Skip to main content

Orofacial Myofunctional Therapy

  • Chapter
  • First Online:
Obstructive Sleep Apnea


Orofacial myofunctional therapy (OMT) uses a combination of physical therapy exercises to improve the bite, breathing, and facial posture of those with orofacial myofunctional disorders (OMDs). OMDs are patterns involving oral and orofacial musculature that interfere with normal growth, development, or function of orofacial structures, or call attention to themselves. The therapy targets the soft tissues of the face, neck, and mouth to establish optimal tongue position and oral rest posture. OMDs can affect people of all ages, and treatment is customized based on age and symptoms. OMT has been used as a clinical solution for OMD for several decades worldwide, and its success has been documented. Still, there is a paucity of solid scientific evidence due to a lack of financial support. OMT to treat sleep-disordered breathing can be a reasonable option as a complementary therapy used with other methods that are backed by more solid evidence. Only in those cases where patients do not adhere to other therapies should OMT be prescribed uniquely.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions



Apnea–hypopnea index


Control pause


Drug-induced sleep endoscopy


Ear, nose, throat specialist


Epworth sleepiness scale


Grams per square centimeter


Iowa oral performance instrument




Orofacial muscle disorder


Orofacial myofunctional therapy


Obstructive sleep apnea


Upper airway collapsibility


Randomized controlled trial


Sleep-disordered breathing


Tongue digital spoon.


Upper airway


  1. Mason RM, Franklin H. Orofacial myofunctional disorders and otolaryngologists. Otolaryngology. 2014;4(04):e110.

    Article  Google Scholar 

  2. Garliner D. In: Garliner D, editor. Myofunctional therapy. Philadelphia: Saunders; 1976.

    Google Scholar 

  3. Puhan MA. Didgeridoo playing as alternative treatment for obstructive sleep apnoea syndrome: randomised controlled trial. BMJ. 2006;332(7536):266–70.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Meghpara S, Chohan M, Bandyopadhyay A, Kozlowski C, Casinas J, Kushida C, Camacho M. Myofunctional therapy for OSA: a meta-analysis. Expert Rev Respir Med. 2021;22:1–7.

    Article  CAS  Google Scholar 

  5. O’Connor-Reina C, Ignacio Garcia JM, Rodriguez Ruiz E, Morillo Dominguez MDC, Ignacio Barrios V, Baptista Jardin P, Casado Morente JC, Garcia Iriarte MT, Plaza G. Myofunctional therapy app for severe apnea-hypopnea sleep obstructive syndrome: pilot randomized controlled trial. JMIR Mhealth Uhealth. 2020;8(11):e23123.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Carrasco-Llatas M, O’Connor-Reina C, Calvo-Henríquez C. The role of myofunctional therapy in treating sleep-disordered breathing: a state-of-the-art review. Int J Environ Res Public Health. 2021;18(14):7291.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Eckert DJ, White DP, Jordan AS, Malhotra A, Wellman A. Defining phenotypic causes of obstructive sleep apnea: identification of novel therapeutic targets. Am J Respir Crit Care Med. 2013;188(8):996–1004.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Dotan Y, Pillar G, Tov N, Oliven R, Steinfeld U, Gaitini L, et al. Dissociation of electromyogram and mechanical response in sleep apnoea during propofol anaesthesia. Eur Respir J. 2013;41(1):74–84.

    Article  CAS  PubMed  Google Scholar 

  9. Bilston LE, Gandevia SC. Biomechanical properties of the human upper airway and their effect on its behavior during breathing and in obstructive sleep apnea. J Appl Physiol. 2014;116(3):314–24.

    Article  CAS  PubMed  Google Scholar 

  10. Guilleminault C, Huang YS, Quo S. Apraxia in children and adults with obstructive sleep apnea syndrome. Sleep. 2019;42(12):zsz168.

    Article  PubMed  Google Scholar 

  11. O’Connor-Reina C, Plaza G, Garcia-Iriarte OMT, Ignacio-Garcia JM, Baptista P, Casado-Morente JC, De Vicente E. Tongue peak pressure: a tool to aid in the identification of obstruction sites in patients with obstructive sleep apnea/hypopnea syndrome. Sleep Breath. 2020;24(1):281–6.

