Perioperative Surgical Care

 

OROFACIAL MYOLOGists collaborate with surgeons

Our providers may collaborate with a surgeon to provide pre-habilitative, re-habilitative, and habilitative care for any of the following procedures:

  • Jaw surgeries
  • Tonsillectomy
  • Adenectomy
  • Nose surgeries
  • Surgeries to address oral soft tissue restrictions
  • And more
Tongue with Bandaid

orofacial Myofunctional therapy and tissue preparation with manual lymphatic drainage should be done before and after surgeries of the head, neck, and jaw.

Pre-surgical pre-habilitation is a standard prerequisite of many surgical procedures, as it helps the body prepare for surgery, heal faster, and more easily achieve normal post-operative function. In collaboration with the surgeon, our providers can help patients to prepare for surgery with manual lymphatic drainage and massage to induce relaxation and redirect blood and lymph flow as well as exercises to optimize mobility and function.

Post-surgical rehabilitation or habilitation is crucial. Surgical reconstruction does not necessarily correct function; therefore, it is imperative for the patient to adapt to new anatomical structures. Our providers offer targeted exercises and stimulation to establish or restore function, mobility, proprioception, and sensation. Manual lymphatic drainage and massage can also be used to limit swelling and scar tissue formation.

Changes in tongue position, function, or both, may occur as the result of anatomical changes in the mouth; however, orofacial myofunctional therapy can help patients appropriately adapt to their new anatomical structures of the nose, mouth, and jaw. Orofacial myofunctional therapy can improve quality of life and functions of breathing, chewing, swallowing, and speech. It may also reduce the chance of relapse in the surgical patient.

 

Don’t just take our word for it…. See the research for yourself!


Research: Orofacial Myology, Manual Lymphatic Drainage, and Orthognathic/Jaw Surgery (e.g., MMA, Le Fort surgery, genioplasty, mandibular osteotomy, maxillary osteotomy, joint replacement, or others)

