Make it Make Sense, Or If You Prefer, Unsolved Mysteries, Solved

In my 30 plus years of working with infants, I noticed that two cohorts formed. One group’s feeding issues were completely resolved with standard occupational therapy and craniosacral therapy. Another group was back in about two weeks with all of the same restrictions and issues present. I was baffled. I knew I was missing something, but had no idea what.

Around 2012, infants started coming in having already had their tethered oral tissues released, or alternately, had a session with me, then received releases of TOT, and back to be seen by me. All therapeutic interventions integrated once the tethered oral tissues were released. In 2013, I was speaker at a local hospital’s breastfeeding conference. The other speaker that day was one of the national experts on tethered oral tissues. I then knew that release of tongue, lip and cheek ties facilitated feeding, but I was also seeing integration of cranial function. I could not, at the time fathom how releasing TOT could effect cranial function. I did a deep dive into cranial anatomy. I quickly became frustrated with the literature. Of course, all of the images are two dimensional. I was investigating a problem that existed in three dimensions.

I eventually developed a working model. This hypothesis was validated in a human dissection class in January of 2022. I was privileged to study with Tom Myers and the master anatomist, Todd Garcia. The deep front line had already been documented by Myers and Garcia.

It is easy to see how the deep front line connects the tongue with structures all the way to the bottom of the feet.

The question then was, how does the tongue connect with the membranes that hold the skull together?The intracranial membrane system consists of the falxes cerebri and cerebelli, dividing the cerebral, and cerebellar hemispheres. The tentorium cerebelli separates the cerebral hemispheres from the cerebellum. It stretches from ear to ear. The falx form a vertical membrane in the sagittal plane that runs from the crista galli of the ethmoid bone, travels along the metopic suture, the sagittal suture, to the internal occipital protuberance, all the way to the foramen magnum. The falx also connects the ethmoid, frontal, both parietals and the occipital bones. The tentorium cerebelli is a double layer of the dura mater that separates the occipital and temporal lobes of the cerebral hemispheres from the cerebellum and brainstem.

All of that said, how do we get from the lip and tongue to the intramembrane system? The lip (labial) tie is straightforward. We go directly from frenulum to internasal septum to vomer to ethmoid. The falx attaches to the crista galli of the ethmoid. The tongue (lingual) pathway is more complex. The superior pharyngeal constrictor is the intermediate structure connecting the tongue to the intracranial membranes. It has four origins of attachment. The one that applies to this research model is the glossopharyngeal section of the origin of the muscle. There are lateral fibers attached to the tongue. Tension applied to the tongue travel to the superior pharyngeal constrictor which attaches to the pharyngeal tubercle, about one cm anterior to the foramen magnum. From there, the pharyngeal aponeurosis travels to the foramen magnum, splits and attaches to the petrous portions of the temporal bones.

The inner sanctum of the cranial vault has been reached. This explains the occurrence of expansion of the cranial bones, as documented by head circumference changes occurs.

In summary it just makes sense that feeding would be more efficient when the tongue, lips and cheeks are able to freely move in order to manage liquids and boluses of solid food inside the mouth.

Further research is warranted. For now, I am satisfied that I have a working model to explain what I was observing in infants under my care.