The Hands and the Tongue

New Perspectives on the
Functional Swallow and Intelligent Palpation

The Tongue of the Patient
and the Hands of the Osteopath
 assume a role of even greater significance for the maintenance of health
 and the recovery from dysfunction.


Is the world flat or is the world round?
The world view of anatomy and physiology is rapidly evolving in this century.
A difference of perception and understanding are at a crossroads
– There is no motion in the sutures of the skull. 
– There is subtle motion between the sutures of the skull.

This critical difference in perspective, this disparity in understanding,
lies at the heart of these findings. 
Can science look beyond the ‘fish-bowl’ world view in which they find themselves?
Neuroscience is exploring a heretofore ‘unknown’ phenomena of the brain
 the Glymphatic System.  And this ‘Brain Drain’ system is dependent on motion during sleep.

Is the world flat or is the world round?
Growing pains in anatomy and physiology.

And what role does
 the Tongue and the Swallow play in Glymphatics and CSF movement?
The Cranial Osteopathic functional perspective adds a new dimension
for both patient and doctor.

The importance of the
tongue and the functional swallow
of the patient
 generates a new understanding
in the Cranial Osteopathic Orofacial perspective.

Palpatory skills of the practitioner
to affect this CSF | Glymphatic system
provides another level of awareness
in functionality and treatment potentials.

In the Cranial Connection orientation,
the findings and questions that surround
Glymphatics and Cerebrospinal Fluid (CSF)
  fall into the domain of the
Cranial Rhythmic Impulse (CRI): 
– the inherent cranial motion
 –  a possible mechanism of movement and transport.

Contemporary neuroscience research in the glymphatic system has more questions than answers at this time.
Sleep is the primary force for ‘glymphatic clearance’ – brain washing – of toxins.
The implications for neurogenerative disease is paramount.
However, the question remains HOW does this ‘brain washing’ during sleep occur?
Transport by the venous system has been ruled out. 

The evidence of lower-frequency pressure oscillations to drive this fluid-transport system
has been noted by neuroscientists.
In the world of the cranial osteopath, the ability to see these pulsations and oscillations
 that trained practitioners have been able to palpate for over fifty years
gives much-awaited validation of a reality not accepted by tradition.

How does a functional swallow relate to this newly discovered glymphatic system?
Perhaps more than we can imagine!
But, first must come the acknowledgement of subtle cranial motion between cranial bones.
A belief in the raison d’etre of the bevel –
– more than a fluke of evolutionary development in the human skull.  
Bone beveling and the domain of the ‘suture’ is a functional reality designed for motion.

The  action of the tongue, the swallow and the maxillary midline suture
become key players in the ‘inherent cranial motion’
that lives in the world of the CRI (cranial rhythmic impulse) and can be palpated.

Will there be a merger of minds and evolutionary understanding
between osteopathy, orthodontics/facial development and neuroscience?

The head (cranial vault) of both adult and infant are similar in size and shape.
However, the growth of the cranio-mandibular complex from birth to adult is remarkable.

The mandible is a unique bone,
providing the essential life functions  of chewing, swallowing and breathing.

Functional swallowing develops the face.
Functional chewing grows a mandible.

Female Adult Skull

Infant Skull

The pressure of the tongue in the palate
(roof of the mouth) gently massages the maxillary suture (midline suture), helping to
widen the palate –
growing the face.

Furthermore, when swallowing,
 the suction action of the tongue
in the upper back region of the palate
pulls down on the vomer and ethmoid bones which lie directly above the palate. 

 This in turn stimulates the midline joint structure – the semi-cartilaginous spenobasilar
symphysis (SBS),

thereby creating a pumping action
into the center of the cranium –
the functional swallow.

The Interface of Osteopathy and Orthodontics

Tasha Turzo, DO is internationally recognized
for her orofacial osteopathic contribution to the Cranial Concept, having worked in tandem with dentists and facial development
 for over twenty-five years.
The primary importance of the temporal bone
and jaw joint in facial development
is now intersecting with dental/orthodontic
awareness and practice. 
The orthodontic community is beginning to recognize that the jaw joint is connected to the skull –
a game changer in the world of orthodontics.

We all know people who have worn braces
 and then have to wear retainers
 for the rest of their life or their teeth will ‘migrate’
and their bite will shift.
 This ‘dental’ phenomenon underscores
the inherent motion in the skull  
and the cranial osteopathic concept.
Teeth and occlusion are manifestations of a functional whole – an effect and visible result of the
body in totality.

