Release of the information presented here has been authorized by the patient solely for educational purposes, and it remains the property of Root Cause Resolutions, LLC. The information here is not available for distribution.
Patient Overview
Female, age 5
The patient was seen for an airway assessment by a functional dentist at MiBöca Dentistry in Elkhorn, Nebraska, due to parental concerns of mouth breathing and snoring.
During the assessment, it was noted that the patient had slightly enlarged tonsils and generalized brown staining on teeth, which is often an indication of mouth breathing. A comprehensive assessment by a myofunctional therapist was recommended, which I completed at a later date.
Note - the patient was participating in occupational therapy treatment and had an evaluation by an ENT for enlarged tonsils during the same timeframe as myofunctional therapy. For several patients, an interdisciplinary approach is key to success!
Clinical Presentation
Myofunctional Examination
Symptoms
Acid reflux
ADD/ADHD
Bedwetting
Nasal congestion
Poor coordination
Restless sleep until age 2.5
Thumb/digit sucking
Pacifier used until age 2
Chewing difficulties
Moderate snoring
Speech struggles - /sh/, /ch/
Sensory and emotional regulation difficulties
Enlarged tonsils
Mouth breathing
Tongue seeking - also noted by the patient's OT
Supplemental Treatments
HealthyStart Habit Corrector - nighttime wear started 9/2023, ongoing
MyoMunchee - daytime use started 8/2023, ongoing
Occupational therapy for sensory tongue-seeking habit
No history of a sleep test
No history of CPAP/BiPAP use
No history of a tongue release
Clinical Exam
Palatal tori
Narrow palate
Thick alveolar ridge & premaxilla - low tongue posture
Maxillary cant to the right
Venous pooling
Class I primary dentition
Tonsils - grade 2
Mallampati - class II
2mm overjet
No midline shift
No crossbite
No open bite
Mild to moderate overbite
No temperomandibular joint (TMJ) click/pop
Functional Evaluation
Mainly mouth breathing
Slight floor of mouth compensation
Competent lip closure
No noted speech difficulties
Grade 2 anterior and posterior tongue tie.
Low resting tongue posture.
Poor tongue awareness and tone.
Therapies Provided
The patient went through 5 sessions of orofacial myofunctional therapy from August 2023 to November 2023. No release of tethered oral tissues (TOTs) such as tongue, lip, or buccal ties was completed.
The patient is doing a few myofunctional exercises as needed to help maintain muscle tone long term.
Functional Improvements
I noted during the patient's final session that she was nasal breathing almost the entire appointment without behavior modification! The patient also improved her lingual palatal suction significantly and had removed most/all floor of mouth compensation.
The patient also had better awareness of diaphragmatic breathing along with improved tongue tone and positioning.
The patient's tonsils are maintaining at grade 1 to grade 2, so no surgical removal is recommended at this time.
Outcome
Intermolar width
Initial = 25.2mm
Final = 27.8mm - +2.6mm
Functional Range of Motion
Initial
Comfortable mouth opening (CMO) - 40mm
TRMR-TIP - 25mm (62.5%)
TRMR-LPS - 25mm (62.5%)
Final
CMO - 42mm - +2mm
TRMR-TIP - 39mm (92.9%) - +30.4% increase in range of motion
TRMR-LPS - 32mm (76.2%) - +13.7% increase in range of motion
The patient's parents report that she has had improvement in symptoms after doing myofunctional therapy and occupational therapy for a few months.
Overall, the patient is sleeping better, no longer wets the bed, snoring has decreased from moderate to mild, and she is doing better with nasal breathing during the daytime.
Options for further treatment
The patient is continuing to use her HealthStart Habit Corrector for nighttime wear
The patient is continuing to use her MyoMunchee for daytime habit elimination of tongue seeking
Use of a REMplenish straw is recommended to help maintain tongue tone long term
As the patient is still growing, we will monitor for palatal growth, teeth crowding, and tongue space over time. The goal is to maintain symptom and habit elimination and prevent the need for significant orthodontic treatment and/or removal of enlarged tonsils.
Because the patient was able to reduce/eliminate her symptoms so well through MFT, no release of tethered oral tissues is planned at this time.
A reevaluation for maintenance of symptom improvements and compensation eliminations will be completed in early 2024, and any further treatment, if needed and/or wanted by the patient, will be discussed at that time.
Talk soon,
Liz Laney, Myofunctional Therapist
*None of the information included in this post is intended to be medical advice. Please talk with your healthcare provider(s) before making lifestyle changes or starting/stopping any medications and/or diets.
Case report last updated 1/2024
Comments