties.”

Schievano D, Rontani RM, Berzin F (1999). Influence of myofunctional therapy on the perioral muscles. Clinical and electromyographic evaluations. Journal of Oral Rehabilitation, Jul;26(7):564-9.

· Level 4

· Case series; 13 subjects

· “The therapy can improve morphology and function of the muscles in mouth breathing patients with no nasal airway obstruction.”

Silvestre-Donat FJ, Silvestre-Rangil J (2014). Drooling. Monographs in Oral Science, May;24:126-34. doi: 10.1159/000358793. Epub 2014 May 23.

· Level 5

· Expert opinion

Silvestre-Rangil J, Silvestre FJ, Puente-Sandoval A, Requeni-Bernal J, Simo-Ruis JM (2011). Clinical-therapeutic management of drooling: Review and update. Medicina Oral, Patologia Oral y Cirugia Bucal, Sep 1;16(6):e763-6.

· Level 5

· Expert opinion

Thompson DJ, Throckmorton GS, Buschang PH (2001). The effects of isometric exercise on maximum voluntary bite forces and jaw muscle strength and endurance. Journal of Oral Rehabilitation, Oct;28(10):909-17.

· Level 1

· Randomized control study; 28 subjects

· “Increases in maximum bite force can be easily produced with training, but that actual strengthening of the jaw muscles is more difficult to achieve.”

Yanagisawa Y, Matsuo Y, Shuntoh H, Horiuchi N (2014). Effect of expiratory resistive loading in expiratory muscle strength training on orbicularis oris muscle activity. Journal of Physical Therapy Science, Feb;26(2):259-61. doi: 10.1589/jpts.26.259. Epub 2014 Feb 28.

· Level 4

· Case series; 23 subjects

· “Orbicularis oris muscle activity increased with increasing expiratory resistive loading.”

OMT For Stability Post Oromaxillofacial Surgery

Gallerano G, Ruoppolo G, Silvestri A (2012). Myofunctional and speech rehabilitation after orthodontic-surgical treatment of dento-maxillofacial dysgnathia. Progress in Orthodontics, May;13(1):57-68. doi: 10.1016/j.pio.2011.08.002. Epub 2012 Jan 25.

· Level 4

· Case series; 19 subjects

· “Only through an interdisciplinary approach it is possible to intercept and re-educate all the functions that are not compliant with the structural changes and to eliminate a tendency to relapse of the dysgnathia.”

Girard M, Leroux C (2015). Muscle and function management by the physiotherapist in orthodontic and orthodonto-surgical treatment. Oral myofunctional rehabilitation. L’Orthotontie Francaise, Mar;86(1):95-111. doi: 10.1051/orthodfr/2015012. Epub 2015 Apr 17.

· Level 5

· Expert opinion

· Positive outcome incorporating orofacial myofunctional therapy.

Pereira, JBA & Bianchini EMG. (2011). Functional characterization and temporomandibular disorders before and after orthognathic surgery and myofunctional treatment of class II dentofacial deformity. Revista CEFAC, 13(6):1086-1094. doi: 10.1590/S1516-18462011000600015.

· Level 4

· Case series

· “Temporomandibular dysfunction was present in most of the sample, with remission of the signs in 81% of the cases involved.”

Perry BJ, Richburg BD, Pomahac B, Bueno EM, Green JR (2017). The Effects of Lip-Closure Exercise on Lip Strength and Function Following Full Facial Transplantation: A Case Report. American Journal of Speech Language Pathology, Jun 22;26(2S):682-686. doi: 10.1044/2017_AJSLP-16-0101.

· Level 5

· Case study

· “Results revealed improvements in labial strength, speed of lip movement, and range of motion during speech.”

Prado DG de A, Berretin-Felix G, Migliorucci RR, Beuno M da RS, Rosa RR, Polizel M, Teixeira IF, Gaviao MBD (2018). Effects of orofacial myofunctional therapy on masticatory function in individuals submitted to orthognathic surgery: a randomized trial. Journal of Applied Oral Science, 26:e20170164. doi:10.1590/1678-7757-2017-0164.