Image from Tasha Turzo,  DO
The face  literally  ‘hangs’ off the temporal bones. 
And the paired TM joints/temporal bone
assume a primary significance
 in body balance and function.

At the same time, a revolution in orthodontics is approaching world-wide recognition as well,
thanks to Mike Mew, DDS and the phenomenon of “Mewing”.

Having evolved through three generations of orthodontists, Mew’s contribution to facial development
emphasizes the primary importance of the palate and tongue function
 BEFORE working with teeth and braces. 
This orientation is producing quite an overhaul and ‘expansion’ of the orthodontic profession –
from malocclusions (crooked teeth) airway functionality or lack thereof (sleep apnea), 
TMD (temporomandibular joint dysfunction) as well as facial esthetics. 

The evolutionary interface of these two professions is underscoring
 what orthodontists have seen and cranial osteopaths have palpated
for over seventy-five years.

Let’s investigate the tongue and the swallow of the patient and the hands of the osteopath.

For more information on this topic, visit 


‘Mewing’, Orthotropics, and Forwardontics


 Tongue activity is very important for all ages
…and has far-reaching functional significance in the Cranial Osteopathic Orofacial perspective.

Mewing and Oral Myology

What is

Mewing’, a tongue activity that can be learned by young and old alike,
is a technique that involves a functional resting position of the tongue. 
Place the tongue against the palate (roof of the mouth) behind the upper teeth,
and while keeping the lips closed, maintain nasal breathing. 
Swallowing with a ‘suction’ action with the tongue in the upper back portion of the palate 
creates a functional swallow.


According to Dr. Michael Mew, DDS, British orthodontist

 “the correct postural placement
of the tongue on the roof of the mouth
(the palate) helps
 align the teeth, 
sharpen your jaw line,
accentuate your cheekbones,
and even straighten your nose naturally….
all without invasive surgeries or expensive orthodontics.

This (correct tongue placement) can also
diminish wrinkles
 and improve your airways,

bringing your maxilla (upper jaw) forward,
and potentially extending your lifespan
 by enlarging your airways, reducing snoring and sleep apnea.”

“It works because in your skull you have these cracks called sutures  that help the bones to enlarge evenly as children grow, one of them being on the roof of your mouth (maxillary suture). If you apply consistent pressure on this (suture) using your tongue, it can make your face grow just like using an expanded device.”

And thus the word “Orthotropic” 
‘ORTHO’ for straight and ‘TROPIC’ for growth.” 
(boldface parenthesis added)

Dr. Mike Mew’s Ultimate Mewing Guide | BEGINNER

“Mewing” Short 


Meet Sandra Kahn, DDS
 ‘Orthotropics’ updated in the United States – ‘Mewing’ reinforced
Author of 
JAWS: The Hidden Epidemic
BioScience: The Jaw Epidemic: Recognition, Origins, Cures, and Prevention
Forwardontics:  Grow/Feel/Look/Breathe Better

Posture and Breathing

Respiration is the only function in the body that has two organs: nose or mouth.

Compensatory breathing is done through the mouth.
The nose MUST be functioning especially while sleeping:
Closed Mouth with Nasal Breathing

Breathing is controlled by the brainstem, NOT the brain. 
If the nose has resistance during sleep, there is struggling;
The brain is engaged and the mouth opens.
Sleep apnea is born.

Conversation with Sandra Kahn, DDS

What is Oral Myology and a Myofunctional Therapist

The Mewing craze has promoted recognition of the TONGUE
 – a critical first piece of the orofacial ‘puzzle’.

 Image from

The Myofunctional Therapist | Orofacial Myologist
is usually part of a “swallowing” team effort
with dentist, osteopath, orthodontist, otolaryngologist, myofunctional and/or speech therapist.

Myofunctional therapy is an exercise training program
for correcting tongue posture and facial muscles:
PT (physical therapy) for the tongue.
– how to strengthen the tongue, and
– how to engage the appropriate position of the tongue for a
  “Functional Swallow”.

BUT there is much more: 
Myofunctional therapy is more than “Mewing tongue awareness’:  
MYO offers neurophysiological exercises to create a proper swallow ‘reflex’ 
…a retraining of the brain.

 Mewing Transformed


 Image from

Several pieces remain missing
in this Orofacial Puzzle. 

What are they?

