Development of swelling following orthognathic surgery at various cooling temperatures by means of hilotherapy–a clinical, prospective, monocentric, single-blinded, randomised study

A reliable and reproducible method for repositioning 3D images to calculate changes in facial volume after orthognathic surgery

PURPOSE

An accurate, reproducible method to calculate post-operative facial swelling in patients who have undergone orthognathic surgery is important to evaluate the effects of different therapies and surgical techniques on edema. The purpose of this study was to describe such a method and assess its reliability.

MATERIALS AND METHODS

A prospective study of patients undergoing orthognathic surgery was conducted. 3D facial photographs were taken on these patients immediately postoperatively, and again at least 21 days later using the 3DMD face system (3DMD LLC., Atlanta, GA, USA). These were cropped using specific anatomic points and the difference in facial volume between the photographs was calculated. Intra-rater reliability and inter-rater reliability were assessed using the Intraclass Correlation Coefficient (ICC).

RESULTS

30 patients were included in the study for analysis. When the difference in facial swelling was calculated twice by the same rater, the mean difference between the two measurements was 4.0 ± 4.2 mL. When calculated by two separate raters, the mean difference was found to be 5.0 ± 3.8 mL. The ICCs for intra-rater and inter-rater reliability were excellent at 0.979 and 0.981 respectively.

CONCLUSION

This method allows for reproducible calculation of post-operative facial swelling and could be useful to evaluate the effects of different therapies used to limit swelling and to track the resolution of swelling. It can also potentially be used as a visual aid for patient counseling during the pre-surgical visits.

External application of dandelion combined with borneol effectively reduced pain and facial swelling after jaw surgery

BACKGROUND

To explore the effects of the combination of dandelion with borneol on the maxillofacial region of patients after jaw surgery in reducing the acute inflammatory reaction after surgery, the degree of facial swelling, pain, and limitation of mouth opening, and increasing patient satisfaction.

METHODS

A total of 120 patients who met the inclusion criteria were randomly divided into 4 groups: group A: ice compress; Group B: dandelion; Group C: borneol; Group D: dandelion combined with borneol. Patients were evaluated on the day of the operation, the first day, and the second day after the operation.

RESULTS

External application of dandelion combined with borneol had a better controlling effect on facial swelling and limited mouth opening compared with the single treatment groups, and the satisfaction score was higher ( P  < .05).

CONCLUSION

External application of dandelion combined with borneol was effective in the treatment of maxillofacial swelling and pain. This approach quickly relieved swelling, restored the limitation of mouth opening, and improved patient satisfaction.

Perioperative therapies to reduce edema after orthognathic surgery: a systematic review and meta-analysis

Objective To systematically review the literature and assess the effectiveness of perioperative systemic and nonsystemic therapies in reducing edema after orthognathic surgery. Study Design Four databases (PubMed, Web of Science, Bireme, and Scopus) were searched. Only randomized clinical trials were included and assessed using the RoB 2.0 software (Cochrane Collaboration, London, UK). Studies were grouped into time of assessment and systemic/nonsystemic therapy. Results Eighteen studies were included in this review (8 in the meta-analysis, n = 349). The qualitative assessment of systemic (enzyme therapy, dexamethasone, betamethasone, and Venoplant) and nonsystemic therapies (thermotherapy and K-Taping) appear to reduce edema. Manual lymphatic drainage (MLD) after 72 hours (CI: -1.03 to 2.31; P = .45), and 30 days (CI: -1.53 to 0.49; P = .49), and laser after 24 hours (CI: -1.36 to 1.48; P = .93), 72 hours (CI: -4.81 to 2.92; P = .63), 30 days (CI: -3.44 to 0.99; P = .28), and 90 days (CI: -1.83 to 0.96; P = .54) showed no significance. Thermotherapy reduced edema after 48 hours (CI: -48.47 to -13.31; P = .0006) and 30 days (CI: -14.73 to -1.98; P = .01). Conclusion The Grading of Recommendations, Assessment, Development and Evaluations tool showed moderate evidence for thermotherapy (significant reduction of edema), whereas the MLD and laser results were rated as high certainty of evidence (no reduction of edema).

Systematic mapping review of orthognathic surgery

STUDY DESIGN

Systematic mapping review AIM AND SCOPE: The objective of this mapping review was to identify, describe, and organize clinical research currently available from systematic reviews and primary studies regarding co-interventions and different surgical modalities used in orthognathic surgery (OS) and their outcomes.

METHODS

Systematic reviews (SRs), randomized controlled trials, and observational studies that evaluated perioperative OS co-interventions and surgical modalities were identified in an exhaustive search of MEDLINE, EMBASE, Epistemonikos, Lilacs, Web of Science, and CENTRAL. Grey literature was also screened.

RESULTS

Included were 35 SRs and 253 primary studies, 103 from SRs, and another 150 identified in our search. Overall, SR quality was rated as critically low, with only two SRs rated as of high quality. 19 questions on population, interventions, comparisons, and outcomes (PICO) extracted from the SRs focused on osteosynthesis methods, surgical cutting devices, and use of antibiotics, corticosteroids, and induced hypotension. Also identified were 15 research gaps. Evidence bubble maps were created to graphically depict the available evidence.

CONCLUSION

Future high-quality research, both primary and secondary, is needed to address the knowledge gaps identified in this systematic mapping review.

Shall we use cryotherapy in the treatment in surgical procedures, in acute pain or injury, or in long term pain or dysfunction? - A systematic review

PURPOSE

This review aimed to evaluate the certainty of evidence for the use of cryotherapy in patients with musculoskeletal disorders.

METHODS

PubMed, Embase, Cochrane Library and AMED were searched from January 2000 to January 2018 (update June 2019) for systematic reviews (SRs) and randomized controlled trials (RCTs) reporting outcomes on pain, swelling, range of motion (ROM), function, blood loss, analgesic use, patient satisfaction and adverse advents. The papers were categorised into: surgical procedures, acute pain or injury and long-term pain or dysfunction. Methodological quality and risk of bias were assessed using the AMSTAR and the Swedish Health Technology Assessment instruments. Level of certainty of evidence was synthesized using GRADE.

STUDY SELECTION

Eight SRs and 50 RCTs from a total of 6027 (+839) were included. In total 34 studies evaluated cryotherapy in surgical procedures, twelve evaluated cryotherapy use in acute pain or injury and twelve studies evaluated cryotherapy in long-term pain and dysfunction.

RESULTS

The certainty of evidence is moderate (GRADE III) after surgical procedures to reduce pain, improve ROM, for patient satisfaction and few adverse events are reported. Cryotherapy in acute pain and injury or long-term pain and dysfunction show positive effects but have a higher number of outcomes with low certainty of evidence (GRADE II).

CONCLUSION

Cryotherapy may safely be used in musculoskeletal injuries and dysfunctions. It is well tolerated by patients. More advanced forms of cryotherapy may accentuate the effect. Future research is needed where timing, temperature for cooling, dose (time) and frequency are evaluated.

A randomized, prospective trial to assess the safety and efficacy of hilotherapy in patients after orthognathic surgery

Purpose

A post-operative cooling method in oral and maxillofacial surgery is the cooling with hilotherapy. The aim of this study was the post-operative comparison of cooling temperatures of 18°C and 22°C. The parameters of this trial were swelling and the post-operative pain levels.

Methods

This study included 156 patients, divided into two groups among whom a mono-one, bignathic osteotomy or genioplasty was indicated. The post-operative assessment of swelling was performed using a 3D optical scanner. This examination was repeated on post-operative days 1, 2, 3, 7, 14, 30, and 90. The examination on day 90 served as a reference value in respect of swelling and pain.

Results

Group 1 (18°C, 78 patients) showed an increase in post-operative swelling on the 1^st post-OP day of 52.06 ± 35.41ml. The maximum was reached on the 2^nd post-OP day with 75.82 ± 38.97ml. On the 30^th post-OP day, residual swelling measured 11.60 ± 12.62ml. Group 2 (22 °C, 78 patients) showed an increase in postoperative swelling on the 1^st post-OP day of 76.07 ± 63.15ml. The maximum was reached on the 2^nd post-OP day with 106.97 ± 69.63 ml. On the 30^th post-OP day, residual swelling measured 14.36 ± 32.26ml. The differences between the two groups and between different visits were statistically significant.

Conclusion

The study results indicate less residual swelling in group 1 on the 30^th post-OP day, possible based on the lower cooling temperature. The post-operative pain exhibits a comparable level of pain intensity between the two groups. In overall terms, a subjectively more agreeable treatment was observed in group 1.

Effects of Water-Circulating Cooling Mask on Postoperative Outcomes in Orthognathic Surgery and Facial Trauma

The purpose of this study was to perform a systematic review and meta-analysis of randomized clinical trials (RCTs) investigating the efficacy of hilotherapy on postoperative pain, swelling, neurosensory impairment and patient satisfaction. The authors analyzed RCTs comparing the use of hilotherapy versus conventional cryotherapy or no cold treatment for orthognathic surgery and repair of facial trauma. The authors assessed the risk of bias and strength of evidence according to the Cochrane guidelines and GRADE rating system, respectively. Treatment effects were defined as weighted or standardized mean difference using the inverse variance method. Five RCTs were included. Postoperative pain and swelling in patients using hilotherapy were lower comparing to the control group in the postoperative day 2 (Pain: MD -1.75, CI 95% -2.69 to -0.81; Swelling: MD -21.16 mL, CI 95% -38.91 to -3.41) and in the final evaluation (Pain: MD -0.31, CI 95% -0.44 to -0.18; MD -4.45 mL, CI 95% -7.87 to -1.03). Patients reported higher satisfaction with hilotherapy, but no differences were found for neurosensory impairment. Current evidence suggests that hilotherapy is effective in reducing postoperative pain and swelling in orthognathic surgery and repair of facial fractures and may lead to improvements in patient satisfaction in the recovery phase.

Three-Dimensional Evaluation of the Effects of Kinesio Taping on Postoperative Swelling and Pain after Surgically Assisted Rapid Palatal Expansion

Objectives

The purpose of the present study was to evaluate the effects of kinesio taping on pain and swelling after surgically assisted rapid palatal expansion.

Material and Methods

A total of 21 (12 male and 9 female) patients with transverse maxillary deficiency were enrolled in the study. Kinesio taping (KT) was applied unilaterally in each patient, whereby sides of the face with KT application were included into the (a) KT group and the other sides were included into the (b) non-KT group. Changes in facial volume were evaluated on digital images using the 3dMD Face System. Pain scores were assessed at postoperative days 1, 2, 3, 4, 5, 6, and 7 using the visual analog scale (VAS). Two-way repeated measures analysis of variance and Mann Whitney U test were used for statistical analyses.

Results

Swelling was significantly lower in the KT group compared to the non-KT group from T0 to T1 (36.42 [SD 19.71] mm³ vs. 183.84 [SD 49.33] mm³) and was significantly greater in the non-KT group compared to the KT group from T0 to T2 (70.88 [SD 15.73] mm³ vs. 21.46 [SD 13.39] mm³) (P < 0.001 for both). The VAS scores were significantly lower in the KT group compared to the non-KT group at all time points (P < 0.05).

Conclusions

The application of kinesio taping after maxillofacial surgery reduced the pain and swelling in the postoperative period. Kinesio taping can be used as an alternative to other methods that are used for the reduction of postoperative complaints.