DOI: 10.1051/odfen/2015044 J Dentofacial Anom Orthod 2016;19:203 © The authors The oromaxillofacial rehabilitation in orthodontic-surgical protocols Th. Gouzland1,2, M. Fournier1 1 Kinesiologist, specializing in oromaxillofacial rehabilitation 2 Educator SUMMARY Oro-maxillo-facial rehabilitation is an ancient practice that has developed over recent years through research and integration with physiotherapists in multidisciplinary teams, as is the case with orthodontic- surgical procedures. At the same time, the progress made in orthognathic and orthodontic surgery over the last 20 years encourages more and more patients to undergo surgery. Preoperative treatment is based on early assessment and preparation for optimal surgical conditions to come up with a functional plan. A short stay in a hospital, focusing on rehabilitation, is recommended. During the postoperative phase, the key objectives are to ensure the muscles and arteries all function perfectly, acceptance of the new face, and the immediate correction of any orofacial dyspraxia that has occurred during myofunc- tional therapy. The various specialists in this multidisciplinary team must constantly be in communication. The importance of postoperative physiotherapy will be illustrated by a study consisting of 35 cases of maxillomandibular osteotomy with orthodontic preparation and monitoring. The purpose of this study is to show occurrence of suboccipital and cervical muscle tensions as well as masticatory muscles. Then we will be able to see the importance of these practices, the impact on recovery, the impact on posture and how best to treat. KEYWORDS Physiotherapy, orthognathic surgery, orthodontic, myofunctional therapy, muscles, posture INTRODUCTION The progress made in the techniques and comfortable recovery. This fits into and the results obtained by coupling the current social view where one’s orthognathic surgery with orthodontics image is given greater importance. allows the specialists to fix any func- Similarly, a lot of research has been tional and esthetic problems in patients conducted on well-being and physical affected by facial dysmorphia or major balance, which includes occlusal bal- occlusal disorders. The patients benefit ance and balancing muscular tension. from a less-invasive surgery, with short- As a result, more and more patients are er recovery times and a more functional opting to have surgery. Address for correspondence: Article received: 30-09-2015. Thierry Gouzland Accepted for publication: 30-10-2015. Polyclinique Bordeaux-Tondu 145 rue du Tondu This is an Open Access article distributed under the terms of the Creative Commons Attribution 33082 Bordeaux Cedex License (http://creativecommons.org/licenses/by/4.0), E-mail: [email protected] which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 1 Article available at https://www.jdao-journal.org or https://doi.org/10.1051/odfen/2015044 TH. GOUZLAND, M. FOURNIER The role of rehabilitation and techniques in the area and with medicine in general. In 2015, a new definition was adopted by the National While the face is growing, the cor- Assembly. Such terms as: preven- relation between form and function tion, health promotion, diagnosis, and is well documented22,25,28. This facial university research emerged, but of growth is influenced by predetermined particular importance was the “treat- genetic factors but also by acquired ment of movement disorders and de- epigenetic factors. A correlation ex- ficiencies or alterations in functional ists between the face and its orofacial capacity,” which corresponds to the functions. The structure allows the treatment of the orofacial sphere. The function to proceed and the function professional, following a diagnostic as- will then be modeled on the structure. sessment, has the freedom to choose A good functional dynamic facilitates what to do and takes responsibility for a harmonious morphology. Similarly, his actions. dysfunctions contribute to the devel- opment of dysmorphic disorders. The orthognathic surgical teams coordi- Orofacial myofunctional nate with precise treatment plans to rehabilitation create new facial architecture and to restore an ideal dental occlusion. The As with any orthopedic surgery, re- desired occlusal balance and dental habilitative care provides a comfort- alignment are linked to muscular bal- able postoperative recovery in terms ance and functional orofacial symme- of managing the pain, schedule, and try13. However, if orofacial dyspraxia quality of life of the patients. However, is not corrected, there is an increased the complexity of the cephalic region risk of delaying recovery or even caus- requires specific training. The face is a ing a relapse10,12. The kinesiologist, the