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While Orofacial Myofunctional Therapy itself is non surgical, it is intimately tied to surgical interventions. The most common intersection is the surgical release of tethered oral tissues (TOTs), known as a frenectomy or frenuloplasty. Additionally, therapy plays a vital role in the recovery from jaw surgeries (orthognathic surgery) and in supporting airway reconstruction.
The “Surgery and Recovery” phase in the context of OMDs refers to the collaborative management of these procedures. The therapist prepares the tissue before the scalpel touches it and guides the rehabilitation afterwards. Without this therapy, the surgical release often fails to yield functional improvement due to scarring or muscle memory.
Modern surgical techniques for frenectomies utilize lasers or piezoelectric scalpels, which are less traumatic than traditional scissors. However, the success of these high tech tools relies entirely on the low tech, high effort rehabilitation that follows.
A frenectomy is the removal or modification of the frenulum, the band of tissue restricting the tongue or lip. 21st century techniques have moved away from simple “clipping” to complete functional releases.
CO2 Lasers are the gold standard. They vaporize the tissue with extreme precision, sealing nerve endings and blood vessels instantly. This results in a “bloodless” surgery with less post operative pain. The laser also sterilizes the wound, reducing infection risk.
Some surgeons perform a “Functional Frenuloplasty.” This is a more extensive procedure than a simple release. It involves dissecting the fascia to ensure the tongue is completely free from the floor of the mouth.
This procedure is always done in conjunction with myofunctional therapy. Sutures are often placed to guide healing and prevent the diamond shaped wound from closing up vertically, which would recreate the restriction.
Ideally, the myofunctional therapist works closely with the surgeon. In some models, the therapist is present during the procedure or sees the patient immediately afterwards. This ensures that the patient understands exactly how to move the newly freed tongue.
The therapist verifies that the release is functionally adequate. They might ask the surgeon to release “a little more” based on the patient’s ability to elevate the tongue to the palate during the procedure.
The first two days after a frenectomy are the most challenging. The mouth is sore, and the tongue is swollen. However, movement is critical. The “active wound management” protocol begins within hours of the surgery.
Pain is managed with over the counter analgesics. The patient is encouraged to consume cold, soft foods which act as a natural numbing agent. The primary goal is to keep the wound from gluing itself back together.
AWM is the defining feature of modern recovery. The patient must stretch the wound 4 to 6 times a day for several weeks. This involves placing fingers in the mouth and physically lifting the tongue or pulling the lip.
This prevents “primary intention” healing where the edges stick together. Instead, it forces “secondary intention” healing, where new tissue fills in the gap, resulting in a longer, more flexible frenulum.
Releasing a tongue tie changes the biomechanics of the entire head and neck. Muscles that were tight (like the trapezius) may relax, while muscles that were weak (like the tongue elevators) are suddenly working hard.
This can lead to temporary muscle soreness or “body aches” as the system realigns. Bodywork, such as Craniosacral Therapy (CST) or myofascial release, is highly recommended during this phase to help the body integrate the change.
For patients undergoing jaw surgery to correct skeletal discrepancies, OMT is crucial for stability. After the jaws are moved, the muscles must adapt to the new skeletal frame.
Therapy helps reduce post surgical swelling through lymphatic movement exercises. It also retrains the tongue to rest in the new, larger palate, preventing the relapse that occurs if the tongue continues to push against the surgical sites.
After a release or surgery, the basic biological rhythms must be re learned. A tongue that was tied could not perform a proper peristaltic swallow. Now that it is free, the brain must update its software.
The therapist guides the patient through drills to integrate the new range of motion into the swallow. This is the bridge between having the ability to move and actually using that movement in daily function.
All surgeries create scar tissue. In the mouth, this tissue must remain flexible. If the wound management is neglected, thick, fibrotic scar tissue can form, causing a loss of mobility.
Therapists teach deep tissue massage techniques for the floor of the mouth and tongue. This helps break down collagen fibers and ensures the new frenulum remains pliable and functional.
Recovery is not over when the wound closes. The true recovery is the neurological adaptation. It takes months for the new range of motion to become the “new normal.”
The patient continues therapy exercises to build strength in the newly liberated muscles. The goal is to reach a point where the tongue naturally rests on the palate without conscious effort, signaling the end of the recovery phase.
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The procedure itself is usually done under local anesthesia, so it is not painful. The laser also seals nerve endings. However, there will be soreness and discomfort for a few days afterwards as the anesthesia wears off and healing begins.
If you don’t do the exercises, the wound will heal by sticking back together, and your tongue will be tight again. The exercises also teach your brain how to use the new movement; otherwise, you will keep using your old habits.
When the frenulum is released, the cut opens up into a diamond shape. This is the raw surface that needs to heal. Your goal during recovery is to keep this diamond tall and open, preventing it from flattening out or closing up.
Technically, the tissue can reattach if the wound is not managed properly, making it feel like it “grew back.” This is why the post operative stretches are so critical. True regrowth of the frenulum itself is rare if the release was complete.
You can eat immediately after the anesthesia wears off. In fact, eating is encouraged as the movement helps the tongue. Stick to soft, cool foods for the first few days to avoid irritating the wound.
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