Hi! I wondered if I could run a client by you who called me today. It was exciting since it was my first ‘real’ client! The mom shared with me that her son is 14 and going into freshman year. He has an open bite on the right side and a class III malocclusion. He has a lateral production of sh – according to mom. She took him to an ortho in Indiana who told her that the only way to correct his ‘tongue positioning’ was to have tongue surgery to reduce the size of his tongue. (yikes!) He told her he had ‘macroglossia’ in laymens’ terms. Mom is a nurse and knew to get a second opinion. An ortho at the Univ. of Illinois told her that the only way to correct what he called a ‘tongue protrusion’ was to put a crib in and not mess around with any type of therapy as ‘it doesn’t work anyway’. She then got another opinion from an ortho who told her that a crib has NEVER been effective in his experience, and to either do neuromuscular facilitation (using the CD he gave her!) or seek out services for orofacial myofunctional therapy. My question is about the neuromuscular facilitation – I know some about it and am not sure where to learn more. I did not know what to say to the mom about it and whether it is an effective approach, and was very honest with her about this. Is this something that I should know how to do in my practice and if so, how can I learn more? Thanks so much for your time on this! K
The final person she saw seems to have been keeping up with state of the art information much more than the previous ones. Neuromuscular facilitation has for some time been considered a main component in orofacial myology treatment. The following definition gives us a good sense of why the exercise regimen, as we teach it, aligns with the concept behind neuromuscular facilitation: If a certain movement is performed repetitively, it stimulates the body’s adaptation process and results in greater ease of movement automatic activity.
With regard to some of the other information you provided, we have to know if the tongue CAN fit comfortably into the palate. If he has adequate space for the tongue “up there” then macroglossia is an even more obscure possibility than I likely mentioned in your class. It probably doesn’t ever exist in non-syndromatic patients. If the palate is too high and/or narrow, then that might be the reason for the tongue’s moving laterally. In that case, we need the palate expanded. It sounds more like the CL III is a culprit. Try moving your mandible forward as you attempt to make words with /s/ in them. You will lateralize, no doubt! Is the Class III truly a skeletal one? You have to know if he is ABLE to move into a more normal occlusion or whether it is a structural Class III that needs to be attended to either orthodonitically (if not too late) or heaven forbid…surgically. The speech issue is the least of it, in my opinion. If he has a significant Class III profile, then you might not be able to help with the lateral lisp right now. He must be able to bowl his tongue, bracing it on the inside of his upper lateral dentition and obtaining enough support to produce an acceptable /s/. Of course, he must pass or maximize Prof exam one first. I hope I answered your questions, but if not, let me know….! Sandra