Postoperative Physiotherapy After Open Temporomandibular Joint Surgery: A 3-Step Program

Purpose: This study aimed to ascertain the value of postoperative physiotherapy after open temporomandibular joint (TMJ) surgery and provide a usable approach for practitioners. Materials and Methods: The authors performed a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines of literature concerning the results of postoperative physiotherapy after open TMJ surgery to evaluate its effect on rehabilitation. PubMed Central, Web of Science, Cochrane Library Plus, CINAHL, and EMBASE were used to conduct this search and all articles up to April 1, 2018 (total, 675 articles) were included. Risk of bias in nonrandomized controlled trials (non-RCTs) and other observational studies was assessed using the Methodological Index for Non-Randomized Studies (MINORS) scale. The Cochrane Collaboration's tool was used for evaluating RCTs. Maximal mouth opening (MMO) before and after surgery was evaluated, as was the physiotherapeutic protocol used during the postoperative period. Evaluation of lateral movement and pain also was included, if this information was provided. Results: Initially, 675 articles were found, 6 of which were included after screening. Risk of bias was found to be unclear in the included RCTs and rather high in comparative and noncomparative articles. Three studies concluded that patients who received postoperative physiotherapy had a significantly larger increase in MMO (P<.05) compared with patients who did not receive any postoperative physiotherapy. No difference in lateral movement was found (P>.05). Mean visual analog scale pain score was significantly lower in patients who were treated with physiotherapy according to 2 of the included articles (P<.05). Conclusions: Based on the current scientific literature included in this systematic review, it can be concluded physiotherapy after open TMJ surgery plays an important role in achieving good postoperative results. The authors provide a scheme for its effective use. (C) 2018 American Association of Oral and Maxillofacial Surgeons