Bimaxillary Advancement with Complicating Factors:
A Case Study
Patricia Brinkman-Falter, RDH, MS, COM ®

INTRODUCTION

  • ​Bimaxillary surgery is gaining favor as first treatment for OSA
  • Posture is affected because of airway constriction
  • No protocol exists for soft tissue recovery
  • Often there are craniofacial dystrophies
  • TMD can accompany OSA because of parafunctional behaviors
  • Diabetes, high blood pressure and rapid breathing are common complicating health factors

OBJECTIVES

  • Identify myofunctional disorders and prepare musculature and swallow for bimaxillary surgery
  • Examine post surgical expectations and tools available to promote overall patient wellness 
  • Identify health conditions that motivate a  patient to pursue bimaxillary surgery.

HISTORY

  • Childhood mouth breather, posterior tongue tie, bruxism, snoring
  • Orthodontia twice with head gear, four bicuspid extractions, later ALF and myofunctional therapy
  • Piper 5 degenerative TMJD, with prior arthrocentesis
  • Multiple apneas in REM sleep, fragmented sleep
  • Increased heart rate, blood pressure, weight gain,and retinopathy

DISCUSSION

  • Easier aspiration of thin liquids immediately after surgery
  • Vocal changes – softer, intonation changed
  • Normal swallow was immediately used
  • Soft palate was non functional
  • Tongue rest posture was much easier

RESULT

  • Increased airway, resulting in better posture, restful sleep
  • Less stress on TMJ and surrounding musculature
  • Normalized swallow, rest posture and voice quality
  • Exercises should be individualized for abilities

Key Finding: Orofacial Myofunctional Therapy is an important adjunct to the successful recovery of Bimaxillary surgery

Pre-Surgery

3 Weeks Post Surgery

3 Months Post Surgery

6 Months Post Surgery

Scientific Poster presented at the 2019 IAOM conference

EXERCISES USED

WEEK 1

  • Squirt liquids into mouth
  • Palatal tracing
  • Hyoid release
  • Wiggle jaw side to side
  • Move lips
  • Trigeminal trace (T-Touch)

WEEK 2

  • Add tongue points
  • Add tongue to spot exercises
  • Start use of small straws for thin liquids

WEEK 3

  • Point and trace combined
  • Started used of maroon spoon
  • Tongue on Spot words
  • Lip smacks

MONTHS 2-3

  • Start opening jaw with tongue blades
  • Lymph drainage massage
  • Coherent breathing
  • Marshalla’s “Butterfly”
  • Soft palate/uvula pull
  • Surprised Turtle

MONTHS 3-6

  • Soft chew diet
  • Tongue presses
  • Singing
  • Upper cheek toning

SLEEP STUDIES

DESATURATIONS
                   Prior     Present
Mean            94            98 
Minimum      90             97
Maximum     99             99

PULSE RATE
                  Prior      Present
Mean            77             76   
Minimum      56             57
Maximum    113            80      

RESPIRATORY INDICES
                  Prior       Present
pRDI            28              0
pAHI            6.3           .25
ODI              3.5             0

STUDY PRODUCTS

Font Resize
Contrast