Myo before expander or vice versa?
Q: An orthdontist recommended a palatal expansion after myofunctional therapy for an 8 year old.. I explained that the palatal expansion should take place before myo and she felt that myo would go first and the tongue would widen the palate. You said the tongue would not widen that palate at 8 years of age. Can you help me to understand why the tongue is not going to widen it. Is it because of the patient’s age? Is there an age at which the tongue will naturally widen a narrow palate?
A: Response by Dr. Robert Mason. Actually, no. The palate naturally widens by a process of apposition (adding) bone on the oral surface and resorbing bone on the nasal surface of the palate. You can mention the work of Enlow and Hans here whose book Essentials of Facial Growth. The role of the tongue at rest is useful but not a major contributor. Expecting the tongue to naturally widen the palate at any age, especially 8, is not a reasonable goal. The point is that if the orthodontist can widen the palate and then allow you to adapt the tongue rest posture and functions to that expanded position, this is the recommended protocol; the house needs to be fixed before the tongue can properly function in the environment in which it resides. With a narrow palate, the tongue is encouraged to thrust forward at rest and during function to adapt to the narrow maxilla. Here again, I would decline treating this kid if OMT is mandated by the orthodontist first.