· Level 1

· Randomized control study; 48 subjects

· “There were positive effects of orofacial myofunctional therapy on the clinical and electromyography aspects of chewing in individual submitted to orthognathic surgery.”

OMT For Symptoms of OSA, SDB, UARS

Cao MT, Sternbach JM, Guilleminault C (2017). Continuous positive airway pressure therapy in obstructive sleep apnea: benefits and alternatives. Expert Review of Respiratory Medicine, Apr;11(4):259-272. doi: 10.1080/17476348.2017.1305893. Epub 2017 Mar 17.

· Level 5

· Expert opinion

· Positive outcome incorporating orofacial myofunctional therapy.

Camacho M, Certal V, Abdullatif J, Zaghi S, Ruoff CM, Capasso R, Kushida CA (2015). Myofunctional therapy to treat obstructive sleep apnea: a systematic review and meta-analysis. Sleep. 2015;38(5):669-675. doi:10.5665/sleep.4652.

· Level 1

· Meta-analysis of 9 studies

· “Current literature demonstrates that myofunctional therapy decreases apnea-hypopnea index by approximately 50% in adults and 62% in children.”

Camacho M, Guillleminault C, Wei JM, Song SA, Noller MW, Reckley LKm Fernandez-Salvador C, Zaghi S (2018). Oropharyngeal and tongue exercises (myofunctional

therapy) for snoring: a systematic review and meta-analysis. European Archives of Otorhinolaryngology, Apr;275(4):849-855. doi: 10.1007/s00405-017-4848-5. Epub 2017 Dec 23.

· Level 1

· Meta-analysis of 9 studies

· “Myofunctional therapy has reduced snoring in adults based on both subjective questionnaires and objective sleep studies.”

Cooper, A (2010). Orofacial myology and myofunctional therapy for sleep related breathing disorders. Sleep Medicine Clinics, Mar 5(1), 109 – 113.

· Level 5

· Expert opinion

Correa, CC, Berretin-Felixx G (2015). Myofunctional therapy applied to upper airway resistance syndrome: a case report. Sociedade Brasileira de Fonoaudiologia, 27(6), 604-609. doi: 10.1590/2317-1782/20152014228

· Level 5

· Case study

· “The effect of myofunctional therapy in a case of upper airway resistance syndrome was positive for all parameters.”

De Dios JAA, Brass SD (2012). New and Unconventional Treatments for Obstructive Sleep Apnea. Neurotherapeutics, 9(4), 702–709. doi.org/10.1007/s13311-012-0146-5.

· Level 3

· Literature review

· “There is no strong physiologic evidence linking pharyngeal training with improvement of obstructive sleep apnea.”

de Felicio CM, da Silva Dias FV, Trawitzki LVV (2018). Obstructive sleep apnea: focus on myofunctional therapy. Nature and Science of Sleep, Sep 6;10:271-286. doi: 10.2147/NSS.S141132. eCollection 2018.

· Level 3

· Literature review; 11 studies

· “Orofacial myofunctional therapy is effective for the treatment of adults in reducing the severity of obstructive sleep apnea and snoring, and improving the quality of life. Orofacial myofunctional therapy is also successful for the treatment of children with residual apnea.”

Diaferia G, Badke L, Santos-Silva R, Bommarito S, Tufik S, Bittencourt L (2013). Effect of speech therapy as adjunct treatment to continuous positive airway pressure on the quality of life of patients with obstructive sleep apnea. Sleep Medicine, Jul;14(7):628-35. doi: 10.1016/j.sleep.2013.03.016. Epub 2013 May 20.

· Level 1

· Randomized control study; 100 subjects

· “Speech therapy alone as well as in association with continuous positive airway pressure treatment might be an alternative treatment for the improvement of quality of life in patients with obstructive sleep apnea.

