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


  • 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


  • 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


  • Childhood mouth breather, posterior tongue tie, bruxism,
  • 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


  • 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


  • 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
Upper cheek toning

Sleep Studies

Mean 94 98
Minimum 90 97
Maximum 99 99
Mean 77 76
Minimum 56 57
Maximum 113 80
pRDI 28 0
pAHI 6.3
ODI 3.5 0