Adult mix of hypernasality and myo issues

Hi, This Monday I will see a 25 year-old with a repaired bilateral cleft lip and palate who has hyper nasal speech. She has very obvious myo issues as well just by looking at her smile and face: (crowded teeth, open mouth posture, etc). I thought that I would treat her case like any other myo case as far as oral habits? She presents with asymmetric lips due to the cleft repair. Would you recommend the Battle Button exercise? Could any of the exercises hurt her lips? I feel like this is a silly question but you and Becky said in class that there are no silly questions. … I feel nervous because I have not had a client with a cleft palate repair before. Thank you ahead of time for your help!

I will attempt to answer you, but if I knew WHY this person is coming to you, it would be much easier to provide a more thorough response.  Is she coming for her voice issue only or  was she sent as a myo case? · Or both? I would likely handle each of those scenarios somewhat differently, working in conjunction with any medical/dental person sending her. If she came to you only for the hypernasal speech production, then you will have to ease her into the information about myo and how it relates to the findings you obtain during your orofacial examination. You could call attention to the asymmetry and explain how the Myo exercises maximize the lips and other oral and facial muscles and functions. As for exercises, unless her repair was recent, she probably can follow through with usual myo exercises from the Myo Manual. As I mentioned in class, we don’t do anything that hurts or aggravates any condition. I doubt that will be the case, but your case history and oral exam will be important to review in order to know how to proceed. What are her goals? Remember that we maximize each patient according to their capacities and in conjunction with their treatment goals. Adult mix of hypernasality and myo issues