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Face, Jaw and Head Conditions

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Craniofacial Pre & Post-Surgical Care

For Which Surgical Procedures do the Physical Therapists of PhysioPartners Renaissance CranioFacial Group Provide Care?

The specialized physical therapists of PhysioPartners Renaissance CranioFacial Group provide rehabilitation for the following surgical procedures, which will accelerate the healing process and promote a faster post-surgical recovery.

  • Orthognathic surgery, jaw reconstruction, offering pre and post operative physical therapist care
  • TMJ arthroscopic surgery
  • Arthrocentesis or lavage
  • Surgically-facilitated orthodontic therapy (SFOT)
  • Reconstruction post cancer treatment
  • Facial reconstruction after trauma
  • Cosmetic plastic surgery
  • Head, neck, tongue and throat cancer surgery rehabilitation
  • Brain tumor surgery
  • Post nasal septum surgery, retraining nasal breathing
  • Post neurosurgery
  • Cochlear implant surgery
  • Facial paralysis nerve grafting

Pre and Post Surgical Physical Therapy Treatment Will Consist of the Following:

  • Techniques to reduce post-surgical edema or swelling.  Our physical therapists are trained to recognize, assess and treat post-surgical edema with specialized techniques to enhance the lymphatic system, including lymphatic drainage massage.  This specialized technique, will encourage the body to create new pathways to drain excess of fluid or activate existing ones. Resolving post surgical swelling is key to minimizing scar tissue formation and lymphedema drainage massage increases circulation. This specialized, extremely gentle technique, promotes the layers of healing tissue aligning themselves in an optimal manner to reduce thickening and scarring under the skin.
  • Soft tissue mobilization and myofascial release also are used to treat fibrotic or scar tissue, promoting optimal healing, reducing swelling, thickening and scarring under the skin.
  • Breathing re-training to restore nasal and diaphragmatic proper breathing pattern to improve overall health and sleep.  In many surgical cases, nasal breathing is impaired during the healing process. Breathing training and re-education is essential to return to normal health and energy levels after surgery. 
  • Myofunctional Therapy to train the tongue, lips, and teeth to properly chew, swallow and support a healthy airway.  
  • Specialized manual therapy to the neck, face, jaw and shoulders help promote proper posture and alignment for optimal function. Joint mechanics will be assessed by our manual physical therapists for limitations in the TMJ, neck, spine, and pelvis.  Limited mouth opening is often found in post-orthognathic surgery patients, and intra-oral manual therapy to the TMJ can help improve mobility and restore normal range of motion in order to be able eat adequately.
  • Functional Manual Medicine to the cranium can gently influence the cranial-sacral system and the cranial bones/sutures. 
  • Postural retraining to restore proper posture of the spine and body with cutting edge techniques that incorporate breathing, exercises to improve oral posture for proper eating and chewing, and overall biomechanics training applied to daily activities. 
  • Modalities, such as light laser and ultrasound may be used to reduce pain, reduce scarring and promote faster healing.  Light laser treats painful points at the cellular level and increases circulation to promote oxygen exchange to the tissues. Ultrasound gently warms the layers of muscle tissue under the skin during the healing process to allow more oxygenated blood to flush the healing tissues and improve circulation. Biofeedback may be used to retrain the facial muscles for facial paralysis patients to both strengthen the weak side of the face and decrease over-compensation by the strong the facial muscles.  
  • Specific exercises will be prescribed for the face, head, neck and shoulders to improve strength and range of motion of the upper body and restore comfort when speaking, chewing, swallowing and facial expression, as well as accelerate return to normal activities and exercise.

Orthognathic Surgery

What Specialized Training Do the Physical Therapists of PhysioPartners Renaissance CranioFacial Group Have in Orthognathic Surgery Rehabilitation?

Dr. Hobson has spent several years training with post-surgical head and neck physical therapist experts, Dr. Mariano Rocabado and Susana Petermann, PT in Santiago, Chile. In Chile, they have developed a post-surgical protocol for orthognathic surgery and facial surgery to restore normal function that we are proud to offer here at PhysioPartners Renaissance CranioFacial Group.  Treatment of the neck and TMJ are critical in promoting optimal outcomes with orthognathic surgery. Dr. Hobson has trained her staff and also teaches these techniques to other physical therapists at the University of St. Augustine for Health Sciences.