Mew’s Orthotropics boldly questions his own profession of Orthodontics, 
which has also rapidly expanded into facial development with (rapid) expansion palate devices
not to mention treating Swallowing, Sleep Apnea and Temporomandibular Joint Dysfunction (TMD).

What happened to
braces and
straightening teeth?

The Orthodontic profession is being questioned and challenged.

Is the ‘Mewing’ controversy a reaction to the statement
 ‘ just like using an expanded device’?

 Image from

The traditional field of Orthodontics
is in an era of transformation and rapid change
….along with our faces.

Breathing and Swallowing have risen to a new stature.
What organ is paramount in both breathing and swallowing?
A new perspective and orientation is unfolding:
and, the supremacy of the Tongue enters into our awareness.

Regardless of how much ‘facial change’ can evolve with
Mewing, Forwardontics, Oral Myology, Orthodontics, or Surgery
this focus on breathing and swallowing
intersects within our mouth and nose (oropharynx),
the territory of the Otolaryngologist
…and don’t forget the Neurologist (cranial nerves) and the Pulmonologist (lungs)!

Could there more to the Swallow than facial development,
both functional and aesthetic?

Awareness | Self-Help | Prevention

Self-Help is commendable in any health-care profession.
Patient age and severity of dysfunction
are primary variables that can influence the potential for change.

In the world of dentistry, Mike Mew and Sandra Kahn
are instrumental in challenging the status quo and promoting awareness of facial development.

What can the patient do to facilitate any treatment and enhance positive change?
How much can any given patient change with Self-Help?

When to seek professional treatment?  
And where and from whom…in this world of controversial options?

Mike Mew, DDS
has provided remarkable and literally ‘mouth-opening’ information for
Self-Help Guidance with ‘Mewing’
first, awareness and secondly, tools for

Functional Swallowing
…a ‘light-force’ / pressure from the back tongue that stimulates the palate
at the midline (maxillary) suture in response to this gentle movement and pressure.

…an activity which can and does affect everyone!

Sandra Kahn, DDS

 Following in the Self-Help and Prevention footsteps
of Mike Mew, DDS and Orthotropics,
Sandra Kahn has created several devices.

Better Breathing and Oral Posture

Both devices are “created to promote nasal breathing and correct resting oral posture.”

The Up-Locker Vacuum Activator aids
“in the prevention of malocclusion, poor jaw development and obstructive sleep apnea
caused by chronic oral breathing in children and adults.”

– Worn ONLY during the day.
– Trains the tongue for proper positioning in the mouth.
– Maintains negative pressure with a visual aid feedback system,
thereby assisting the user in recognition of correct tongue placement.

The BOW, designed
for children (small)  or adults (large)
is the first bimaxillary protraction mask
without facial support. The Bow anchors from the chest and forehead, leaving upper and lower jaws free to respond to light, constant, forward pull.

Image from

Is this device used
to not only correct
oral posture
but also to enhance breathing?

What about the lower torso?

 What else
remains to be discovered 
in the orofacial puzzle?

I wonder what is being affected by altering facial development
whether utilizing self-help Mewing, myofunctional therapy,  professional dental/orthodontic intervention with intra-oral devices, or surgical procedures (orthognathic surgery), 

What is happening in the lower body that could affect orofacial interventions?
Conversely, what is happening with orofacial interventions that could affect the lower body?

What are the ’causes’ of oral dysfunction?
What are ‘effects‘ before, after or during orofacial change; 

How to discern the difference between cause and effect?
Is the lower jaw retracted because the pelvis is dysfunctional: upper body compensation?
Is the upper jaw too forward because of a thoracic cage (chest) dysfunction?

Welcome to the world
of the

Cranial Osteopathic Orientation

 – encompassing the functionality
of the body in its

fascial totality.


…and encompassing the interconnectivity of
Orthondontics, Orofacial Myology,
Orthotropics and Otolaryngology.

All function within the Fascial Network,
the ignored and unrecognized
  ‘internet’ communication system of the body…

a sensitive network that responds
to intelligent palpation – TOUCH.

A whole-body approach to health

…a treatment from TONGUE to TOE

Image from @drstevenlin

 with the Fascial Network
of the body and
The Cranial Connection.

The tongue, the ‘kingpin’
of this communication system, 
affects not only swallowing
but also breathing!

From the tongue
 and muscles of the jaw,
through the middle of the body,
to the arch of the foot..

The head is connected to the rest of the body.
There is a communication system encompassing ALL of these ‘specializations’
that is ignored and unrecognized
… the interconnectivity of the fascial network.

