Orofacial and cervical myofunctional intervention programs for adults undergoing orthognathic surgery: a scoping review

Borges, Allya Francisca Marques; Araújo, Ramon Cipriano Pacheco de; Souza, Samara Fernandes da Silva; Ferraz, Aline Xavier; Araújo, Cristiano Miranda de; Magalhães Junior, Hipólito Virgílio; Cavalcanti, Renata Veiga Andersen; Taveira, Karinna Veríssimo Meira

doi:10.1590/2317-1782/e20240358pt

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Critical Review or Scoping Review • CoDAS 37 (6) • 2025 • https://doi.org/10.1590/2317-1782/e20240358en linkcopy

Orofacial and cervical myofunctional intervention programs for adults undergoing orthognathic surgery: a scoping review

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose To map orofacial and cervical myofunctional intervention programs developed for adults undergoing orthognathic surgery.

Research strategies Search of Cochrane, EMBASE, LILACS, LIVIVO, PubMed/Medline, Scopus, and Web of Science databases, as well as gray literature.

Selection criteria The review included studies addressing therapeutic programs and myofunctional exercises and their influence on the stomatognathic system of adults undergoing orthognathic surgery, without time or language limitations. Secondary studies, populations under 18 years old, and comorbidities associated with dentofacial deformities were excluded.

Data analysis Two reviewers extracted data comprising different topics, especially the assessment process, orofacial and cervical myofunctional intervention, and identification of intervention outcomes.

Results Five studies were considered eligible. They were published between 2006 and 2018, with participants aged 19 to 31, predominantly females, and used postoperative guidelines consisting of isometric, isotonic, postural, and functional exercises, as well as tactile-kinesthetic and thermal stimulation, with a positive emphasis on functional improvement of the stomatognathic system.

Conclusion These studies addressed the application of orofacial myofunctional therapy after orthognathic surgery. The interventions, not yet validated, involved specific protocols of postural and functional exercises and tactile-kinesthetic and thermal stimulation. The results demonstrated a significant improvement in the performance of orofacial functions, enhanced subjective perception of oral health, and improvements in muscle tone and mobility of orofacial structures. Orofacial myofunctional therapy is an important approach in postoperative rehabilitation of the stomatognathic system.

Keywords:
Myofunctional Therapy; Dentofacial Deformities; Orthognathic Surgery; Stomatognathic System; Rehabilitation

