Orofacial myofunctional condition of patients with facial trauma in different stages of recovery

Oliveira, Giovanna Ismério de; Costa, Isabella Karine da Silva; Melo Filho, Sérgio Murilo Cordeiro de; Araújo, Fábio Andrey da Costa; Studart-Pereira, Luciana Moraes

doi:10.1590/1982-0216/202527114323

Brasil

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ORIGINAL ARTICLES • Rev. CEFAC 27 (1) • 2025 • https://doi.org/10.1590/1982-0216/202527114323 linkcopy

Orofacial myofunctional condition of patients with facial trauma in different stages of recovery

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Purpose: to describe the global orofacial myofunctional condition of patients presented with facial trauma and analyze postural and mobility aspects related to swallowing function at different stages of recovery.

Methods: an analytical and cross-sectional study with 36 participants, aged 19 to 67 years, conducted in five stages (D1, D2, D3, D4, and D5), on the 8^th to 60^th day after trauma, using the adapted Orofacial Myofunctional Evaluation Protocol with Scores (OMES). Descriptive and inferential statistical analysis was performed using the paired Student's t-test or paired Wilcoxon test, and the Friedman test which compared the five evaluations. A 5% margin of error was used in the decision of the statistical tests.

Results: in lip movements, the majority (69.4%) had severe inability. In tongue movements, the two related categories (imprecise and severe inability) had percentages of 52.8% and 41.7%, respectively. In jaw movements, the majority (83.3%) had severe inability. The median OMES score was lowest in D1 (29.00), followed by D2 (33.00), highest in D5 (46.00), and ranged from 39.50 to 41.00 in the other two evaluations, with significant differences between D1 and D3, D4 and D5, and D2 and D5.

Conclusion: the orofacial myofunctional condition progressed, spontaneously and positively, throughout the evaluations. However, attention is needed from the professionals involved.

Keywords: Facial Injuries; Stomatognathic System; Myofunctional Therapy

Variable	n (%)
TOTAL	36 (100.0)
Age range
Youth	2 (5.6)
Young adults	21 (58.3)
Adults	11 (30.6)
Older adults	2 (5.6)
Sex
Males	33 (91.7)
Females	3 (8.3)
Etiology
Motorcycle accident	15 (41.7)
Car accident	2 (5.6)
Physical aggression	10 (27.8)
Other	9 (25.0)
Location of the trauma
Midface	6 (16.7)
Lower face	1 (2.8)
Lower and midface	29 (80.6)
Type of trauma
Single fracture	1 (2.8)
Multiple fractures	35 (97.2)

Variable	n (%)
TOTAL	36 (100.0)
Lip posture
Severe dysfunction	3 (8.3)
Mild dysfunction	13 (36.1)
Occlusion with tension	15 (41.7)
Normal occlusion	5 (13.9)
Vertical jaw posture
Open mouth: mild dysfunction	12 (33.3)
Dental occlusion: No free functional space	2 (5.6)
Normal posture	22 (61.1)
Appearance of the cheeks
Severe volume	4 (11.1)
Mild volume	31 (86.1)
Normal	1 (2.8)
Appearance of the face
Severe asymmetry	6 (16.7)
Mild asymmetry	30 (83.3)
Tongue position
Adaptation/dysfunction	18 (50.0)
Normal	16 (44.4)
Not informed	2 (5.6)
Lip movements
Severe inability	25 (69.4)
Imprecise	11 (30.6)
Tongue movements
Severe inability	15 (41.7)
Imprecise	19 (52.8)
Not informed	2 (5.6)
Jaw movements
Severe inability	30 (83.3)
Imprecise	5 (13.9)
Not informed	1 (2.8)
Cheek movements
Severe inability	17 (47.2)
Imprecise	17 (47.2)
Precise	2 (5.6)
Breathing
Oronasal: Severe	1 (2.8)
Oronasal: Mild	22 (61.1)
Nasal: Normal	13 (36.1)
Swallowing: lip behavior
Severe	1 (2.8)
Moderate	11 (30.6)
Mild	15 (41.7)
Normal	6 (16.7)
Not informed	3 (8.3)
Swallowing: tongue behavior
Adaptation/dysfunction	19 (52.8)
Contained in the oral cavity	12 (33.3)
Not informed	5 (13.9)
Swallowing: head movements
Present	32 (88.9)
Absent	1 (2.8)
Not informed	3 (8.3)
Tension of facial muscles
Present	33 (91.7)
Not informed	3 (8.3)
Food spillage
Present	10 (27.8)
Absent	23 (63.9)
Not informed	3 (8.3)
Liquid bolus
One swallow	33 (91.7)
Not informed	3 (8.3)
Chewing
Not performed	36 (100.0)
Performed
Movements of the head and other parts of the body
Present	33 (91.7)
Absent	1 (2.8)
Not informed	2 (5.6)
Abnormal posture
Present	36 (100.0)
Absent