    Article  PubMed  Google Scholar 

  12. Vargervik K, Miller AJ, Chierici G, Harvold E, Tomer BS. Morphologic response to changes in neuromuscular patterns experimentally induced by altered modes of respiration. Am J Orthod. 1984;85(2):115–24.

    Article  CAS  PubMed  Google Scholar 

  13. Linder-Aronson S. Adenoids. Their effect on mode of breathing and nasal airflow and their relationship to characteristics of the facial skeleton and the dentition. A biometric, rhino-manometric and cephalometro-radiographic study on children with and without adenoids. Acta Otolaryngol Suppl. 1970;265:1–132.

    CAS  PubMed  Google Scholar 

  14. Lee SY, Guilleminault C, Chiu HY, Sullivan SS. Mouth breathing, “nasal disuse,” and pediatric sleep-disordered breathing. Sleep Breath. 2015;19:1257–64.

    Article  PubMed  Google Scholar 

  15. Messineo L, Taranto-Montemurro L, Azarbarzin A, Oliveira Marques MD, Calianese N, White DP, Wellman A, Sands SA. Breath-holding as a means to estimate the loop gain contribution to obstructive sleep apnoea. J Physiol. 2018;596(17):4043–56.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  16. Mangin D, Bequignon E, Zerah-Lancner F, Isabey D, Louis B, Adnot S, Papon JF, Coste A, Boyer L, Devars du Mayne M. Investigating hyperventilation syndrome in patients suffering from empty nose syndrome. Laryngoscope. 2017;127(9):1983–8.

    Article  PubMed  Google Scholar 

  17. Van Dixhoorn J, Duivenvoorden HJ. Efficacy of Nijmegen questionnaire in recognition of the hyperventilation syndrome. J Psychosom Res. 1985;29(2):199–206.

    Article  PubMed  Google Scholar 

  18. Galeotti A, Festa P, Viarani V, et al. Prevalence of malocclusion in children with obstructive sleep apnoea. Orthod Craniofac Res. 2018;21:242–7.

    Article  PubMed  Google Scholar 

  19. Messner AH, Walsh J, Rosenfeld RM, Schwartz SR, Ishman SL, Baldassari C, Brietzke SE, Darrow DH, Goldstein N, Levi J, Meyer AK. Clinical consensus statement: ankyloglossia in children. Otolaryngol Head Neck Surg. 2020;162(5):597–611.

    Article  PubMed  Google Scholar 

  20. Jiménez DG, Romero MC, Galán IR, Martínez MG, Pando MR, Prieto CL. Prevalence of ankyloglossia in newborns in Asturias (Spain). Anales de Pediatría (English Edition). 2014;81(2):115–9.

    Article  Google Scholar 

  21. Guilleminault C, Huseni S, Lo L. A frequent phenotype for paediatric sleep apnoea: short lingual frenulum. ERJ Open Res. 2016;2(3):00043–2016.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Guilleminault C, Akhtar F. Pediatric sleep-disordered breathing: new evidence on its development. Sleep Med Rev. 2015;24:46–56.

    Article  PubMed  Google Scholar 

  23. Flores-Mir C, Korayem M, Heo G, Witmans M, Major MP, Major PW. Craniofacial morphological characteristics in children with obstructive sleep apnea syndrome: a systematic review and meta-analysis. J Am Dent Assoc. 2013;144(3):269–77.

    Article  PubMed  Google Scholar 

  24. Katyal V, Pamula Y, Martin AJ, Daynes CN, Kennedy JD, Sampson WJ. Craniofacial and upper airway morphology in pediatric sleep-disordered breathing: systematic review and meta-analysis. Am J Orthod Dentofac Orthop. 2013;143(1):20–30.e3.

    Article  Google Scholar 

  25. Marchesan IQ. Lingual frenulum protocol. Int J Orofacial Myol. 2012;38:89–103.

    Article  Google Scholar 

  26. Hazelbaker AK. Assessment tool for lingual frenulum function (ATLFF). Clin Lactat. 2017;8(3):132–3.

    Article  Google Scholar 

  27. Zaghi S, Valcu-Pinkerton S, Jabara M, Norouz-Knutsen L, Govardhan C, Moeller J, Sinkus V, Thorsen RS, Downing V, Camacho M, Yoon A. Lingual frenuloplasty with orofacial myofunctional therapy: exploring safety and efficacy in 348 cases. Laryngoscope Investig Otolaryngol. 2019;4(5):489–96.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Genther DJ, Skinner ML, Bailey PJ, Capone RB, Byrne PJ. Airway obstruction after lingual frenulectomy in two infants with Pierre-Robin sequence. Int J Pediatr Otorhinolaryngol. 2015;79(9):1592–4.