Author, Year, Country, Study Design	Objective	Methodological characteristics		Assessment		Classification of dentofacial deformity	Time since surgery	Intervention			Main outcomes
Author, Year, Country, Study Design	Objective	Sample	Age	Instruments used	Temporal parameters	Classification of dentofacial deformity	Time since surgery	Programs/Exercises	Frequency		Main outcomes
Migliorucci et al.(⁵), Brazil, Randomized clinical trial	To verify the impact of myofunctional therapy on orofacial functions and the quality of life of patients undergoing orthognathic surgery.	OMT group: 12 (7F, 5M)	$\pm$ 26.35	Orofacial Myofunctional Assessment Protocol (MBGR) and Oral Health Impact Profile-OHIP-14	Before the surgical procedure and 3 months after orthognathic surgery.	Class II: 5 Class III: 7	The intervention began 40 days after surgery.	Tactile-kinesthetic and thermal stimulation. Isometric, isotonic, and functional exercises	Once a week for 8 to 15 weeks		Significant improvement in orofacial functions, such as breathing (p=0.005), chewing (p=0.006), swallowing (p=0.003), and speech (p=0.012). Positive impact on quality of life, according to OHIP-14 (p=0.018)
Migliorucci et al.(⁵), Brazil, Randomized clinical trial		No-OMT group: 12 (7F, 5M)	$\pm$ 26.35			Class II: 5 Class III: 7	The intervention began 40 days after surgery.	No participation in the exercise program.			Significant improvement in breathing (p=0.044) and quality of life, according to the OHIP-14 (p=0.003). No improvement in chewing (p=0.757), swallowing (p=0.060), or speech (p=0.539) parameters
Prado et al.(¹¹), 2018, Brazil, Randomized clinical trial	To investigate the effects of orofacial myofunctional therapy on the masticatory function of individuals with dentofacial deformities undergoing orthognathic surgery.	TG (OMT): 13 (7F, 6M)	29.31 ( $\pm$ 8.87)	Orofacial Myofunctional Evaluation Protocol with Scores-extended (OMES-E) and electromyography	Before and after the surgical procedure (3 and 6 months)	Class II: 4 Class III: 9	The intervention began 30 days after surgery	Tactile-kinesthetic and thermal stimulation. Isometric, isotonic, postural, and functional exercises.	Once a week for 10 weeks.		Increase in the maximum OMES-E score from P0 (13.23 ± 3.06) to P1 (15.92 ± 3.84) and P2 (16.0 ± 3.51), and from P0 (4.3 ± 2.56) to P2 (6.92 ± 2.78). The number of masticatory cycles increased from P0 (11.34 ± 2.87) to P2 (13.79 ± 2.44). Lip tone increased from P0 (0 - 0%) to P1 (6 - 46.15%) and P2 (8 - 61.54%), and mobility from P0 (4 - 30.77%) to P1 and P2 (11 - 84.61%). Bite, head movements, food spillage, and tongue tone did not differ significantly. Abnormal head posture persisted in 2 to 8 individuals.
Prado et al.(¹¹), 2018, Brazil, Randomized clinical trial		UTG (OMT): 10 (7F, 3M)	31.20 ( $\pm$ 7.02)		Before and after the surgical procedure (3 and 6 months)	Class II: 7 Class III: 3	The intervention began 6 months after surgery, after all initial assessments were completed.	The group did not participate in the exercise program throughout the evaluation period. The intervention occurred after the study was completed.			Bite did not differ significantly between the periods, but there were more individuals with abnormal lower lip tone and lip and tongue mobility.
Trawitzki et al.(¹⁸), 2006, Brazil, Cohort study	To determine the effect of interdisciplinary treatment in a patient with Class III dentofacial deformities by analyzing the electromyographic activity of the temporal and masseter muscles during chewing and biting.	P1 group**: 15 (4M, 11F)	M: $\pm$ 21.2 years F: $\pm$ 24.9 years	Ultrasound	3 months before orthognathic surgery*	Class III	The intervention started 15 days after surgery and lasted 6 months*	Group P1 is identical to group P2. However, it is being used as a reference for pre-surgical evaluation in group P2.			There are no results to be analyzed.
		P2 group**: 15 (4M, 11F)	M: $\pm$ 21.2 years F: $\pm$ 24.9 years		6 to 8 months after orthognathic surgery*	Corrected Class III		Post-surgical guidance. Isometric, isotonic, postural, and functional exercises. Tactile and thermal sensory stimulation*	Once a week for 6 months.		Significant increase in masseter thickness in P2, both at rest and when biting, compared to P1. However, P2 values remained lower than those of the control group, bilaterally.
		Control group: 15 (4M, 11F)	M: $\pm$ 20.8 years F: $\pm$ 24 years		Before and after orthognathic surgery, in the periods mentioned in the experimental groups.	Absence of dentofacial deformity	OMT not performed	No participation in the exercise program.			Higher values with statistical significance, when compared to P1 and P2, regarding the thickness of the masseter muscle, bilaterally.
Trawitzki et al.(¹⁹), 2011, Brazil, Cohort study	To analyze the effect of integrated orthodontic treatment, orthognathic surgery, and orofacial myofunctional therapy on the thickness of the masseter muscle in patients with class III dentofacial deformities, 3 years after orthognathic surgery.	P1 group**: 13 (3M, 10F)	M: $\pm$ 22 years F: $\pm$ 27 years	Ultrasound	2 to 74 days before orthognathic surgery.	Class III	The intervention started 15 days after surgery and lasted 6 months.	Group P1 is identical to group P3. However, it is being used as a reference for pre-surgical evaluation in group P3.			There are no results to be analyzed.
		P3 group**: 13 (3M, 10F)	M: $\pm$ 22 years F: $\pm$ 27 years		Data were obtained over 3 years to 3 years and 8 months postoperatively (3 years and 2 months).	Corrected Class III		Post-surgical guidance. Isometric, isotonic, postural, and functional exercises. Tactile and thermal sensory stimulation*	Once a week for the first 11 months after surgery.		Significant increase in the thickness of the right and left masseter (P < 0.01). In comparison with the control group, a significant difference was observed for the right masseter at rest (P < 0.01) and when biting (P < 0.05), and for the left masseter at rest (P < 0.05). There was no significant difference for the left masseter when biting (P = 0.05).
		Control group: 15 (4M, 11F)	M: $\pm$ 21 years F: $\pm$ 24 years		Before and after orthognathic surgery, in the periods mentioned in the experimental groups.	Absence of dentofacial deformity	OMT not performed.	No participation in the exercise program.			There are no results to report.
Trawitzki et al.(²⁰), 2010, Brazil, Cohort study	To investigate the effect of interdisciplinary treatment on the electromyographic activity of the masticatory muscles in patients with Class III dentofacial deformities, 3 years after surgical correction.	P1 group***:13 (3M, 10F)	M: $\pm$ 22 years F: $\pm$ 27 years	Electromyography	Before the surgical procedure.	Class III	The intervention started 15 days after surgery and lasted 6 months.	Group P1 is identical to group P3. However, it is being used as a reference for pre-surgical evaluation in group P3.			In the T and M muscles, there were significant differences between the P1 and P3 Groups, in chewing and biting, with higher values in P3***
		P3 group***:13 (3M, 10F)	M: $\pm$ 22 years F: $\pm$ 27 years		Data were collected over 3 years to 3 years and 8 months postoperatively (3 years and 2 months).	Corrected Class III		Post-surgical guidance. Isometric, isotonic, postural, and functional exercises. Tactile and thermal sensory stimulation*		It lasted an average of 11 months.	In EMG activity, there was a significant disparity (P < 0.05) in the values of the M muscle during chewing and biting, with higher values in P3***
		Control group: 15 (11F, 4M)	M: $\pm$ 21 years F: $\pm$ 24 years		Before and after orthognathic surgery, in the periods mentioned in the groups.	Absence of dentofacial deformity.	OMT not performed.	No participation in the exercise program.			Statistically significant difference in EMG activity for M and T muscles in different situations

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Sociedade Brasileira de Fonoaudiologia Al. Jaú, 684, 7º andar, 01420-002 São Paulo - SP Brasil, Tel./Fax 55 11 - 3873-4211 - São Paulo - SP - Brazil
E-mail: revista@codas.org.br

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[1] Caption: F = female; M = male; OMT = orofacial myofunctional therapy; TG = treated group; UTG = untreated group; P0 = before surgery; P1 = 3 months after surgery; P2 = 6 months after surgery; P1** = before surgery; P2** = 6 months after surgery; P1*** = before surgery; P3*** = postoperative (3 years to 3 years and 8 months); OHIP-14 = Oral Health Impact Profile; M = Masseter muscle; T = Temporalis muscle

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Information provided by the author of the included study(¹⁸)