Variable	Evaluation
	D1	D2	D3	D4	D5
	n (%)	n (%)	n (%)	n (%)	n (%)
TOTAL	36 (100.0)	16 (100.0)	6 (100.0)	5 (100.0)	4 (100.0)
Lip posture
Severe dysfunction	3 (8.3)	-	-	-	-
Mild dysfunction	13 (36.1)	1 (6.3)	1 (16.7)	-	-
Occlusion with tension	15 (41.7)	11 (68.7)	2 (33.3)	2 (40.0)	1 (25.0)
Normal occlusion	5 (13.9)	4 (25.0)	3 (50.0)	3 (60.0)	3 (75.0)
Lip movements
Severe inability	25 (69.4)	4 (25.0)	2 (33.3)	-	-
Imprecise	11 (30.6)	10 (62.5)	4 (66.7)	4 (80.0)	3 (75.0)
Precise	-	-	-	-	1 (25.0)
Not informed	-	2 (12.5)	-	1 (20.0)	-
Tongue movements
Severe inability	15 (41.7)	1 (6.3)	-	1 (20.0)	-
Imprecise	19 (52.8)	9 (56.3)	4 (66.7)	1 (20.0)	2 (50.0)
Precise	-	3 (18.7)	2 (33.3)	2 (40.0)	2 (50.0)
Not informed	2 (5.6)	3 (18.7)	-	1 (20.0)	-
Jaw movements
Severe inability	30 (83.3)	5 (31.2)	3 (50.0)	1 (20.0)	1 (25.0)
Imprecise	5 (13.9)	8 (50.0)	3 (50.0)	2 (40.0)	3 (75.0)
Precise	-	-	-	1 (20.0)	-
Not informed	1 (2.8)	3 (18.8)	-	1 (20.0)	-
Swallowing: lip behavior
Severe	1 (2.8)	-	-	-	-
Moderate	11 (30.6)	2 (12.5)	1 (16.7)	1 (20.0)	-
Mild	15 (41.7)	9 (56.3)	3 (50.0)	3 (60.0)	3 (75.0)
Normal	6 (16.7)	5 (31.2)	2 (33.3)	1 (20.0)	1 (25.0)
Not informed	3 (8.3)	-	-	-	-
Swallowing: tongue behavior
Adaptation/dysfunction	19 (52.8)	3 (18.7)	2 (33.3)	-	-
Contained in the oral cavity	12 (33.3)	12 (75.0)	4 (66.7)	5 (100.0)	4 (100.0)
Not informed	5 (13.9)	1 (6.3)	-	-	-
OMES score statistics
Mean ± SD	33.53 ± 5.29	41.13 ± 5.82	41.50 ± 6.28	42.20 ± 5.81	46.25 ± 5.12
Minimum	21.00	29.00	32.00	36.00	41.00
Q1	29.25	36.50	36.50	36.50	41.50
Median	35.00	43.00	42.00	42.00	46.00
Q3	37.00	45.75	46.75	48.00	51.25
Maximum	42.00	48.00	49.00	49.00	52.00

