Surgery vs Orthodontic + Orofacial Myology Treatment Background

A SLP reports that a local oral-maxillofacial surgery claims that a tongue thrust is a rare occurrence, and that when seen with an anterior open bite, an oral-maxillofacial surgeon should treat the problem surgically rather than having the patient undergo orthodontic treatment. The surgeon’s claim is that thrusting is related to a small oral cavity and that this signals the need for jaw surgeries to enlarge the oral environment. The SLP involved wondered about the truth of the connections claimed by the surgeon.  I have asked Dr. Robert Mason, DMD, PhD, ASHA Fellow.  See link to his website page:https://orofacialmyology.com/robert-mason/ His responses follow: There are no data to support this bizarre perspective. This is the first time I have ever been exposed to this unfounded theory. What the surgeon contends is not compatible with available literature or perspectives about tongue thrusting and orofacial myofunctional disorders (OMD’s). The current State-of-the-Art with orofacial myofunctional disorders is presented in an update article that I wrote for the website www.SpeechPathology.com, and featured on the website during the month of February, 2009. This can be accessed on the website by clicking on the orange heading Articles, then finding and opening the article titled: An Update on Orofacial Myofunctional Disorders: More than Tongue Thrust. It is well known, or should be, that the tongue adapts to the space available. A case in point is the patient with a Class III skeletal mandible and a large-appearing tongue. When the mandible is surgically reduced/setback, the tongue adapts and appears smaller. This is well discussed in an article in the Journal of Oral Surgery, v. 30, 184-192 (1970) by Wickwire, White and Proffit. The position of the hyoid bone serves as a useful marker in evaluating the change in resting tongue posture following setback surgery. As well, there is a long history of orthodontic treatment involving the extraction of teeth, especially bicuspids without the subsequent development of thrusting. Extraction patients do not demonstrate a history characterized by the development of tongue thrusting as a result of the extractions. The etiology of tongue thrusting during speech and swallowing has a link to unresolved airway issues and allergic rhinitis. So a thrust is a clinical sign that signals the need to evaluate the status of the posterior airway. For example, enlarged faucial tonsils can compete with the tongue for space, and a forward rest posture or even a thrust can serve as an adaptation of the tongue to maintain the integrity of the airway for breathing. As the above-mentioned update article explains, there is a difference between an anterior interdental rest posture of the tongue, and a thrust. Thrusting itself is now viewed as an adaptation to rather than a cause of malocclusion, while an anterior rest posture has a strong link to the development or maintenance of some malocclusions. So although there are data to support the view that open bites can lead to thrusting, this does not imply that the oral cavity is too small, but rather that the tongue can behave in an opportunistic manner when a space is made available. The claim that tongue thrusters have a reduced oral cavity size and should be treated surgically by oral-maxillofacial surgeons rather than by orthodontists has no merit and should be summarily dismissed as a treatment option. Robert M. Mason, DMD, PhD Speech-Language Pathologist, CCC – ASHA Fellow Professor of Orthodontics (retired) Department of Surgery Duke University Medical Center, NHS Medical Adviser,