  • “Clenching and bruxism must be controlled post- surgery or significant damage can occur to the jaw structures, occlusal interrelationship, and TMJs, particularly when maxillary osteotomies have been performed. Splints, bite plates, and night guards are usually ineffective postsurgery to prevent clenching and bruxism and may cause some patients to clench more, increasing loading forces to the jaws, muscles, and TMJs. These devices should not be used for at least 6 months postsurgery, if at all.” Source
  • “Bruxism [tooth clenching] and dysfunctional oral habits were shown to be risk factors for the presence of TMD [temporomandibular dysfunction] symptoms also after combined orthodontic and surgical treatment. Treating such habits before orthognathic surgery should help prevent TMD.” Source
  • “Our results support the premise that a simple noninvasive exercise program initiated shortly after orthognathic surgery can lessen the objectionable impression of negative altered sensations.” Source
  • “These results signify the necessity of the following: (1) systematized recording of swallowing reflexes, not only before orthognathic surgery but also during postoperative follow-up; (2) pronouncement of information on the increased relapse tendency for patients with a longer oral period of swallowing; (3) modification of surgical designs for overcorrection in these patients; and (4) proposal of swallowing therapy as part of their postoperative rehabilitation…Our results support the hypothesis that BSSO (bilateral sagittal split osteotomy) modulates the swallowing function… Additionally, our results suggest that, the presence of longer oral period of swallowing piecemeal deglutition may indicate the tendency to skeletal relapse.” Source
  • “A faster decrease in swelling in the intervention group was observed on 3-dimensional scans. Furthermore, patients receiving MLD [manual lymphatic drainage] reported reduction in swelling and pain within the first month after surgery.” Source
  • “Manual lymphatic drainage was effective in reducing facial measurements in orthognathic surgery postoperatively.” Source
  • “Early relapse following orthognathic surgery often results from erroneous planning, intra-operative error, or wound healing problems. Late relapse frequently results in the presence of continued late, pathologic or asymmetrical growth, failure of physiologic adaptation of surrounding structures, or due to errors in the magnitude and/or direction of surgical movement.” Source
  • “…The oral myologist needs to play an active role in the post-surgical healing and the re-establishment of proper muscle function as well as proprioception following orthognathic surgery. The oral myologist can also be a supportive member of the ‘team approach’ to orthognathic surgery.” Source
  • “In a patient undergoing post-surgical reconsolidation of his/her functional equilibrium even an uncontrolled speech defect may lead to an unstable result. Only through an interdisciplinary approach it is possible to intercept and re-educate all the functions that are not compliant with the structural changes and to eliminate a tendency to relapse of the dysgnathia.” Source
  • “There was improvement of masseter muscle thickness in patients with class III dentofacial deformity three years after orthognathic surgery associated with orthodontic treatment and orofacial myofunctional therapy, as demonstrated by increased muscle thickness which tended to be close to that of control subjects.” Source
  • “The orthognathic surgical teams coordinate with precise treatment plans to create new facial architecture and to restore an ideal dental occlusion. The desired occlusal balance and dental alignment are linked to muscular balance and functional orofacial symmetry. However, if orofacial dyspraxia is not corrected, there is an increased risk of delaying recovery or even causing relapse.” Source
  • “The present study showed that in orthognathic patients 1) AS [atypical swallowing] was associated with relapse regardless of dentofacial deformity or surgical procedure performed and 2) AS can appear after treatment in patients who were initially free of it. Source
  • “…OMT brought favorable physiological changes in the performance of electromyographic duration with decrease in act and cycle and increase in the number of chewing cycles after surgery. Furthermore, the clinical results showed that the orofacial myofunctional therapy could provide improvement in aspects related to maximum score of OMES-E, masticatory type, lower lip tone, and tongue mobility…. Thus, the importance of OMT for individuals with DFD [dentofacial deformity] undergoing OGS [orthognathic surgery] becomes evident.” Source
  • “Orthognathic surgery is generally recommended to correct large inter-maxillary or maxillofacial discrepancies. It therefore generates a relatively large displacement of the centers of gravity of the displaced parts, which is a modification of the activity of the various muscle groups due to technical movements (disintegration) or skeletal displacements (stretching). Surgery also facilitates cervical and cervico-cranial joint reorganization and the need for functional adaptation (labial, lingual, ventilatory, etc.)… It is essential to factor their postural balance in the etiology of their dysmorphoses as well as to determine how it will affect their treatment. It should prevent us from being iatrogenic with patients presenting a postural risk, and it helps increase the stability of corrections made.” Source
  • “It seems that functional decompensation can be induced by training with specific instructions about masticatory function, in order to acquire functional adaptation after surgical orthodontic treatment.” Source
  • “The orthognathic surgery alone improved breathing and quality of life. However, the surgical procedure associated with myofunctional treatment, besides improving all oral functions investigated and quality of life, provided better functional performance in breathing, chewing, swallowing, and speech.” Source
  • “Relapse in some cases after surgical orthodontic treatment may be due to muscular imbalance in the oral facial muscles and poor tongue position during function and rest… Good relationships between morphology, oral function, and muscular behavior are very important for the stability of normal dentition and normal jaw relationship after surgical orthodontic treatment. Normally maintained forces from a balanced occlusion also reduce the possibility of relapse.” Source
  • “Based on information related to the treatment planning of the DFD (Dento-Facial Deformity), the speech therapist may perform the therapy aimed at preparing the musculature involved in the surgical procedure, as well as to eliminate harmful oral habits and address the cases of habitual mouth respiration, signs and symptoms of TMD and/or other conditions not related with the DFD. After surgery, speech therapy aims to reduce the facial edema, stimulate the orofacial sensitivity, facial mimic and range of mandibular movements with gradual reintroduction of food consistencies and adjustments of orofacial functions within the limits of each case.” Source
  • “Sleep surgery has come a long way in just three decades. There is healthy discourse on indications, methodology, and efficacy. The role of surgery is not to replace, but to augment and complete the care a comprehensive sleep care team provides. It is not in a strict definition of surgical success where we rest our laurels, but in the patient’s overall treatment success. From that perspective, airway surgery for OSA is not merely reconstructive, it is also restorative in nature. Restoration of proper form allows re-education of healthy function.” Source
  • “Early postural evaluation in patients undergoing orthognathic surgery is necessary to enable a fast rehabilitation, aiming to improve the mandibular function and masticatory muscle activity and to reduce the incidence of myofascial pain, postural imbalances, and skeletal relapse. Early rehabilitation can restore mandibular function and masticatory muscle activity after orthognathic surgery, and different upper cervical spine positions influence the masticatory muscle activity.” Source
  • “The stomatognathic system consists of multiple structures that act harmoniously to perform their functional tasks. It has muscular and ligamentous connections in the cervical region that form a complex system known as the craniocervical- mandibular system. In the upright standing body posture, head position is maintained by an intricate relationship between the muscles of the head, neck, and shoulder girdle—any imbalance in this relationship can lead to local postural changes or changes in other body muscle chains…These results suggest that correction of class III dentofacial deformities by bimaxillary orthognathic surgery can produce systemic postural adjustments, especially posterior displacement of the head and trunk and knee and ankle valgus.” Source
  • “As with all relapse, prevention is key, and there is increased awareness of myofunctional therapy as an adjunctive treatment with any upper airway surgery.  We now incorporate myofunctional therapy in the perioperative care of MMA patients. In our experience, relapse after soft tissue and MMA operations is associated with instability of the tongue base. Tongue instability tends to be associated with advanced age or weight gain. Conservatively, we have used radiofrequency ablation of the tongue base as an intervention. Recently, we have started providing patients with UAS as an option with Phase 1 and Phase 2 relapse. The exclusion criteria for UAS include AHI greater than 65 and circumferential collapse of the velum during DISE. From our first series of patients who underwent UAS after MMA, everyone has been a candidate, as circumferential collapse of the velum was not seen after MMA (8- to 15-year follow-up). With effective sequencing of Phase 1 surgery, UAS, and MMA balanced between current best evidence of airway examination and patient preference, OSAS as a chronic disease has become highly amenable to long-term surgical care.” Source
  • “…Initial complaints included functional difficulties. The functional disorders were described. TMD was observed in the majority of the sample. After treatment the complaints decreased; the majority of the patients showed remission of the TMD and functional improvement… There are specific myofunctional modifications related to the stomatognathic functions and to TMD in Class II Dentofacial deformity patients. Both the surgery and the speech therapy produced myofunctional modifications, with reduction of initial complaints, as well as a decrease of TMD and correction of functional patterns. The swallowing function was the most benefited by the treatments.” Source