It is necessary to stand back and perceive the whole “elephant”
in this body network instead of focusing on the tongue (swallowing)
or the trunk (otolaryngology),
or the airway/hypopharynx (sleep apnea),
or the ears and jaw (TMD),
or the mouth (orthodontics, dentistry and orthotropics.)

The ‘Whole’ moves, breathes, chews and swallows…
and is connected to a Body
 ..a Body that not only affects but also is affected by

 these, essential integrated functions of daily life, swallowing and breathing.

Medical interventions can decrease or augment function,
thereby raising awareness of these habitual behaviors.

Facial Development with Fascial Integrity

There is another orofacial treatment option that
addresses the posture of the whole body.
Posture is an outcome, emerging from the integrity and functionality
 of the fascial network in conjunction with facial change and development.

…a modality that can augment, accelerate, and guide this change.

The ALF Approach
book presents the
underlying causes of
– crooked teeth,
– jaw pain, and
– postural changes

 …and the “WHY”
behind relapse.

Discover the critical
functions of
– nasal breathing,
– chewing
– functional swallowing, and
 – resting position of the tongue in the upper palate.

…the elements of
optimal facial form and
dental postural health. 

Learn about
the utmost importance of
tongue function and
nasal breathing
to optimize the airway.

Observe the importance of a “forward” orthodontic treatment that
increases the airway space
 as it augments
normal growth and development of the face.

Osteopathic light palpation
can assist, reinforce and enhance the light force exerted
by the ALF appliance in orofacial development
…not only in the head and upper torso, but in the whole body.

Image from

Image from

Image from

A Whole-Body Approach for Facial Development

Facial Change with Fascial Integrity

Personal Observations and Addendum

Mewing’ and ‘Forwardontics‘ are the Gateway into a panoramic viewpoint
 rapidly emerging in medical specializations
surrounding orofacial development and treatment.

…not only integrating these emerging ideas, but also
focusing on functional and fascial integration of the whole body as facial change unfolds.

 The first goal of the ALF appliance is to promote a functional swallow.

I wonder if this “Functional Swallow”
with its 2000+ times-a-day gentle ‘suctioning massage’ of the palate
stimulates the maxillary (palatal) midline suture,
which in turn helps facilitate and stabilize the subtle motion of the cranial mechanism.
And thus, the myofunctional/ALF  interface with the osteopathic paradigm
of the primary respiratory mechanism and cranial motion. 

The ALF Appliance and Myofunctional Therapy both have similar goals…
and both can work in tandem with Osteopathic treatment
 to augment the functionality of the whole body.

 John Mew proclaimed he was fifty years ahead of his time. 

And Mike Mew has stated: 
“One patient does not a study make, but an example to learn from.”

I am that one patient
…40 years ahead of my time.

Forty Years

My anecdotal history – my StoryTelling –
is not a double-blind or scientific study,
simply a retelling of what happened,
…what was done
and what has been undone.

My traumatic dental history, curiosity and asking questions produced The Cranial Connection (1986) within five years of discovering  this ‘different medical perspective’.  

I was on my way to medical school writing a research paper for a graduate class in physiological psychology…..and the paper ended up at a medical convocation, became an introductory text for medical students and circled the globe to interested dentists, medical doctors, physical therapists. and osteopaths.

This is now being rewritten for the
interested and curious patient and/or parent.

And, at the same time 40 years ago,  I also was a parent with two children at the ‘orthodontic’ age.
The decision-making I made because of my learning from dental/orthodontic TMD chaos is underscored today
by this major shift in perspective now surfacing.

My behavior was similar to Sandra Kahn, DDS – the mother –  looking for different options for her children. However, I was an ‘educated’ patient with a spinal fusion, not an orthodontist.  ‘Whole-body’ repercussions between jaw and spine were more than ‘text-book’ knowledge and medical theories –
an experiential knowing had evolved.

I found a forward-thinking orthodontist who practiced ‘craniofacial orthopedics’ during the early 80’s
and a team approach was implemented: 
Craniofacial Orthopedics plus Cranial Osteopathic treatment.

This orthodontist understood
that repositioning the jaw
can and would affect the structure and functionality
of the whole body.

My history validates and parallels the
emergence of a new viewpoint in Orthodontics,
 now being labeled as ‘Orofacial Development’.

The recognition of integration and interconnectivity of the whole
thus endorses and empowers the
Cranial Osteopathic Paradigm