Variable	D1 (n = 16)	D2 (n = 16)	p-value
	Mean ± SD	Mean ± SD
	Median (Q₁; Q₃)	Median (Q₁; Q₃)
Lip posture	3.00 (2.00; 3.00)	3.00 (3.00; 3.75)	p⁽¹⁾ = 0.016*
Lip movements	1.00 (1.00; 2.00)	2.00 (1.00; 2.00)	p⁽¹⁾ = 0.063
Tongue movements	2.00 (1.00; 2.00)	2.00 (2.00; 2.50)	p⁽¹⁾ = 0.016*
Jaw movements	1.00 (1.00; 1.00)	2.00 (1.00; 2.00)	p⁽¹⁾ = 0.016*
Swallowing: lip behavior	3.00 (2.00; 3.25)	3.00 (3.00; 4.00)	p⁽¹⁾ = 0.125
Swallowing: tongue behavior	2.00 (2.00; 3.00)	3.00 (3.00; 3.00)	p⁽¹⁾ = 0.219
OMES	33.31 ± 5.69	41.13 ± 5.82	p⁽²⁾ < 0.001*
	34.50 (29.00; 37.00)	43.00 (36.50; 45.75)
Variable	D2 (n = 6)	D3 (n = 6)	p-value
	Mean ± SD	Mean ± SD
	Median (Q₁; Q₃)	Median (Q₁; Q₃)
Lip posture	3.00 (2.75; 3.25)	3.50 (2.75; 4.00)	p⁽¹⁾ = 0.500
Lip movements	1.50 (1.00; 2.00)	2.00 (1.00; 2.00)	p⁽¹⁾ = 1.000
Tongue movements	2.00 (2.00; 2.50)	2.00 (2.00; 3.00)	p⁽¹⁾ = 1.000
Jaw movements	2.00 (1.00; 2.00)	1.50 (1.00; 2.00)	p⁽¹⁾ = 1.000
Swallowing: lip behavior	3.00 (2.00; 3.25)	3.00 (2.75; 4.00)	p⁽¹⁾ = 0.500
Swallowing: tongue behavior	3.00 (2.00; 3.00)	3.00 (2.00; 3.00)	p⁽¹⁾ = 1.000
OMES	37.83 ± 7.39	41.50 ± 6.28	p⁽¹⁾ = 0.188
	37.00 (31.25; 45.00)	42.00 (36.50; 46.75)
Variable	D3 (n = 5)	D4 (n = 5)	p-value
	Mean ± SD	Mean ± SD
	Median (Q₁; Q₃)	Median (Q₁; Q₃)
Lip posture	4.00 (3.00; 4.00)	4.00 (3.00; 4.00)	p⁽¹⁾ = 1.000
Lip movements	2.00 (1.00; 2.00)	2.00 (2.00; 2.00)	p⁽¹⁾ = 1.000
Tongue movements	2.00 (2.00; 2.50)	2.50 (1.25; 3.00)	p⁽¹⁾ = 1.000
Jaw movements	1.00 (1.00; 2.00)	2.00 (1.25; 2.75)	p⁽¹⁾ = 0.250
Swallowing: lip behavior	3.00 (2.50; 4.00)	3.00 (2.50; 3.50)	p⁽¹⁾ = 1.000
Swallowing: tongue behavior	3.00 (2.00; 3.00)	3.00 (3.00; 3.00)	p⁽¹⁾ = 0.500
OMES	42.00 ± 6.89	42.20 ± 5.81	p⁽¹⁾ = 0.938
	45.00 (35.00; 47.50)	42.00 (36.50; 48.00)
Variable	D4 (n = 4)	D5 (n = 4)	p-value
	Mean ± SD	Mean ± SD
	Median (Q₁; Q₃)	Median (Q₁; Q₃)
Lip posture	3.50 (3.00; 4.00)	4.00 (3.25; 4.00)	p⁽¹⁾ = 1.000
Lip movements	2.00 (2.00; 2.00)	2.00 (2.00; 2.75)	p⁽¹⁾ = 1.000
Tongue movements	2.00 (1.00; -)	2.50 (2.00; 3.00)	p⁽¹⁾ = 1.000
Jaw movements	2.00 (1.00; -)	2.00 (1.25; 2.00)	p⁽¹⁾ = 1.000
Swallowing: lip behavior	3.00 (2.25; 3.75)	3.00 (3.00; 3.75)	p⁽¹⁾ = 1.000
Swallowing: tongue behavior	3.00 (3.00; 3.00)	3.00 (3.00; 3.00)	p⁽¹⁾ = 1.000
OMES	41.00 ± 5.94	46.25 ± 5.12	p⁽¹⁾ = 0.125
	39.50 (36.25; 47.25)	46.00 (41.50; 51.25)