    Article  PubMed  Google Scholar 

  29. Clark HM, Solomon NP. Age and sex differences in orofacial strength. Dysphagia. 2012;27(1):2–9.

    Article  PubMed  Google Scholar 

  30. de Felício CM, da Silva Dias FV, Folha GA, de Almeida LA, de Souza JF, Anselmo-Lima WT, Trawitzki LV, Valera FC. Orofacial motor functions in pediatric obstructive sleep apnea and implications for orofacial myofunctional therapy. Int J Pediatr Otorhinolaryngol. 2016;90:5–11.

    Article  PubMed  Google Scholar 

  31. Villa MP, Evangelisti M, Martella S, Barreto M, Del Pozzo M. Can myofunctional therapy increase tongue tone and reduce symptoms in children with sleep-disordered breathing? Sleep Breath. 2017;21:1025–32.

    Article  PubMed  Google Scholar 

  32. Rodríguez-Alcalá L, Martín-Lagos Martínez J, O’Connor-Reina C, Plaza G. Assessment of muscular tone of the tongue using a digital measure spoon in a healthy population: a pilot study. PLoS One. 2021;16(2):e0245901.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Guimarães KC. Apnéia e ronco: tratamento miofuncional orofacial. São José dos Campos/SP Ed Pulso. 2009.

    Google Scholar 

  34. O’Connor RC, Plaza G, Ignacio-Garcia JM, Baptista Jardin P, Garcia-Iriarte MT, Casado-Morente JC, De Vicente GE, Rodriguez-Reina A. New mHealth application software based on myofunctional therapy applied to sleep-disordered breathing in non-compliant subjects. Sleep Sci Pract. 2020;4:3.

    Article  Google Scholar 

  35. O’Connor RC, Garcia-Iriarte M, Casado-Morente J. New app “Apnea Bye” increases adherence in myofunctional therapy to treat sleep disordered breathing. In: Otolaryngol Neck Surg (1 Suppl). 2018 Presented at: American Academy of Otolaryngology-Head and Neck Surgery 2018 Annual Meeting & OTO Experience; October 7–10, 2018; Atlanta, GA.

    Google Scholar 

  36. Díaz M, Salazar A, Bravo F, Ocampo-Garcés A. Tratamiento del síndrome de apneas e hipopneas obstructivas del sueño con terapia miofuncional orofaríngea: Experiencia en hospital público de Chile. Rev otorrinolaringol cir cabeza cuello. 2019;79(4):395–403.

    Article  Google Scholar 

  37. Rodriguez-Alcalá L, Ignacio-García J, Serrano Angulo MS, Benjumea F, Casado JC, O’Connor- Reina CI. Tongue+ protocol for the diagnosis of obstructive sleep apnoea in Quirónsalud Marbella hospital [version 1; peer review: awaiting peer review]. F1000Research. 2022;11:322.

    Article  Google Scholar 

  38. O’Connor-Reina C, Ignacio Garcia JM, Rodriguez Alcala LR, Rodríguez Ruiz E, Garcia Iriarte MT, Casado Morente JC, Baptista P, Plaza G. Improving adherence to myofunctional therapy in the treatment of sleep-disordered breathing. J Clin Med. 2021;10(24):5772.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations


Corresponding author

Correspondence to Carlos O’Connor-Reina .

Editor information

Editors and Affiliations

6.1 Electronic Supplementary Material

Example of atypical swallowing (MP4 2300 kb)

Tongue tie surgery (MP4 112914 kb)

Conventional soropharyngeal exercises (MP4 8600 kb)

APP-based oropharyngeal exercises (MP4 9115 kb)

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

O’Connor-Reina, C., Borrmann, F., Rodriguez-Alcala, L. (2023). Orofacial Myofunctional Therapy. In: Baptista, P.M., Lugo Saldaña, R., Amado, S. (eds) Obstructive Sleep Apnea. Springer, Cham.

Download citation

  • DOI:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-35224-9

  • Online ISBN: 978-3-031-35225-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics