Manual Therapy and Kinesio Taping on Temporomandibular Joint Dysfunction Following Oral Surgeries
Condition: Temporomandibular Joint Dysfunction
MeSH terms: Joint Diseases; Temporomandibular Joint Disorders; Temporomandibular Joint Dysfunction Syndrome
Study type: Interventional

Summary: 
      Oral surgeries include various types such as impacted wisdom tooth surgery, oral cyst
      enucleation (cystectomy), surgical incision and drainage of odontogenic abcess, oral tumor
      excision and open reduction and internal fixation of mandibular fracture (ORIF). Oral
      surgeries are usually associated with pain, swelling and inability to open the mouth. Those
      symptoms reach the maximum intensity between the third to fifth days postoperatively for the
      swelling and 24 to 48 hours postoperatively for the pain and then, they gradually diminished
      until the 7th day postoperatively
    

Detailed description: 
      Oral surgery concerned with the diagnosis and surgical treatment of congenital or acquired
      diseases, dysfunction, defects or injuries of the mouth and jaw. Oral surgeries include
      various types such as impacted wisdom tooth surgery, oral cyst enucleation (cystectomy),
      surgical incision and drainage of odontogenic abscess, oral tumor excision and open reduction
      and internal fixation of mandibular fracture (ORIF).

      Temporomandibular joint dysfunction: It is one of post operative complications that occur
      post oral surgeries which include several symptoms as pain,edema and trismus. Pain is the
      most common and limiting clinical manifestation of this dysfunction, as well as decreased
      mobility of the jaw, both of which impacts quality of life. The multifactor etiology of
      temporomandibular joint dysfunction often requires multidisciplinary healthcare professionals
      to manage difficult symptoms, including chronic pain. Many studies have identified a variety
      of conservative interventions, such as physical therapy, for patients with temporomandibular
      joint disorders, including joint mobilization, tissue mobilization,dry needling, friction
      massage, patient education, splints, modalities, stretching, coordination
      activities,strengthening exercises, and combinations of these techniques. postoperative major
      complications such as pain, edema and trismus in various oral surgeries such as tooth
      extraction, maxillary expansion, and orthognathic surgeries. Oral surgical procedures are
      often accompanied by a multitude of complications including pain, swelling, and morbidity.
      These are the result of inflammatory processes induced by the surgical wound healing.

      Facial edema: During surgeries, inflammatory chemicals such as prostaglandins, leukotrienes,
      bradykinins, and platelet-activation factors are secreted by damaged tissue. Moreover,
      excessive lymph production causes disturbances in local lymphatic circulation. Inflammatory
      chemicals create endothelial gaps to increase vascular permeability. In addition, macrophages
      and mast cells in damaged tissues produce histamine, serotonin, and eicosanoids; alter the
      local constitution of blood vessels; and release nitric oxide, eventually resulting in
      vasorelaxation. These chain reactions increase blood vessel relaxation and vascular
      permeability and result in the accumulation of interstitial fluid, eventually resulting in
      tissue swelling and pain.

      Trismus: It is defined as prolonged tetanic spasm of masticatory muscles of jaw. the
      transient jaw stiffness usually reaches its peak on the 2nd day post surgery. It is diagnosed
      from clinical examination of the maximal interincisal distance (MID) <40-45 mm caused by
      contracture and not by obstructive joint impingement.The factors contributing to trismus are:
      (1) Multiple needle penetrations correlate with a greater incidence of post injection
      trismus. (2) Elevation of flap beyond the external oblique ridge. (3) At times, the patient
      hurts his/her own tongue or cheek under the effect of anesthesia resulting in reflex trismus.

      kinesio taping (KT) was developed by the Japanese therapist and academic lecturer. More than
      30 years ago, he created a special tape, which by the correct application, i.e. sticking with
      a small stretch (about 15%) to the skin, raises the surface of the skin, thereby increasing
      the space between the dermis and fascia . The expansion of this space, should reduce lymph
      retention. The patch used for this method has a thickness and weight similar to skin. The
      waterproof tape is made of 100% cotton, while the adhesive on the inside is applied in the
      shape of a fan strip, which allows the air to flow. When stretched beyond its normal length
      and applied, it recoils and creates a pulling force on the skin, thus improving blood and
      lymph flow by alleviating hemorrhage and congestion of lymphatic fluid.

      Manual therapy (MT) is one of the various types of interventions for treating patients with
      temporomandibular joint dysfunction and include: Mobilization exercise stretching exercise,
      coordination exercise, rang of motion exercise and strengthening exercise. Within other body
      regions, manual therapy intervention has been detailed and summarize the efficacy of
      treatment approaches.Strengthening, stretching/flexibility, and motor control exercises have
      demonstrated to be efficacious in reducing pain and disability in patients with chronic low
      back pain,as well as mechanical neck pain. Despite a review and meta-analysis the efficacy of
      exercise therapy and dosage has yet to be determined for patients with temporomandibular
      joint dysfunction. exercises intended to increase mobility of the temporomandibular joint
      and/or muscles of the jaw. Exercise therapy aims to reduce clinical symptoms such as pain in
      the muscles and joints, and improve motor function by moving whole or part of the
      body.Exercise can be classified into self exercise by patients and manual therapy that
      physiotherapists apply to patients. Self exercise is often offered as home exercise or
      self-care program that can be done at home. manual exercise therapy includes mobilization,
      stretch,muscle strengthening exercise and coordination exercise.
    

Intervention name(s): Kinesio tape; Gauze pack; ice pack; Manual therapy; Analgesic; Proteolytic enzymes; Mouth wash; Soft cold diet
Intervention type(s): Device; Other; Device; Procedure; Drug; Drug; Drug; Dietary Supplement
Intervention description(s): Skin-colored Kinesiology Tape (ARES tape,5 cm×5 m) is waterproof tape is made of 100% cotton,applied in the shape of a fan strip, waterproof. The width is 5 cm and thickness of 0.5 mm (5 cm×5 m ).This tape is sticking with a small stretch (about 15%).; Place gauze pack over surgical site for one hour after surgery.; Ice packs will be applied for 6 hours after surgery in all patients; passive and active range of motion, stretching exercises, resistive mouth exercises, mobilization exercises and coordination exercices.; NSAIDs like ibuprofen (600-800 mg) or declophenac sodium (50-150 mg) 3 times a day; 1-2 ampoules daily IM box of 3 ampoules of 5 mg crystallized and lyophilized chymotrypsin (450 E. A. Units) + 3 ampoules of 3 ml apyrogenic saline for one week.; use 0.12% chlorhexidine or povidone iodine mouthwash daily; For the day of surgery
Other intervention name(s): Exercises
Intervention MeSH terms: Analgesics
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Triple (Participant, Investigator, Outcomes Assessor)
Primary purpose: Treatment
Keywords: Kinesio taping; Manual therapy; Oral surgeries