Variable	Evaluation					p-value
	D1	D2	D3	D4	D5
	Median	Median	Median	Median	Median
	(Q₁; Q₃)	(Q₁; Q₃)	(Q₁; Q₃)	(Q₁; Q₃)	(Q₁; Q₃)
Lip posture	2.00 ^(A)	3.00 ^(B)	3.50 ^(BC)	3.50 ^(BC)	4.00 ^(C)	p⁽¹⁾ < 0.001*
Lip posture	(1.25; 2.75)	(3.00; 3.75)	(3.00; 4.00)	(3.00; 4.00)	(3.25; 4.00)
Lip movements	1.00 ^(A)	1.00 ^(AB)	1.50 ^(BC)	2.00 ^(BC)	2.00 (^(C)	p⁽¹⁾ = 0.031*
Lip movements	(1.00; 1.00)	(1.00; 1.75)	(1.00; 2.00)	(2.00; 2.00)	2.00; 2.75)
Tongue movements	1.00	2.00	2.00	2.00	2.50	p⁽¹⁾ = 0.500
Tongue movements	(1.00; -)	(2.00; 2.00)	(2.00; 2.00)	(1.00; -)	(2.00; 3.00)
Jaw movements	1.00	1.00	1.00	2.00	2.00	p⁽¹⁾ = 0.500
Jaw movements	(1.00; 1.00)	(1.00; -)	(1.00; 1.75)	(1.00; -)	(1.25; 2.00)
Swallowing: lip behavior	2.00 ^(A)	2.50 ^(AB)	3.00 ^(BC)	3.00 ^(BC)	3.00 ^(C)	p⁽¹⁾ = 0.006*
Swallowing: lip behavior	(2.00; 2.75)	(2.00; 3.00)	(2.25; 3.75)	(2.25; 3.75)	(3.00; 3.75)
Swallowing: tongue behavior	2.00 ^(A)	2.00 ^(A)	2.50 ^(A)	3.00 ^(B)	3.00 ^(B)	p⁽¹⁾ = 0.016*
Swallowing: tongue behavior	(2.00; 2.00)	(2.00; -)	(2.00; 3.00)	(3.00; 3.00)	(3.00; 3.00)
OMES	29.25 ± 1.26 ^(A)	34.75 ± 6.50^(AB)	40.25 ± 6.55^(BC)	41.00 ± 5.94^(BC)	46.25 ± 5.12 ^(C)
	29.00	33.00	41.50	39.50	46.00	p⁽¹⁾ = 0.007*
	(28.25; 30.50)	(29.75; 41.50)	(33.50; 45.75)	(36.25; 47.25)	(41.50; 51.25)

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ABRAMO Associação Brasileira de Motricidade Orofacial Rua Uruguaiana, 516, Cep 13026-001 Campinas SP Brasil, Tel.: +55 19 3254-0342 - São Paulo - SP - Brazil
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[TFN1] Captions: n = absolute frequency; % = relative frequency