Wound Care Management and Myofunctional Therapy Protocols

Orofacial myologists are often called upon by dentists to provide pre-and post-op frenectomy exercise protocols and are assumed to be knowledgeable on what to expect, how long to continue, etc. Because it is difficult to put into a short narrative all my own practice approaches, let us consider some suggestions to help therapists better communicate with referring doctors.

First in importance is to understand and be able to explain how Wound Care Management (WCM) differs from Myofunctional therapy (Myo). These two programs tend to be erroneously "lumped" together into the same category. Many surgery providers lack knowledge on how to manage wounds after surgery and are under the impression that WCM and Myo are one and the same. Unfortunately, they might automatically refer patients requiring wound care directly to orofacial myologists, some of whom are not equipped to handle wound care.

When a surgeon completes a release and then just sends them out, it puts SLPs, RDHs and other Myo providers in a difficult position because all the anatomy has been removed without an opportunity to observe what it was like prior to the procedure. This indicates the importance of partnering with surgeons and educating them that this process is not just about the surgery. If a relationship can be developed where the therapist is able to shadow the doctor, the therapist will be in a better position to explain the necessity of referring the patient for Myo assessment prior to the release to establish baselines.

Also of utmost importance is to understand the distinct differences between working with infants versus older children and adults. With patients that can follow instructions, for example, the Pre-Test of Proficiency is given prior to surgery to establish a baseline of function and mobility. With infants, of course, this is not possible.

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Infants: All my infants met with a lactation consultant prior to any surgery to establish the baseline feeding transfer, evaluate the latch and to determine if there were any other feeding difficulties that might be the reason for baby not doing well at the breast; ie: mom's anatomy, lack of milk production, etc.

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My protocol for infants involved two types of "active wound care exercises": 1) inside the mouth, 2) outside the mouth. These are not very involved and they don't take a lot of time. Partners and family members were very happy to help with the outside exercises.

They focus on the following: tongue mobility, lateralization, moving tongue in and out of the mouth, suctioning, finger lifts under the tongue, and separation of the lip from the wound site using a pinch and lift technique (non-painful). Parents usually needed to do the tongue lifts and lip separation. Outside also included buccinator stretches and gentle masseter massages.

My post op appointment was 1 week after the release so that I could evaluate wound healing. The babies also were referred back to the lactation consultant to be seen approximately 5-7 days after the release so that the baby could get back to the breast. I made certain to work very closely with my lactation consultants to be sure they understood the goals of active wound care.

Children: 9 months – 3+ years: Although surgery can be done at most any age, it's the after surgery care that can be difficult in this age range. Each child needs to be assessed individually and the timing of surgery can be a tough decision. Usually, 4 years and up is the standard, but the youngest I worked with doing Myo was 3+ years old. Each child is different in their ability to comprehend, follow instructions, and then do the exercises independently with supervision.