Diaferia G, Santos-Silva R, Truksinas E, Haddad FLM, Santos R, Bommarito S, Gregorio LC, Tufik S, Bittencourt L (2017). Myofunctional therapy improves adherence to continuous positive airway pressure treatment. Sleep and Breathing, May;21(2):387-395. doi: 10.1007/s11325-016-1429-6. Epub 2016 Dec 2.

· Level 1

· Randomized control study; 100 subjects

· “Our results suggest that in patients with obstructive sleep apnea syndrome, myofunctional therapy may be considered as an adjuvant treatment and an intervention strategy to support adherence to continuous positive airway pressure treatment.

Frey L, Green S, Fabbie P, Hockenbury D, Foran M, Elder K (2014). The essential role of the COM in the management of sleep-disordered breathing: a literature review and discussion. International Journal of Orofacial Myology, Nov;40:42-55.

· Level 3

· Literature review

· Positive outcome incorporating orofacial myofunctional therapy.

Guilleminault C, Huang YS, Monteyrol PJ, Sato R, Quo S, Lin CH (2013). Critical role of myofascial reeducation in pediatric sleep-disordered breathing. Sleep Medicine, Jun;14(6):518-25. doi: 10.1016/j.sleep.2013.01.013. Epub 2013 Mar 21.

· Level 3

· Retrospective study; 24 subjects

· “Absence of myofascial treatment is associated with a recurrence of sleep disordered breathing.”

Guilleminault C, Sullivan SS (2014). Towards restoration of continuous nasal breathing as the ultimate treatment goal in pediatric obstructive sleep apnea. Enliven: Pediatrics and Neonatal Biology, 1(1): 001.

· Level 5

· Expert opinion

· “Oral breathing is an important clinical marker of orofacial muscle dysfunction, which may be associated with palatal growth restriction, nasal obstruction, and/or disorders of musculoskeletal dysfunction.”

Guimaraes KC, Drager LF, Genta PR, Marcondes BF, Lorenzi-Filho G (2009). Effects of oropharyngeal exercises on patients with moderate obstructive sleep apnea syndrome. American Journal of Respiratory and Critical Care Medicine, May 15;179(10):962-6. doi: 10.1164/rccm.200806-981OC. Epub 2009 Feb 20.

· Level 1

· Randomized control study; 31 subjects

· “Oropharyngeal exercises significantly reduce obstructive sleep apnea syndrome severity and symptoms and represent a promising treatment for moderate obstructive sleep apnea syndrome.”

Huang Y-S, Guilleminault C (2012). Pediatric obstructive sleep apnea and the critical role of oral-facial growth: evidences. Frontiers in Neurology, 3:184. doi:10.3389/fneur.2012.00184

· Level 3

· Literature review of lesser level research

· “Pediatric obstructive sleep apnea in non-obese children is a disorder of oral-facial growth.”

Hugan YS, Guilleminault C (2017). Pediatric Obstructive Sleep Apnea: Where Do We Stand? Advances in Otorhinolaryngology, 80:136-144. doi: 10.1159/000470885. Epub 2017 Jul 17.

· Level 5

· Expert opinion

· Positive outcome incorporating orofacial myofunctional therapy.

Huang YS, Quo S, Berkowski JA, Guilleminault C (2015). Short lingual frenulum and obstructive sleep apnea in children. International Journal of Pediatric Research, Apr;1:003.

· Level 3

· Retrospective study; 27 subjects

· Oral myofunctional therapy was built in to the treatment program.

Ieto V, Kayamori F, Montes MI, Hirata RP, Gregorio MG, Alencar AM, Drager LF, Genta PR, Lorenzi-Filho G (2015). Effects of oropharyngeal exercises on snoring: a randomized trial. Chest, Sep;148(3):683-691. doi: 10.1378/chest.14-2953.

· Level 1

· Randomized control study; 39 subjects

· “Oropharyngeal exercises are effective in reducing objectively measured snoring and are a possible treatment of a large population suffering from snoring.”

