Abstract
Swelling, pain and trismus constitute the major post-operative morbidity after surgery for mandibular fractures. We assessed the role of kinesio taping in mitigating these. Two groups of 15 patients were compared; those who had such applied to the side of the fracture and a control group of those who did not. Pain, swelling and trismus were assessed pre-operatively, and on the second, third and fifth post-operative days, and found to be significantly less in the study group. This simple technique is therefore effective. It is a simple frugal intervention without any side effects.
Introduction
Mandibular fractures cause swelling, pain and trismus leading to difficulty in speech and swallowing. This inflammatory response is a consequence of the initial trauma as well as surgery which results in post-operative morbidity, invalidity and decreased quality of life.1,2 Non-steroidal anti-inflammatory drugs and steroids are often prescribed to control this inflammatory tissue response, but this medication is associated with known undesirable side effects.3,4
Materials and methods
Our prospective interventional study was conducted in a tertiary teaching hospital in Central India over a period of 6 months (January 2021–July 2021). Institutional ethical approval and written, informed consent from all patients were duly acquired. Thirty patients with isolated fracture of mandible (without associated facial bone fractures) were randomised into two groups; with taping and without. Pregnant and lactating women, patients with facial skin infections or abrasion, or allergy to tape were excluded. All patients were subjected to the same standardised surgical protocol performed. Fracture fixation was performed using intermaxillary fixation in 22 patients (KT – 11, control – 11) for favourable fractures and by open reduction and plate fixation in 8 patients (KT – 4, control – 4) for unfavourable fractures.
Before application of tape, the skin was cleansed with spirit to remove any dirt and oil. The length of the tape was individually measured; on average 7 × 7 cm tape was used, three longitudinal slits being made to make four strips 1 cm wide. Patients were asked to turn their faces to the opposite side in order to generate slight tension and the adhesive tape was then applied from the base of the mandible in the submandibular region (a fixed point) and covered the area below the ear lobe towards the entire labial commissure (Figure 1). The tape (Dynaplast, Johnson & Johnson Pvt. Ltd, 501 Arena Space, Jogeshwari (E), Mumbai, India) was applied in the immediate post-operative directly after surgery and maintained for 5 days post-operatively. It was not changed during the observation period.
Technique of tape application.
Post-operatively, 750mg paracetamol bd, 500 mg amoxicillin bd and 0.12% chlorhexidine mouth washes tds were given for 5 days.
Post-operative pain was assessed by the Visual Analogue Score (VAS).
Swelling was assessed just before surgery and on second, third and fifth days after surgery, using measuring tape, three measurements being taken. The first was from tragus to lip commissure, the second was from lateral canthus of the eye to the angle of the mandible and the third from the angle of the mandible to the lip commissure. (Figures 2 to 4) Oedema measurements were presented as the mean of all three line measurements (in cm) for all patients.
First measurement for the assessment of swelling from tragus to the lip commissure.
Second measurement for the assessment of swelling from lateral canthus of the eye to the angle of the mandible.
Third measurement for the assessment of swelling from the angle of the mandible to the lip commissure.
Trismus was assessed by inter-incisor distance measured by a rigid ruler in mm.
Collected data were analysed, using IBM SPSS version 23.0, and presented as a mean with SDs. Both groups were compared using independent sample t-test. P-values <0.05 were considered significant.
Results
We studied 30 patients (only 1 female) with mean age of 3.7 years ranging from 18 to 52 years with unilateral mandibular fractures. Swelling, VAS and trismus were significantly less in the control group as seen on the second, third and fifth post-operative days (Table 1).
Comparison of swelling, inter-incisor distance and Visual Analogue Score (VAS) between the study and control groups.
Measurements shown for swelling, inter-incisor distance and VAS are mean values of all patients.
There were no complications related to tape application.
Discussion
Mandibular fractures and their surgical treatment lead to significant post-operative swelling, pain and trismus. Conventionally, these patients are treated by oral analgesics and anti-inflammatory drugs. Other modalities include dexamethasone injection, low-level laser treatment, ice therapy and lymphatic massage, though these interventions bring their own concerns. Pre-operative dexamethasone injection can cause poor wound healing and increased risk of infection. Ice therapy is simple and economical but can delay the healing and lengthen the recovery process. Laser therapy and lymphatic massage can only be performed by a professional therapist and are expensive, requiring direct physical manipulation.5–7
Kinesio taping (KT) has long been used in the prevention and treatment of musculoskeletal pain following injuries. 8 Other indications for its usage are osteoarthritis, carpal tunnel syndrome and functional disorders of masticatory muscles. 9 Recently, its indications have been extended to reduction of lymphoedema and treatment of hypertrophic scars, keloids and scar contractures. 10
KT has an elasticity of ∼140% and is applied to the skin using a certain amount of traction, thereby generating a pulling force resulting in skin convolutions, which in turn increase the interstitial space between the skin and underlying connective tissue, thus promoting the follow of blood and lymphatic fluid. 11 Other mechanisms include support of injured part, reducing pain by decreasing pressure on nociceptors and alleviating muscle spasm. 12
Significant reduction in pain, swelling and trismus is seen when the tape was used which is probably due to the rapid reduction of oedema and pain. Post-operatively paracetamol alone was needed. Similar benefits using KT have already been recorded.13,14 Application of the tape before the fifth day post-op (by a GP) if not previously applied may still be useful.
The small number of cases, possible placebo effects and impossibility of assessor blinding, subjectivity in swelling assessment and lack of standardisation of the tape application method limit the generality of our study but the obvious beneficial effect with a simple frugal intervention without any side effects needs widespread consideration.
Footnotes
Declaration of conflicting interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) received no financial support for the research, authorship, and/or publication of this article.
Statement of consent for image publication
Consent to publish these findings and images were obtained from the patients.