TMJ Arthroscopy

What is TMJ Arthroscopy (Arthroscopic Surgery) and Why is CranioFacial Physical Therapist Care Important as an Adjunct Treatment? 

An arthroscopy allows your surgeon to see inside your temporomandibular joint (TMJ) using a camera inserted through a small cut on your face. Your surgeon can diagnose problems such as a torn cartilage (TMJ disk) and damage to the surface of the joint.  In some cases, when there is damage to the TMJ disc or displacement causes the joint to catch, click, pop or lock, you may benefit this type of surgery.  We recommend undergoing pre and post-surgery craniofacial physical therapist care to ensure the most optimal outcome.

Our craniofacial physical therapists will perform skilled manual therapy to the TMJ and cervical spine to optimize the outcome of TMJ arthroscopic surgery.  Balancing the position of the upper neck and jaw bone improves joint mechanics and achieved with skilled manual therapy, tongue training (Myofunctional Therapy), nasal breathing training and postural re-education of the spine and the cranium.

Arthrocentesis (Lavage) Procedure

Why is It Important to See a CranioFacial Physical Therapist after Arthrocentesis Procedure?

An arthrocentesis, also called a lavage, is a procedure during which the jaw joint is washed out with sterile fluid with the goal of returning the TMJ disc or cartilage to a normal position within the joint.  Our craniofacial physical therapists are trained in restoring optimal TMJ joint mechanics, but at times the TMJ disc or cartilage restrictions prohibit free movement.  We work with many oral surgeons who perform this procedure to help flush the joint and allow the disc to free up and improve position.  Our skilled craniofacial physical therapists will restore optimal TMJ mechanics pre and post arthrocentesis procedure to optimize mouth range of motion with reduced clicking, catching or locking. 

Surgically Facilitated Orthodontic Therapy (SFOT), Maxillary Skeletal Expander (MSE), Surgically Assisted Rapid Palatal Expansion (SARPE) Treatment

Surgically Facilitiated Orthodontic Therapy (SFOT) is an advanced procedure that pinpoints and treats the underlying problems of insufficient alveolar bone and compromised arch forms in patients with maligned teeth. It is an alternative to the traditional orthodontic approach to managing dental crowding and malocclusion and is airway-directed.  Our craniofacial physical therapists are trained in head and neck manual therapy and Myofunctional Therapy (tongue training).  The SFOT is sometimes followed by an Maxillary Skeletal Expander (MSE), a non-surgical orthopedic palatal expansion device for adults with a narrowed, high-angle palate, or upper and lower jaw discrepancy. This technique utilizes micro implants or mini screws to anchor the expander in the roof of the mouth.  The craniofacial physical therapist treatment serves as an adjunct treatment to SFOT and MSE and allows the individual to restore the proper tongue function and position and promotes nasal breathing.  Many patients may have narrowed jaws associated with improper swallow and resting position of the tongue, and addressing these functions can help stabilize and optimize the procedures. 

Facial Paralysis Surgery

What Experience Do the Physical Therapists of PhysioPartners Renaissance CranioFacial Group in Treating Facial Paralysis and Facial Nerve Graft Surgery?

Dr. Hobson has spent an extensive amount of time with facial paralysis rehabilitation expert, Todd Henkelmann, PT, who has specialized in this field for over 20 years. She has trained with him and learned specific exercises and hands-on techniques to help patients activate certain parts of the face while avoiding over-activating the areas that work well. The physical therapists of PhysioPartners Renaissance CranioFacial Group use their hands-on skills and biofeedback to help patients pre-and-post surgery. 

What Treatments and Interventions Are Offered by PhysioPartners Renaissance CranioFacial Group for Patients with Paralysis and after Facial Paralysis Nerve Grafting Surgery to Achieve the Best Possible Functional Outcomes?