Lee SY, Guilleminault C, Chiu HY, Sullivan SS (2015). Mouth breathing, "nasal disuse," and pediatric sleep-disordered breathing. Sleep and Breathing, Dec;19(4):1257-64. doi: 10.1007/s11325-015-1154-6. Epub 2015 Apr 16.

· Level 3

· Retrospective study; 64 subjects

· “Assessment of mouth breathing during sleep should be systematically performed post-tonsilloadenoidectomy and the persistence of mouth breathing should be treated with myofunctional therapy.”

Levrini L, Lorusso P, Caprioglio A, Magnani A, Diaferia G, Bittencourt L, Bommarito S (2014). Model of oronasal rehabilitation in children with obstructive sleep apnea syndrome undergoing rapid maxillary expansion: Research review. Sleep Science, 7(4):225-233. doi:10.1016/j.slsci.2014.11.002

· Level 3

· Literature review

· “The program should be customized for each patient. If rapid maxillary expansion is supported by an adequate functional rehabilitation, the possibility to change the breathing pattern is considerably amplified.

Luca B, Martella S, Vitelli O, Bianchini C, Miano S, Ferretti A, Pozzo MD, Villa MP (2013). Myofunctional treatment of sleep disordered breathing in children. European Respiratory Journal, Sep;42(57):4670.

· Level 4

· Case series; 21 subjects

· “Myofunctional therapy could be an efficacious treatment in pediatric obstructive sleep apnea in addition to adenotonisillectomy.”

Moeller JL, Paskay LC, Gelb ML (2014). Myofunctional therapy: a novel treatment of pediatric sleep-disordered breathing. Sleep Medicine Clinics, June;9(2):235-243. doi: 10.1016/j.jsmc.2014.03.002

· Level 5

· Expert opinion

· Positive outcome incorporating orofacial myofunctional therapy.

Mohamed AS, Sharshar RS, Elkolaly RM, Serageldin SM (2017). Upper airway muscle exercises outcome in patients with obstructive sleep apnea syndrome. Egyptian Journal of Chest Diseases and Tuberculosis, Jan;66(1):121-125. doi: 10.1016/j.ejcdt.2016.08.014.

· Level 4

· Case series; 30 patients

· “Upper airways exercises can be a novel easy noninvasive technique to improve apnea-hypopnea index, O2 saturation and snoring thus used in treatment of obstructive sleep apena syndrome patients mainly moderate type.”

Nemati S, Gerami H, Soltanipour S, Saberi A, Moghadam SK, Setva F (2015). The effects of oropharyngeal-lingual exercises in patients with primary snoring. European Archives Otorhinolaryngology, Apr;272(4):1027-1031. doi: 10.1007/s00405-014-3382-y. Epub 2014 Nov 5.

· Level 4

· Case series; 53 subjects

· “Doing the oropharyngeal-lingual exercises significantly decreases the severity of primary snoring.”

Suzuki H, Watanabe A, Akihiro Y, Takao M, Ikematsu T, Kimoto S, Asano T, Kawara M (2013). Pilot study to assess the potential of oral myofunctional therapy for improving respiration during sleep. Journal of Prosthodontic Research, Jul;57(3):195-9. doi: 10.1016/j.jpor.2013.02.001. Epub 2013 Mar 20.

· Level 4

· Case series; 92 subjects

· “From this study, the following conclusions were made: (1) Oral myofunctional therapy significantly increases labial closure force; and (2) the apnea-hypopnea index and SpO2 during sleep are significantly improved after oral myofunctional therapy.”

Suzuki, H., Yoshimiura, M., Iwata, Y., Oguchi, S., Kawara, M., & Chow, C.-M. (2017). Lip muscle training improves obstructive sleep apnea and objective sleep: a case report. Sleep Science, 10(3), 128–131. http://doi.org/10.5935/1984-0063.20170022

· Level 5

· Case study

· “Improved lip closure force, by moving the tongue into the anterior-superior oral cavity, may increase upper airway space and reduce the hypopnea index.”

