ABSTRACT Background Residual obstructive sleep apnea (OSA) is common in childhood OSA even after upper airway obstruction removal by adenotonsillectomy. Orofacial myofunctional therapy (OMT) is becoming a popular treatment in stomatology but lacks adequate evidence of effectiveness in childhood OSA. Our study attempts to evaluate the effect of OMT on childhood OSA by subjective and objective methods. Methods Thirty‐seven children diagnosed with postoperative residual OSA (obstructive sleep apnea) were enrolled in the study and divided into a treated group (n = 21) and a untreated group (n = 16). They were followed up at 0, 1, and 3 months. The degree of mouth opening, modified OSA‐18 questionnaire responses, polysomnography (PSG) findings, and scores of the orofacial myofunctional evaluation with scores (OMES) were recorded pre‐ and post‐therapy. Results Compared with pre‐OMT or untreated children, the degree of mouth opening during sleep and the OSA‐18 total score were significantly decreased after OMT in children with Residual OSA. Furthermore, OMT significantly decreased the apnea‐hypopnea index (AHI), the longest duration of apnea and hypopnea, and the proportion of wakefulness and increased the duration of deep sleep. Moreover, the total score of OMES score and the scores of appearance and posture, mobility and functions were significantly increased after OMT. Conclusion OMT improves the qualities of life and sleep by repairing orofacial myofunctions in residual OSA children. OMT could be an adjuvant treatment for childhood OSA. Trial Registration The trial was registered with the Chinese Clinical Trial Registry ( http://www.chictr.org.cn .). Registration number: ChiCTR2300072252 (07/06/2023).