Bimaxillary advancement with complicating factors: A case study
Patricia Brinkman-Falter, RDH, MS, COM

Orofacial Myofunctional therapy is an important adjunct to the successful recovery of bimaxillary surgery

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

Objective

  • 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 surgeryList items go here

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

Discussions

  • 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

Results

  • 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

Pre Surgery

3 weeks post surgery

3 months post surgery

6 months post surgery

Scientific Poster presented at the 2019 IAOM conference

Surgical Plan

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

Month 2-3
Start opening jaw with tongue blades
Lymph drainage massage
Coherent breathing
Marshalla’s “Butterfly”
Soft palate/uvula pull
Surprised Turtle

Month 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
Mean 77 76
Minimum 56 57
Maximum 113 80
RESPIRATORY INDICES
pRDI 28 0
pAHI 6.3
.25
ODI 3.5 0