vitally important functional site. Signifi- specialist in oromaxillofacial rehabilita- cant functions of the face include res- tion, should be placed at the center of piration, chewing, swallowing, speak- the multidisciplinary team. Knowledge ing, and displaying emotions, and the of the techniques and skills of each face is linked to overall posture. Any specialist as well as communication dysfunction will negatively affect this within the group are vital to obtaining functional equilibrium. Even if it falls the best results and to continue opti- within our field of expertise and profes- mizing the care of the patients. sional nomenclature, the acquisition of specific anatomical, physiopathologi- Kinesiology cal, and technical skills is still neces- sary. These will add to our physical The official definition, dating from therapy abilities as well as our general 1946, describes the profession as par- approach to the patient and the spe- amedical, oriented toward massage. cific vision of the kinesiologist. This became completely obsolete over Although interest in this specialty is the years, especially because it was developing, there are only a few trained out of touch with the developments kinesiologists. Orofacial myofunctional 2 Gouzland Th., Fournier M. The oromaxillofacial rehabilitation in orthodontic-surgical protocols THE OROMAXILLOFACIAL REHABILITATION IN ORTHODONTIC-SURGICAL PROTOCOLS rehabilitation, referred to as myofunc- a hindrance to movement. This makes tional therapy in the English-speaking it easier to choose the type of exercise world, is often referred to as lingual according to the function or action of rehabilitation in France. This term ap- the muscle being treated. When it pears to be quite narrow as our focus comes to contracted, spastic, or hy- is not only on lingual dyspraxia but also pertonic muscles, muscle relaxation is on the platysma facial muscles, the necessary. This can be achieved with masticatory muscles, the temporo- physical therapy using the techniques mandibular joints (TMJs) and so on. It described by Alvarado2. We can also is, therefore, the vision of this maxil- draw upon Schultz’s relaxation tech- lofacial specialty which originated in niques (known as autogenic training), France in the 1960s with Mr Fournier10. cited by Girard and Leroux13 and also After obtaining his degree, Mr Fournier by Alvarado1. This type of technique met Professor Delaire, a maxillofacial is also efficient in fixing certain par- surgeon. His problem was managing afunctions, such as bruxism. Regard- the tongue in the event of orthognath- ing the functional aspects, erroneous ic surgical relapse. Over time and with functions must be reprogrammed the support of Professor Delaire, these and above all must be automatized. concepts and approaches to therapy This capacity for the acquisition or were developed. Meanwhile, in the modification of new motor patterns ‘70s and ‘80s, in the United States, is explained by the brain’s neuronal Straub and Garliner developed their plasticity. Moeller and Paskay25 have work on facial exercises with faults in prepared some guidelines concerning pronunciation as their main focus. this process. First of all, the function must be used regularly or else the Physiology cortical representation of somatosen- sation of these muscles is decreased. Physiological knowledge improves The movement must be as specific our understanding of the mechanisms as possible and must be repeated so associated with rehabilitation. When it that it becomes natural. It must also comes to the muscular components, be increased in intensity to maintain the functional equilibrium between its long-term well-being. They also dis- the agonistic and antagonistic muscles cuss transference—i.e., when a func- must be re-established. In cases of tion is automatized, other associated muscular hypotonia, a muscular rein- functions improve. Interference, on forcement is carried out, which is well the other hand, is a return to the er- outlined by Guimaraes14. Reinforce- roneous movement that continues to ment without movement is isometric be triggered despite the functional cor- and with movement is isotonic. An iso- rection. Therefore the kinesiologist can tonic movement is deemed concentric use all these guidelines to find a func- if the muscle contracts or eccentric if tional balance during the orthodontic the muscle extends. It is, therefore, treatment and the recovery. J Dentofacial Anom Orthod 2016;19:203 3 TH. GOUZLAND, M. FOURNIER PREOPERATIVE PHASE orthodontist can request the assis- tance of the kinesiologist a lot earlier in Once the orthognathic surgical deci- the process if he judges that a patient sion is decided upon by both the ortho- has a dysfunction