|Year : 2020 | Volume
| Issue : 2 | Page : 126-130
Versatility of Kinesio-Taping in Postoperative Swelling, Pain, and Trismus After Surgical Removal of Impacted Lower Third Molars
Dani Mihir Tusharbhai, Mohan Baliga, Aananya Mishra
Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Mangalore Manipal Academy of Higher Education, Manipal, India
|Date of Submission||22-Jul-2020|
|Date of Acceptance||11-Dec-2020|
|Date of Web Publication||16-Feb-2021|
Dr. Dani Mihir Tusharbhai
Department of Oral and Maxillofacial Surgery, Manipal College of Dental Sciences, Mangalore Manipal Academy of Higher Education, Manipal
Source of Support: None, Conflict of Interest: None
Introduction: Although extraction of an impacted lower third molar is a routine procedure, postoperative morbidities typically include swelling, pain, and trismus that increase patient suffering postoperatively. The appliance of Kinesio tape (KT) improves the blood and lymph flow, removing congestions of lymphatic fluid and hemorrhages. The aim of the present study was to evaluate the efficacy of the application of KT on postoperative swelling, trismus, and pain thereby improving the patient condition and well-being. Materials and Methods: Thirty patients with surgical removal of third molars were enrolled and randomized into two treatment groups (with/without KT). The tape was applied immediately after surgery and removed on fifth postoperative day. Facial swelling was measured using a five-line measurement at six specific time points. Pain scores were assessed using a visual analog scale, and mouth opening ability was assessed by means of calipers. The data were analyzed and compared using an independent sample t test. Results: The application of KT significantly reduced postoperative swelling, pain, and trismus. Moreover, patients with KT showed a considerably lower morbidity rate. Conclusion: The application of KT is a self-effacing, less traumatic, economical approach, which is free from an adverse reaction and improves patients’ quality of life. Besides, it can be seen as an adjunct/alternative to steroids or supplementary medications.
Keywords: Kinesio tape, morbidity, pain, swelling, third molar, trismus
|How to cite this article:|
Tusharbhai DM, Baliga M, Mishra A. Versatility of Kinesio-Taping in Postoperative Swelling, Pain, and Trismus After Surgical Removal of Impacted Lower Third Molars. J Orofac Sci 2020;12:126-30
|How to cite this URL:|
Tusharbhai DM, Baliga M, Mishra A. Versatility of Kinesio-Taping in Postoperative Swelling, Pain, and Trismus After Surgical Removal of Impacted Lower Third Molars. J Orofac Sci [serial online] 2020 [cited 2021 May 8];12:126-30. Available from: https://www.jofs.in/text.asp?2020/12/2/126/309582
| Introduction|| |
Surgical removal of impacted lower third molar is among the most routine procedure being executed on a regular basis around the world that is commonly present with swelling, severe pain, and trismus, which in turn causes postoperative distress that adversely affects the patient’s condition of life. Numerous techniques have been tried and described to control the direct inflammatory reaction associated with surgery, including the closure techniques, use of a certain category of drugs like NSAID’s, various antibiotic regimen, and sometimes oral corticosteroids, proteolytic enzymes, intraoral use of laser, or several other therapeutic procedures like cryotherapy or manually drainage of lymph (MLD), among which no particular techniques proved sole effective.
In 1970, Dr Kenzo Kase developed a therapeutic elastic tape well known as Kinesio tape (KT) that have been applied to support damaged muscles and joints, thereby relieving discomfort. Application of KT is assumed to increase lymph and the blood course, it also helps to eliminate clogging of lymphatic fluid thereby aids in a reduction in swelling and discomfort postsurgery.,
The aim of our current study was to check the efficacy of Kinesiology tape on postoperative swelling, pain, and trismus after surgical removal of impacted third molars.
| Materials and Methods|| |
Ethical approval for this study (protocol No. 18022/IEC/MCODS/2018) was provided by the Institutional Ethical Committee of Manipal College of Dental Sciences, Mangalore, on 9 March, 2018. Thirty individuals in the age group of 18 to 40 years (mean age 29) who agreed to participate and signed the written informed consent were enrolled over a 12-month period, and randomly divided into two groups: K-tape group (KT) and no K-tape (no-KT) group. Inclusion criteria were 30 patients with the existence of maxillary and mandibular impacted third molars bilaterally (Pell and Gregory classification: maxilla/mandible class B and C) qualifying for the removal under general anesthesia. Exclusion criteria includes individuals below the age of 18 years, sensitivity to tape, pregnant or lactating women, known allergy to the drugs prescribed in the study, and unwillingness to shave facial hairs.
All surgical extraction of third molars was done under general anesthesia by the same team of surgeons performed in aseptic condition. Mean operation time ranging from 30 minutes to 1 hour. Prophylactic antibiotic (Amoxicillin/clavulanic acid 1.2 g) was administered 1 hour before the surgery. All patients received 1 g Paracetamol intraoperative and 400 mg Ibuprofen was used as a breakthrough analgesic, the kinesiology tapes were applied as the patient shifted to recovery room. No postoperative complications were encountered. All patients were discharged on the same day (daycare procedure).
Immediately after surgery skin was cleaned and three equal strips of KT were applied extending from the supraclavicular to the position of highest swelling. KT was placed along the direction of the lymphatic duct over the sub-mental, sub-mandibular, cervical, pre-auricular, and parotid lymph nodes [Figure 1]. All taping procedures were accomplished by the same operating surgeons. Removal of KT was done after the fifth postoperative day.
