The efficacy of botulinum toxin injections and orofacial myofunctional therapy on orofacial disorders: A systematic review of clinical studies

Background: Botulinum toxin injections are widely used in the orofacial region for cosmetic and therapeutic purposes. Recently, interest has grown in combining Botulinum toxin A injection with facial exercises to enhance or sustain aesthetic and functional outcomes. Objective: To examine the efficacy of Botulinum toxin injections with facial exercise on orofacial disorders. Methods: A comprehensive electronic literature search was conducted across databases. Studies were screened for eligibility, and reviewers independently assessed quality and bias. Results: An electronic search of databases up until Feb 2026 revealed 164,916 Articles. Seven studies met the inclusion criteria, including four RCTs and three prospective clinical studies conducted in a hospital-based setting. Different Botulinum toxins have been used in these studies. Two studies used Onabotulinumtoxin A, two used botulinum toxin (Dysport), and two RCTs used botulinum A toxin (Botox). Additionally, the presented studies performed various myofunctional therapy. Conclusion: The current evidence suggests that facial exercise following Botulinum toxin A injections may enhance treatment outcomes in the orofacial area by sustaining muscle tone and prolonging aesthetic benefits. Further research with larger sample sizes and standardized protocols must establish the effectiveness and best practices of this combined approach.