journal club presentation in maxillofacial surgery

1. Presented by- Dr. Abhijeet Kamble
2nd Year PG
Dept of Maxillofacial and Oral Surgery
Government Dental College, Shimla

2. 1. About the Journal
2. Abstract
3. Introduction
4. Material and Methods
5. Results
6. Discussion
7. Review of Literature
8. References

3. Postoperative Physiotherapy After Open
Temporomandibular Joint Surgery: A 3-Step
Program
Nikolas K.G, Pieter-Jan Loos, Maurice Y. Mommaert

4. • Journal Of Oral Maxillofacial Surgery
• Peer reviewed journal
• Open access PubMed Indexed Journal
• Impact factor – 1.895
• Published by – Elsevier Inc.
• Volume – 81
• Issue – 3
• Year of publication - December 29 , 2018

5.  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.

6.  The role of physiotherapy is very important in articular surgeries such as total knee replacement or in hip
surgery. Although physiotherapy is a non surgical treatment for temporomandibular disorders ( TMDs) and it has
been explored well , the use of postoperative physiotherapy has not been explored that well.
 Although temporomandibular joint (TMJ) surgery aims to improve joint movement and alleviate joint pain,
surgery-induced disuse muscle atrophy of the masticatory muscles can occur. Furthermore, immobilization can
lead to capsular changes and adhesion formation, because abnormal scar tissue formation can occur.
 Physiotherapy can be active or passive in nature. Passive therapy can entail heat or cold application to relax the
muscles or decrease inflammation, respectively.
 Exercises, including passive opening of the mouth with the aid of an apparatus.
 In contrast, active exercises rely on muscle and joint activation, such as electrostimulation of the muscle, and
opening and closing of the joint by the patient without any assistance

7.  This study aimed to ascertain the value of postoperative physiotherapy after open
temporomandibular joint (TMJ) surgery and provide a usable approach for practitioners
Aims and Objectives of the study:

8.  STUDY DESIGN:
-The authors performed a systematic review by conducting a computerized literature search.
This search was performed up to April 1, 2018 according to the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses (PRISMA) guidelines.
Randomized controlled trials (RCTs); non-RCTs; comparative, prospective, and retrospective
studies; and case series were included. Case reports were excluded to provide scientific
soundness. Systematic reviews concerning postoperative physiotherapy and rehabilitation after
TMJ surgery were reviewed to identify possible eligible studies. Only articles written in Dutch,
English, German, or French were included and the full text had to be accessible.

12. Results: