Tethered Oral Tissue (TOTS)

also known as 'tongue-tie'

Orofacial myofunctional disorders involve patterns and behaviors created by inappropriate muscle function involving the tongue, lips, jaw, and face. This also includes noxious oral habits. Tongue thrust is the most common orofacial myofunctional variation. Incorrect positioning of the tongue during swallowing, chewing, and at rest may contribute to improper orofacial development. It can also maintain the misalignment of the teeth. 

A speech pathologist with a certification from the International Association of Orofacial Myology is best suited to treat these disorders. A COM (Certified Orofacial Myologist) will work as part of a team with pediatricians, dentists, ENTs, orthodontists, and oral surgeons. If a child exhibits a combination of myofunctional disorders as well as speech disorders, traditional speech therapy often fails to remedy the speech problem. Numerous studies have shown the effectiveness of myofunctional therapy. 

Certified Orofacial Myologists specialize in the following:

  • Improper oral habits such as thumb and finger sucking/nail biting
  • Tongue tie (ankyloglossia) 
  • Improper tongue resting posture
  • Abnormal chewing and swallowing patterns 
  • Open lip posture 


For frequently asked questions, click here. For a list of Certified practitioners, click here

Open bite/abnormal tongue resting posture.

Watch this very important video for more information

Long Beach Speech

​​​​Rebecca thorsen M.S., CCC-SLP, Com™