Steele CM (2009). On the plausibility of upper airway remodeling as an outcome of orofacial exercise. American Journal of Respiratory and Critical Care Medicine, May 15;179(10):858-9. doi: 10.1164/rccm.200901-0016ED.

· Level 5

· Expert opinion

Um YH, Hong SC, Jeong JH (2017). Sleep problems as predictors in attention-deficit hyperactivity disorder: causal mechanisms, consequences and treatment. Clinical Psychopharmacology and Neuroscience, Feb 28;15(1):9-18. doi: 10.9758/cpn.2017.15.1.9

· Level 5

· Narrative review

· “More research is needed to confirm the effectiveness of myofunctional therapy in pediatric populations.”

Verma RK, Johnson J JR, Goyal M, Banumathy N, Goswami U, Panda NK (2016). Oropharyngeal exercises in the treatment of obstructive sleep apnoea: our experience. Sleep and Breathing, Dec;20(4):1193-1201. doi: 10.1007/s11325-016-1332-1. Epub 2016 Mar 18.

· Level 4

· Case series; 20 subjects

· “Graded oropharyngeal exercise therapy increases the compliance and also reduces the severity of mild to moderate obstructive sleep apnoea syndrome.”

Villa MP, Brasili L, Ferretti A, Vitelli O, Rabasco J, Mazzotta AR, Pietropaoli N, Martella S (2015). Oropharyngeal exercises to reduce symptoms of OSA after AT. Sleep and Breathing, Mar;19(1):281-9. doi: 10.1007/s11325-014-1011-z. Epub 2014 May 26.

· Level 4

· Case series; 14 subjects

· “Oropharyngeal exercises may be considered as complementary therapy to adenotonsillectomy to effectively treat pediatric obstructive sleep apnea.”

Villa MP, Evangelisti M, Martella S, Barreto M, Del Pozzo M (2017). Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing? Sleep and Breathing, Dec;21(4):1025-1032. doi: 10.1007/s11325-017-1489-2. Epub 2017 Mar 18.

· Level 1

· Randomized control study; 54 subjects

· “Oropharyngeal exercises appear to effectively modify tongue tone, reduce sleep disordered breathing symptoms and oral breathing, and increase oxygen saturation, and may thus play a role in the treatment of sleep disordered breathing.”

OMT For Symptoms of Temporomandibular Disorder

Calixtre LB, Gruninger BL, Haik MN, Alburquerque-Sendin F, Oliveira AB (2016). Effects of cervical mobilization and exercise on pain, movement and function in subjects with temporomandibular disorders: a single group pre-post test. Journal of Applied Oral Science, May-Jun;24(3):188-97. doi: 10.1590/1678-775720150240.

· Level 4

· Case series; 12 subjects

· “Significant changes in pain-free MMO, self-reported pain, and functionality of the stomatognathic system in subjects with myofascial TMD, regardless of joint involvement.”

de Felicio CM, Freitas RL, Bataglion C (2007). The effects of orofacial myofunctional therapy combined with an occlusal splint on signs and symptoms in a man with TMD-hypermobility: case study. International Journal of Orofacial Myology, Nov;33:21-9.

· Level 5

· Case study

· “The combination of orofacial myofunctional therapy and an occlusal splint can be beneficial for patients with temporomandibular disorder-hypermobility.”

de Felicio CM, de Oliveira MM, da Silva MA (2010). Effects of orofacial myofunctional therapy on temporomandibular disorders. Journal of Craniomandibular Practice, Oct; 28(4):249-59.

· Level 1

· Randomized control study; 30 subjects

· “Orofacial myofunctional therapy favored a significant reduction of pain sensitivity to palpation of all muscles studied but not for the temporomandibular joints; an increased measure of mandibular range of motion; reduced Helkimo's Di and Ai scores; reduced frequency and severity of signs and symptoms; and increased scores for orofacial myofunctional conditions.”

Haggman-Henrikson B, Wiesinger B, Wanman A (2018). The effect of supervised exercise on localized TMD pain and TMD pain associated with generalized pain. Acta Odontologica Scandinavica, Jan;76(1):6-12. doi: 10.1080/00016357.2017.1373304. Epub 2017 Sep 4.

· Level 4

· Case series; 56 subjects

· “Supervised exercise can reduce temporomandibular disorder pain and increase capacity in patients with temporomandibular disorder.”


Ishiyama H, Inukai S, Nishiyama A, Hideshima M, Nakamura S, Tamoaka M, Miyazaki Y, Fueki K, Wakabayashi N (2017). Effect of jaw-opening exercise on prevention of temporomandibular disorders pain associated with oral appliance therapy in obstructive sleep apnea patients: A randomized, double-blind, placebo-controlled trial. Journal of Prosthodontic Research, Jul;61(3):259-267. doi: 10.1016/j.jpor.2016.12.001. Epub 2017 Jan 4.

· Level 1

· Randomized control study; 25 subjects

· “Jaw-opening exercise prior to oral appliance therapy reduced the risk of temporomandibular disorder pain associated with oral appliance uses.”

Jiang X, Fan S, Cai B, Fang ZY, Xu LL, Liu LK (2016). Mandibular manipulation technique followed by exercise therapy and occlusal splint for treatment of acute anterior TMJ disk displacement without reduction. Shanghai Journal of Stomatology, Oct;25(5):570-573.

· Level 4

· Case series; 44 subjects

· “Mandibular manipulation technique combined with exercise therapy and splint treatment seems to be useful in the treatment of anterior temporomandibular joint disc displacement with reduction, which can help to maintain the complete anatomic disc-condyle relationship.”

Lindors E, Hedman E, Mannusson T, Ernberg M, Gabre P (2017). Patient Experiences of Therapeutic Jaw Exercises in the Treatment of Masticatory Myofascial Pain: A Qualitative Study. Journal of Oral Facial Pain and Headache, Winter;31(1):46-54. doi: 10.11607/ofph.1623.

· Level 5

· Patient interviews; 10 subjects

· “Jaw exercises are a useful treatment valued by patients due to their simplicity and effectiveness.”

Machado BC, Mazzetto MO, da Silva MA, de Felicio CM (2016). Effects of oral motor exercises and laser therapy on chronic temporomandibular disorders: a randomized study with follow-up. Lasers in Medical Science, Jul;31(5):945-54. doi: 10.1007/s10103-016-1935-6. Epub 2016 Apr 16.

· Level 1

· Randomized control study; 102 subjects

· “Low level laser therapy combined with orofacial myofunctional exercises was more effective in promoting temporomandibular disorder rehabilitation than low level laser therapy alone was.”

Makino I, Arai YC, Aono S, Hayashi K, Morimoto A, Nichihara M, Ikemoto T, Inoue S, Mizutai M, Matsubara T, Ushida T (2014). The effects of exercise therapy for the improvement of jaw movement and psychological intervention to reduce parafunctional activities on chronic pain in the craniocervical region. Pain Practice, Jun;14(5):413-8. doi: 10.1111/papr.12075. Epub 2013 May 9.

· Level 3

· Case controlled study; 39 subjects

· “A combination of jaw exercise and psychological intervention to reduce parafunctional activities is more effective than jaw exercise alone for the improvement of craniocervical pain without apparent organic abnormalities.”

Melchior MO, Machado BCZ, Magri LV, Mazzetto MO (2016). Effect of speech-language therapy after low-level laser therapy in patients with TMD: a descriptive study. Sociedade Brasileira de Fonoaudiologia, 28(6), 818-822 doi: 101590/2317-1782/20162015099

· Level 5

· Case series; 5 subjects

· “According to the patients' perception, temporomandibular disorder signs and symptoms were relieved after the application of orofacial myofunctional therapy.”