  • “Muscle and function management by the physiotherapist in orthodontic and orthodonto-surgical treatment. Oral myofunctional rehabilita- tion. Can we hope to dispense with muscle and function management in orthodontic and orthodonto-surgical treatment plans? How can the specialized physiotherapist assist, facilitate and stabilize the work done by the orthodontist and maxillo-facial surgeon and help avoid relapses? Treatment aims to achieve dental alignment and occlusal balance in direct association with balance of the tongue muscles, cutaneous muscles, masticatory and postural muscles and functions in the orofacial region. Restoration of balance between agonist and antagonist muscles is achieved by relaxing contracted muscles and by gradually building up weak muscle tone. If effec- tive and lasting treatment results are to be obtained, active patient participation is mandatory during rehabilitation of oro-maxillo-facial disorders and must encompass the tongue, lips, cheeks, masticatory system, ventilation and general posture as well as management of the parafunctions. These procedures are essential in dentofacial orthopedic treatment of both children and adults. Practical cases will be used to demonstrate the contribution that myofunctional rehabilitation can make. Regard- ing natural functions, very satisfactory results are obtained provided patients do daily muscle exercises and day-long training in the correct postures and practical drills they have been taught over a period of at least six months and under the supervision of the physiotherapist.” Source

 

Research: Orofacial Myology and Surgery of the Tonsils and Adenoids (e.g., tonsillectomy, adenectomy, or adenotonsillectomy)

