Posterior Tongue Tie

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Case history #3:

Posterior Tongue Tie -

the amazing story of Michale Fetzik's 12 year search for migraine relief.

Presented by Michale Fetzik, Orofacial Myofunctional Therapist from Wichita, Kansas


events, low blood sugar, vocalization

T his case presentation chronicles an (talking, singing or crying), physical exer-

Integrative Functional and Multi- tion and fatigue. Headaches began in the

Disciplinary approach to alleviating right scapula/rhomboid region traveling

Chronic Atypical Tension Mi-

superiorly to the right trapezius/right oc-

graines in a 46-year-old female. Headaches cipital area and around the cranium to the

were approximately three times per month right eye. Occurrence was three to four

with duration of three days each. Intensity times per month with duration being ap-

was rated at ten on a ten-point pain scale proximately three days; the only relief was

and considered "debilitating" in nature.

a dark, cool room. Medications were re-

fused due to sensitivity of the patient. In-


teraction with family was affected, as was


ability to work.


vaginal feet-first breech birth


breastfed for one year

Therapeutic interventions employed in an attempt to relieve headaches:


chronic tonsillitis, open-mouth posture, mouth breathing, sinus issues ?

OTC (over the counter) medications:


retractive headgear orthodontics at

Excedrin, ibuprofen, guaifenisen

age 15, for


dietary changes: gluten free, dairy


overbite and anterior open bite

free, sugar free, low-carb diets


post orthodontic sleep issues


BHRT (Bioidentical Hormone Re-

placement Therapy)


forward-leaning posture (leaning forward at waist)


anti-oxidant therapy with nutritional supplements

? ? ?

TMJ appliance for clenching/ grinding at age 29


orthodontic relapse; anterior open bite


headache onset at age 36

bilateral breast reduction: DDD to C cup

chiropractic adjustment (traditional osseous adjustment)

None of the above interventions brought Twelve year history of Chronic Atypi- significant, lasting relief to the headache cal Tension Migraines triggered by stressful presentation.

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Figure 1. Post TMJ therapy and prior to orthodontics. Note upper lip flattening lateral to the philtrum. Note strained smile producing a compensatory head tilt. Profile shows low tongue rest posture in area superior to hyoid bone.


relationship may alleviate the onset of

Tipping Point "Diagnosis": Fibromyalgia headaches. After six months of treat-

ment, while neck tension had resolved

At age 44, the patient was "diagnosed" to a degree, the headache cycle was not

with fibromyalgia by a chiropractor who broken. Initially a day appliance was

suggested this after trigger point evalua- used exclusively. After six weeks, at-

tion and health history consistent with tempt of a night appliance was made,

the condition. Patient did not have in- but was not tolerated due to mouth

creased perception of pain.

breathing. TMJ appliance therapy re-

sulted in an exaggerated anterior open

TMJ Appliance Therapy

bite, which the patient had experienced

At age 45, TMJ (Temporomandibular in her teens. Swallow dysfunction was

Joint) appliance therapy was sought

mentioned during this therapy but no

with the thinking that correcting joint treatment was prescribed. Open-mouth

posture was not addressed.


Orthodontics was recommended to close

anterior open bite. It was at this time

orthodontist prescribed "Orofacial Myo-

functional Therapy" (OMT) to correct an-

terior tongue thrust, a dysfunctional

swallow. Since there were no local thera-

pists and the patient had the necessary

background to complete training, a com-

bination of training and treatment was

sought and achieved. During the next

Figure 2. Post TMJ treatment. Note incorrect tongue placement behind anterior teeth. Mouth breathing, tongue thrust and anterior tongue posture had not yet been treated.

year, Orofacial Myofunctional Therapy was completed. This therapy resulted in a complete resolution of headache incidences. However, chronic neck and


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Figure 3: Screw-type sagittal expander used to advance the pre-maxilla cuspid to cuspid. Note Hang claspTM distal to #6 and #11 (UR6 and UL6). 2mm space distal to the cuspids bilaterally al-

lowed advancement of the mandible.

shoulder tension remained.

(CATS) and continued chiropractic ad-

Myofunctional Therapy corrected justment, yielded the cranial dimension

the open-mouth posture. Lip seal and changes evident in the photos.

tongue/ palate contact was achieved

Craniosacral Fascial Technique

and anterior tongue thrust swallow was (The Gillespie Approach) was used over


a period of four days in the post-

Correct tongue-rest posture al- operative period. This fascial unwinding

lowed forward excursion of the mandi- technique was instrumental in removing

ble, creating a greater need for forward deep fascial strain patterns allowing the

advancement of the mandible. Although mandible to relax even further, as evi-

the practitioner attempted facial tipping denced by change in occlusion.

of the maxillary anterior teeth, the pa-

tient elected to use a removable palatal Results

expander (see pic) with HangTM clasps Following lingual and maxillary central

distal to the canine teeth. This sagittal tether releases, shoulder and neck ten-

device reversed the retractive headgear sion abated completely. Chiropractic ad-

effect of her original orthodontics as a justment and CATS continued until ad-

teen allowing the mandible to move for- justments were held. The debanding and

ward into a new functional occlusion. retention phase was achieved. Mainte-

nance CATS treatments continue on a


four to eight week schedule. Anterior

The patient/therapist was evaluated by movement of the mandible is evidenced

a physical therapist and found to have a in the photos.

floor of mouth restriction or tether

A post-operative respiratory spi-

(sometimes known as Posterior Tongue rometry and pharyngometrystudy was

Tie), which was also connected into the completed and the airway declared "that

alveolar ridge of the mandible in the lin- of an opera singer." Weight loss was

gual aspect; these areas were released achieved; sleep and overall health im-

via laser by her husband (general den- proved.

tist Dr. Stephen P. Fetzik, Wichita, Kan-

Total treatment time and course

sas). This tissue release, in combination of therapy was over a 2 year period. Oc-

with Cranial Adjusting Turner Style

currence of previously scaled migraine

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Fig 4: Post orthodontic treatment on the day of de-banding. Note lift in upper lip vermillion ridge. Note decreased strain in smile and resolution of head tilt. In spite of weight loss, skin tone and muscle turgor are improved. Note tone and lift in the neck muscles superior to hyoid bone which is related to correct tongue posture. Eyelid tone improved and zygomatic arches appear to be wider.

has been zero. One tension headache at pain, improved sleep, weight loss and an

a rating of three was treated with ho- overall sense of well being. The patient

meopathic remedies (arnica and hy-

also received coaching from a Buteyko

pericum). Another tension headache at a Breathing practitioner to reduce the rate

rating of five was treated with one Ex- and volume of breathing which aided in


the transition from mouth breathing to

habitual nasal breathing.


The dramatic improvements in this case Such an integrative approach proved

are evident based on the before and af- very beneficial in this case. Results are

ter photos. Although direct anthropome- currently stable for two years and one

try was not performed in assessment, half years.

the photos seem to indicate that there

were changes in the measurements. Or-

bital dimensions became more symmetrical. Facial Width (Zy-Zy) appears to have increased reflecting cranial stability from palatal support via correct and

Fig 5. Post orthodontics, anterior expansion, myofunctional therapy and both lingual and maxillary central frenectomies

effective tongue rest posture. The man-

dible appears to have moved forward.

Once the maxillary position advanced

via anterior expansion, the mandible

was permitted to move forward. Further

conditioning and training via Myofunc-

tional Therapy consolidated this jaw po-

sition. Release of the posterior lingual

tethering permitted relaxation and fur-

ther comfort in this advancement. Sub-

jective reports from the patient were the

alleviation of Fibromyalgia trigger point


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