Messina G, Martines F, Thomas E, Salvago P, Fabris GBM, Poil L, Iovane A (2017). Treatment of chronic pain associated with bruxism through Myofunctional therapy. European Journal of Translational Myology, Jun 29;27(3):6759. doi: 10.4081/ejtm.2017.6759. eCollection 2017 Jun 27.

· Level 4

· Case series; 24 subjects

· “Myofunctional therapy could be used to reduce facial pain as a consequence of bruxism episodes.”

Richardson K, Gonzalez Y, Crow H, Sussman J (2012). The effect of oral motor exercises on patients with myofascial pain of masticatory system. Case series report. New York State Dental Journal, Jan;78(1):32-7.

· Level 4

· Case series

· “The findings of this case series report suggest an opportunity exists for collaboration between speech-language pathologists and the "traditional" temporomandibular disorder team.”

Sakuma S, Yamaguchi Y, Taguchi N, Ogi N, Kurita K, Ito Y (2017). Pilot study of the short-term effects of range-of-motion exercise for the temporomandibular joint in patients with temporomandibular joint disc displacement without reduction. Journal of Physical Therapy Science, Feb;29(2):274-277. doi: 10.1589/jpts.29.274. Epub 2017 Feb 24.

· Level 4

· Case series; 36 subjects

· “A program that combines exercise for the temporomandibular joint and self-traction therapy can improve range of motion at the joint in the short term and reduce pain and difficulty associated with daily activity in patients with temporomandibular joint disc displacement without reduction.”


OMT For Tongue & Lip Ties

Ferrés-Amat E, Pastor-Vera T, Rodríguez-Alessi P, Ferrés-Amat E, Mareque-Bueno J, Ferrés-Padró E (2016). Management of ankyloglossia and breastfeeding difficulties in the newborn: breastfeeding sessions, myofunctional therapy, and frenotomy. Case Reports in Pediatrics, 2016:3010594. doi:10.1155/2016/3010594

· Level 5

· Case study

· Positive outcome incorporating orofacial myofunctional therapy.

Ferrés-Amat E, Pastor-Vera T, Ferrés-Amat E, Mareque-Bueno J, Prats-Armengol J, Ferrés-Padró E (2016). Multidisciplinary management of ankyloglossia in childhood. Treatment of 101 cases. A protocol. Medicina Oral, Patologia Oral y Cirugia Bucal, Jan 1;21(1):e39-47.

· Level 4

· Case series; 101 subjects

· Positive outcome incorporating orofacial myofunctional therapy.

Ferrés-Amat E, Pastor-Vera T, Rodríguez-Alessi P, Ferrés-Amat E, Mareque-Bueno J, Ferrés-Padró E (2017). The prevalence of ankyloglossia in 302 newborns with breastfeeding problems and sucking difficulties in Barcelona: a descriptive study. European Journal of Paediatric Dentistry, Dec;18(4):319-325. doi: 10.23804/ejpd.2017.18.04.10.

· Level 2

· Cross sectional study with control; 1102 subjects

· “If a frenotomy is necessary, we recommend stimulating suction with myofunctional therapy before and after surgery to avoid scar retraction.”

Iyer VH, Sudarsan S (2015). A comprehensive treatment protocol for lingual frenectomy with combination of lasers and speech therapy: two case reports. International Journal of Laser Dentistry, Jan-Apr;5(1):12-21.

· Level 5

· Case study

· Positive outcome incorporating orofacial myofunctional therapy.

General OMT Topics

Bacha SM, Rispoli CF (1999). Myofunctional therapy: brief intervention. International Journal Orofacial Myology, Nov;25:37-47.

· Level 5

· Expert opinion

· Positive outcome incorporating orofacial myofunctional therapy.

Mason RM (2011). Myths that persist about orofacial myology International Journal of Orofacial Myology, Nov; 37:27-38.

· Level 5

· Expert opinion

· Conclusions

Moeller JL (2012). Orofacial myofunctional therapy: why now? Cranio, Oct;30(4):235-6.

· Level 5

· Expert opinion

· Positive outcome incorporating orofacial myofunctional therapy.