  • “Orofacial myofunctional therapy can be considered as an effective complementary treatment for OSA patients with oral breathing after adenotonsillectomy.” Source
  • “Alterations in the dynamics of swallowing are common in children who have undergone surgery of the tonsils, even at late follow-up.” Source
  • “Although adenotonsillectomy is the first line treatment for children with obstructive sleep apnea syndrome (0SAS), improvement in objectively documented outcomes is often inadequate and a substantial number of children have residual disease. Early recognition and treatment of children with persistent OSAS is required to prevent long-term morbidity.” Source
  • “AT and orthodontic treatment were more effective together than separately to cure OSA in pediatric patients. There was a greater decrease in apnea hypoapnea index (AHI) and respiratory disturbance index (RDI), and a major increase in the lowest oxygen saturation and the oxygen desaturation index (ODI) after undergoing both treatments. Nevertheless, the reappearance of OSA could occur several years after reporting adequate treatment. In order to avoid recurrence, myofunctional therapy (MT) could be recommended as a follow-up.” Source
  • “Removal of nasal obstruction, adenoids, and tonsils have not given beneficial results in the reversion of the habit unless intercepted with various muscle exercises.” Source
  • “Oronasal anatomical and functional abnormalities were quite prevalent and various in persistent sleep-disordered breathing after adenotonsillectomy. Nasal disuse and tongue motor immaturity were associated with a higher obstructive respiratory event index in the long term, whereas craniofacial risk factors might have a more pronounced impact at younger age.” Source
  • “Improvement of myofunctional status seems to be observed in children after surgery. In this study, the improvement was predominantly accomplished during the first 6 months following surgical procedure. Persistent pattern of mouth breathing due to allergic rhinitis may difficult recovery of the myofunctional status. The most adequate post-surgical moment for the otorhinolaryngologist to refer the patient to speech therapist for myofunctional therapy seems to be crucial, as well as the recognition by the speech therapist of the persistence of the obstructive symptoms, re-referring this patient to the physician.” Source
  • “Despite experimental and orthodontic data supporting the connection between orofacial muscle activity and oropharyngeal development as well as the demonstration of abnormal muscle contraction of upper airway muscles during sleep in patients with SDB, myofunctional therapy rarely is considered in the treatment of pediatric SDB. Absence of myofascial treatment is associated with a recurrence of SDB.” Source
  • “We observed a partial recovery in facial muscular and functional changes following adenotonsillectomy, particularly during the first month after surgery. This improvement was especially observed in the “mobility” and “posture” sub-tests. We conclude that waiting for a spontaneous muscular and functional facial recovery during the first month post-operatively seems reasonable. Nevertheless, after this period, if the patient fails to achieve recovery, it may be advised that this child should undergo myofunctional therapy.” Source
  • “Adenotonsillectomy (T&A) may not completely eliminate sleep-disordered breathing (SDB), and residual SDB can result in progressive worsening of abnormal breathing during sleep. Persistence of mouth breathing post-T&As plays a role in progressive worsening through an increase of upper airway resistance during sleep with secondary impact on orofacial growth…. Assessment of mouth breathing during sleep should be systematically performed post-T&A and the persistence of mouth breathing should be treated with MFT.” Source
  • Alterations in the functions of the facial muscle can establish changes in facial skeleton and in the development of occlusion. The effect of mouth breathing on the facial morphology is probably greatest during the growth period. Removal of nasal obstruction, adenoids, and tonsils have not given beneficial results in the reversion of the habit unless intercepted with various muscle exercises.”  Source 
  • “Myofunctional therapy could be an efficacious treatment in pediatric OSA in addition to AT.” Source
  • “…the removal of obstruction does not necessarily increase muscle responsiveness and underlines the potential application of OMT in a multi-modality approach. OMT helps in the restoration of nasal breathing and reduced mouth breathing, which in turn improves nocturnal breathing and reduces OSA in both adult and pediatric populations.” Source
  • “Treatment of pediatric obstructive-sleep-apnea (OSA) and sleep-disordered-breathing (SBD) means restoration of continuous nasal breathing during wakefulness and sleep; if nasal breathing is not restored, despite short-term improvements after adenotonsillectomy (T&A), continued use of the oral breathing route may be associated with abnormal impacts on airway growth and possibly blunted neuromuscular responsiveness of airway tissues. Elimination of oral breathing, i.e., restoration of nasal breathing during wake and sleep, may be the only valid end point when treating OSA. Preventive measures in at-risk groups, such as premature infants, and usage of myofunctional therapy as part of the treatment of OSA are proposed to be important approaches to treat appropriately SDB and its multiple co-morbidities.”  Source
  •  “This study investigated the possible risk factors of residual mouth breathing in children with OSA after complete resolution of OSA. Our findings suggest that older age, large adenoids, and presence of dentofacial abnormalities may be the risk factors for residual mouth breathing after resolved OSA using adenotonsillectomy. Therefore, sleep clinicians should consider the possibility of potential residual mouth breathing after successful adenotonsillectomy and use additional modes of therapy to treat residual mouth breathing in children with OSA.” Source
  • “Myofunctional therapy alone may be successful in treating mild-to-moderate SDB, but in many children with SDB, the best results are achieved with a combination of patient myofunctional retraining and other therapeutic options, such as adenotonsillectomy, oral appliances, or positive airway pressure…. The potential benefits of including a myofunctional therapist in a team approach should not be underestimated.” Source

