The emerging area of orofacial myofunctional therapy: Efficacy of treatment in sleep disordered breathing bringing promise of a new field of medicine
The term "orofacial myofunctional therapy" (OMT) was first introduced into the medical literature by orthodontic pioneer Alfred Paul Rogers 100 years ago as a means to describe what he thought was the critical nature of the position of the tongue on craniofacial morphology and the ensuing orthodontic and occlusal stability [1,2] While OMT has remained at the margins of dentistry, speech language pathology, and other disciplines touching the stomatognathic system (with some particularly bright exceptions in Brazil and regions of Spain and Portugal) gradually gaining interest, only in the last few years has it begun to emerge on the stage of international scientific medical meetings. This prominence is due to the many dozens of papers demonstrating efficacy in the treatment of sleep disordered breathing (SDB) published in just the last few years. When my mother, Joy Lea Moeller (a pioneering leader in the development of OMT, particularly as it relates to SDB) was asked to write a Guest Editorial in this journal 6 years ago, "Orofacial Myofunctional Therapy, Why Now?" [3] we had a mere handful of papers on the efficacy of OMT as an adjunct treatment for SDB. Her bold claim that myofunctional therapy would come into greater prominence by its efficacy in treating OSA turned out a prescient call for action. The key paper she spotlighted, Katia Guimares' [4] 2009 study from Geraldo Lorenzi Fihlo's stellar University of Sao Paulo Instituto do Coracao team, showed in a randomized controlled trial that myofunctional therapy developed for the treatment of OSA patients significantly reduced severity and symptoms. That it was a well designed study, published in the American Thoracic Society's American Journal of Respiratory and Critical Care Medicine, a very wellrespected, high impact journal, led to this paper being in the top 10 of most referenced papers in sleep medicine for several years after its initial publication [5] I have had the good fortune to be a witness and participant in this rising tide. To give a sense of the progression, the biennial 2013 World Sleep Congress in Valencia, Spain had five presentations that referred in some fashion to myofunctional therapy. The 2015 World Sleep Congress in Seoul, Korea had about 15 presentations making some reference. The 2017 World Sleep Congress saw over 40 presentations touch upon some reference to the field, including a formal satellite symposium of the recently founded (2012) world OMT scientific society, the Academy of Applied Myofunctional Sciences (AAMS) [6 8] This momentum owes a great deal to visionary groundwork done at the Stanford University's School of Medicine's Division of Sleep Medicine, much of it led by Christian Guilleminault. Early, bold conviction with statements from 2012, suggesting that myofunctional therapy is critical for addressing pediatric OSA [9] were backed up with work done with Stanford [10] and further corroborated by important ongoing work done by teams led by Maria Pia Villa at Sapienza University of Rome [11] A special center of growing importance in myofunctional therapy research has developed in Hong Kong, particularly at Kwong Wah Hospital in Kowloon, led by Daniel KK Ng. As a result of a comprehensive undertaking beginning 5 years ago, commencing with training a full spectrum of allied professionals (PTs, OTs, sleep physicians, ENTs, sleep techs, et al. important work has been done that was the basis for the Asian Pediatric Pulmonology Society to formally update its pediatric OSA standard of care to include OMT [12] The French Society of Research and Sleep Medicine has recently done the same [13] joining several other medical and dental societies around the world. Additional work had been done identifying orofacial myofunctional disorders (OMDs) as phenotypes for sleep apnea, such as an altered lingual frenulum [14] Greater knowledge around phenotyping is making possible public health initiatives in which I have been privileged to have a direct role. The "Teste da Linguinha," or Frenulum Inspection Law we passed federally in Brazil in 2014 [15] requires all children to have their frenulums inspected at birth and then revised if indicated by the 1st validated tool for this purpose. Not only is this done to facilitate breastfeeding but also to avoid OMDs and their co morbidities, like OSA, throughout the lifespan. Furthermore, meta analyses, such as those by Camacho [16,17] have created more consensus that there is a critical role for OMT in SDB treatment. CRANIO(r) THE JOURNAL OF CRANIOMANDIBULAR SLEEP PRACTICE 2018, VOL. 36, NO. 5, 279 281 https:/doi.org/10.1080/08869634.2018.1512242
Cranio the journal of craniomandibular practice