  • Facial mastication and tongue muscle re-education, known as Myofunctional Therapy
  • Neck and shoulder range-of-motion exercises to improve pain, function, strength, flexibility and reduce scar tissue
  • Hands-on manual therapy to soften soft tissues and free up the connective tissues and fascia networks of the face, neck and anterior fascial chain
  • Treatment for limited mouth opening, such as trismus caused as a response to cancer treatment, including use manual therapy to improve jaw opening and joint mechanics
  • Biofeedback facial exercises to help stimulate the muscles that the nerve will be activating;  in many cases, patients need assistance learning to not “over-activate” the unaffected side of the face
  • Breathing training with postural re-education, as well as specific airway and throat exercises
  • Postural education and biomechanics training to improve optimal head-on-neck position and restoration of the natural curves of the spine
  • Patient education to help you learn how to manage and address some of the post-surgical restrictions and limitations
  • Pain management
  • Lymphedema decongestive therapy, including manual lymphatic drainage, compression and exercises for the lymphatic system

Head and Neck Cancer Treatment

Rehabilitation for survivors of head and neck cancer is a complex process due to the many functional challenges one might face after cancer treatment. Learn what the skilled physical therapists of PhysioPartners Renaissance CranioFacial Group provide for patients with cancer.

What Are the Most Common Limitations After Treatment for Head and Neck Cancer?

  • Difficulty opening the mouth, known as trismus
  • Stiffness of the neck or loss of neck range of motion due to surgery and radiation fibrosis
  • Shoulder weakness after neck dissection and surgical procedures
  • Tongue weakness and low tongue posture, which can affect head and neck posture needed for vital functions, such maintaining a healthy airway space, proper breathing, chewing and overall neutral posture
  • Increased swelling post surgery or due to lymphedema

What Treatments and Interventions are Offered by PhysioPartners Renaissance CranioFacial Group After Treatment for Head and Neck Cancer and Help Achieve the Best Possible Functional Outcomes?

  • Re-education of facial mastication and tongue muscle, known as Myofunctional Therapy
  • Neck and shoulder range-of-motion exercises to improve pain, function, strength, flexibility and reduce scar tissue
  • Hands-on manual therapy to soften soft tissues and free up the connective tissues and fascia networks
  • Treatment for trismus, including use of manual therapy to improve jaw opening and joint mechanics
  • The use of assistive mouth opening devices, such TheraBite® or Dynasplint® as needed for home management
  • Breathing training with postural re-education and specific airway and throat exercises
  • Postural education and biomechanics training to improve optimal head on neck position and restoration of the natural curves of the spine
  • Patient education to help you learn how to manage and address some of the post-surgical restrictions and limitations
  • Pain management
  • Lymphedema decongestive therapy, including manual lymphatic drainage, compression and exercises for the lymphatic system

Megan M Case Report:
Megan presented as a 23 year-old female who reported headaches, facial tension and chronic fatigue. She had difficulty sleeping at night and felt exhausted daily.

She was diagnosed with sleep apnea and learned that her airway was the size of a coffee stirrer versus a slurpee straw. During evaluation, we identified a mouth breathing habit and began addressing the tongue placement, nose and diaphragm breathing, proper head and neck posture and overall core strength.

Due to the very limited airway space and severe breathing symptoms, Megan decided to go through orthognathic surgery to move her lower jaw forward and widen her upper jaw to achieve adequate tongue space in order to improve her nasal and throat airway space.

Treatment after surgery consisted head and neck manual therapy to improve the cranial-vertebral angle, Myofunctional Therapy to improve tongue posture and function, pre and post orthognathic surgery treatment and core stabilization. Following treatment, Megan was able to breathe better and position her head and neck in a healthy and stable posture.

“I celebrate my recovery from jaw reconstruction thanks to the fantastic treatment by the doctors at PhysioPartners Renaissance CranioFacial Group. I learned to understand how correct posture, jaw mechanics and specific exercises affect my chewing and speech. I regained 100% of my mobility and function, and have no residual swelling or pain.”  -Carla S, patient

Please call (312) 986-9833 for more information or schedule an onsite or virtual appointment.

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