 

Research: Orofacial Myology and Nose Surgeries (e.g., nasal septoplasty, rhinoplasty, nasal turbinate reduction, nasal valve surgeries, or others)

  • “Myofunctional therapy, with or without a mouth-closure device may be a useful complement to functional rhinoplasty in maintaining the nasal airway.” Source
  • “…Nasal surgery alone does not consistently improve OSA when measured objectively…. The patients undergoing nasal surgery should understand that it is one component of a comprehensive management plan.” Source

 

Research: Orofacial Myology and Oral Soft Tissue Restriction Surgeries (e.g., frenectomy, frenuloplasty, frenulectomy, Z-Plasty, frenotomy, or others)

  • “This case highlights the role of surgical interventions to help improve oral and tongue posture among patients who seek myofunctional therapy as a treatment for mouth breathing issues. However, it should be noted that pre- and postoperative myofunctional therapy is essential for optimal wound healing and long-term re- education of orofacial functions, including chewing, swallowing, oral rest posture, and nasal breathing. While the risks are not fully identified, clinically, issues such as a tongue thrust, open mouth posture, and speech production errors may still persist after frenuloplasty and may respond to myofunctional therapy.” Source
  • “The Myofunctional Therapy Protocol presented in this pilot study was developed with the aim of making the muscles of the tongue, the floor of mouth and the soft palate more coordinated, and increasing muscle contraction strength, in order to produce improvements on the muscle tone, on orofacial and nasal functions and a better wound healing and functional recovery in the case of surgical therapy (frenulotomy).” Source
  • “It is essential to establish diagnosis criteria to which the clinician should refer in order to decide the treatment plan. This study shows that combined laser and speech-language therapy leads to better results than the resection treatment of the frenulum with laser technique alone.” Source
  • “Lingual frenuloplasty with myofunctional therapy is safe and potentially effective for the treatment of mouth breathing, snoring, clenching, and myofascial tension in appropriately selected patient candidates.” Source
  • “Recent studies suggest that speech, solid feeding, and sleep difficulties may be linked to restricted tongue function. Children with tongue restrictions and speech, feeding, and sleep issues underwent lingual frenectomies with a CO₂ laser, paired with myofunctional exercises. Questionnaires were completed before, 1 week after, and 1 month following treatment. Thirty-seven patients participated in the study (mean age 4.2 years [range 13 months to 12 years]). Overall, speech improved in 89%, solid feeding improved in 83%, and sleep improved in 83% of patients as reported by parents. Fifty percent (8/16) of speech-delayed children said new words after the procedure (P = .008), 76% (16/21) of slow eaters ate more rapidly (P < .001), and 72% (23/32) of restless sleepers slept less restlessly (P < .001). After tongue-tie releases paired with exercises, most children experience functional improvements in speech, feeding, and sleep. Providers should screen for oral restrictions in children and refer for treatment when functions are impaired.” Source

 

Research: Orofacial Myology and Other Surgical Procedures (e.g., tongue reduction/partial glossectomy or others)

 

  • “The purpose of this study was to determine the impact of partial glossectomy (using the keyhole technique) on speech intelligibility, articulation, resonance and oromyofunctional behavior… Improved speech intelligibility, a more complete phonetic inventory, an increase in phonological skills, normal resonance and increased motor-oriented oral behavior were found in the postsurgical condition. The presence of phonetic distortions, lip incompetence and interdental tongue position were still present in the postsurgical condition.” Source
  • “These preliminary findings motivate additional research on the efficacy of lip-strengthening exercises following facial transplantation.” Source