Measurements All measurements were made at six definite time intervals (D): Preoperative [D(-1)], immediately after surgical procedure [Baseline (D0)], on first postoperative day (D1), second postoperative day (D2), third (D3), and fifth (D5) postoperative day successively.
As mentioned in their earlier studies by Ristow et al.,, swelling was quantified with a five-line linear measurement using plastic scale [Figure 2] as follows: (Line 1) from the tragus of the ear to point on commissure of lip; (Line 2) from the tragus of the ear to the pogonion; (Line 3) from the tragus of the ear to lateral canthus of the eye on either side;(Line 4) from lateral canthus of the eye to the inferior point on the angle of the mandible; (Line 5) most inferior point on angle of the mandible to middle of the nasal bone.
The pain level were measured using a 10-level Visual Analogue Scale (VAS), where 0 represents no pain, whereas 5 indicates moderate pain, and 10 is for worst pain. Maximum inter-incisal distance (IID) was calculated with calipers [Figure 3].
Statistical analysis was done using IBM SPSS software (Version 20.0). The data were analyzed between two groups and were compared using an independent sample t test. The overall significance level was set to 5%. Results were evaluated as mean ± standard deviation. The results for both observed sides (right and left) for each patient (n = 30, 60 observations) provided no different or additional information, it was not discussed in the manuscript. P value < 0.05 were measured as statistically significant.
| Results|| |
Thirty patients (15 in both group, with 14 males and 16 females) with the presence of impacted upper and lower third molars bilaterally (60 observation sides) were randomized and included in the study. [Table 1] depicts the demographics and clinical features at baseline. No statistically significant differences were observed with respect to age, gender, and baseline measures of pain, swelling, and trismus (P > 0.05).
Swelling was measured as mean sum of all five-line measurements (From Line 1 through Line 5) in each patient (in cm) at the six definite time intervals. No statistically significant difference was noticed pre-operatively (D(-1)) and directly after the operation at baseline measurement (D0) comparing KT group and no-KT group as shown in [Figure 4]. On comparison, the increase of swelling between baseline (D0) and D1, D2, and D3 after operation, showed a highly significant difference (P < 0.001) between the KT and the no-KT group. While comparing the KT and the no-KT group, the differences in the increase of swelling between D0 and D3 and between D0 and D5 were highly significant (P < 0.001). Although patients in the no-KT group showed an increase in swelling on the second postoperative day, those in the KT group had reduced swelling. Pain score was evaluated by means of a 10-level VAS. The mean of all VAS scores indicates no statistically significant difference (P > 0.05) preoperatively (D-1) and directly after the operation (D0) in both the groups. Although the mean sum of all VAS scores was low to moderate for all patients, patients in the KT group recorded significantly (P < 0.001) lower VAS values as compared to their no-KT counterparts as shown in [Figure 5]. No difference in mouth opening ability was seen at D-1 and at D0 (P > 0.05); but, a statistically significant difference was noticed in the mean mouth opening ability at D2, D3, and D5 in the KT group, in comparison to the no-KT group as shown in [Figure 6].
| Discussion|| |
Surgical removal of the impacted third molar is at times traumatic and often accompanied by postoperative swelling, trismus, and pain. Tissue reactions arise from the inflammatory response as an instant consequence of the surgical procedure. Various studies have been published in the past on the management of postoperative edema and still, no modality was optimally reliable to significantly avert the incidence of postsurgical complications. Henceforth, newer modalities are required to relieve the postoperative discomfort. KT, an alternate taping method, has been hypothesized to have several functions ranging from supporting weakened muscles hence improving muscle activity, decreasing congestion thereby facilitating blood flow and lymphatic drainage to local tissues, reducing pain by stimulating the neurological system, and alleviating muscle spasm. It also helps in elating the skin and directing collected fluids to pass from higher density to lower density spaces, thereby assisting in the management of lymphedema, which is beneficial postoperatively. KT is unique in comparison to other tapes because the elasticity bears elongation up to 130% to 140% of its original length and it is about the same thickness and weight of underlying skin.
Therefore, this study was aimed to measure the efficacy of KT on postoperative pain, facial swelling, and trismus. The increase in swelling was considerably lesser for the KT group as compared to no-KT group. Moreover, the decrease in swelling was even more rapid in the KT group. The application of KT applies pressure or stretches the underlying skin that stimulates cutaneous mechanoreceptors, which causes physiological changes in the taped area, like an increase in blood flow and lymphatic fluids, thereby creating an interstitial space between the skin and the underlying connective tissue.
Application of K-tape also had implication on the reduction of postoperative pain. It decreases pain by pressure reduction on nociceptors., The result of this study showed, moderate to less pain in the KT group in comparison to the no-KT group (VAS < 5).
Our study also evaluated postoperative mouth opening ability that increases significantly faster and sooner in the KT group and the overall patient had less discomfort. No cases of severe allergic reaction were reported after the application of KT. Hence, the overall results of this study indicated that the application of KT considerably lowered the prevalence of swelling in the first 2 days postsurgery. Also, the application of KT has a substantial impact on pain level and mouth opening.
| Conclusion|| |
Thus, the present study concludes that KT application significantly reduces tissue reaction and the degree of edema after surgical removal of lower third molars. Application of KT is beneficial in numerous injuries related to sports, complications after surgery, and also in reducing pain associated with various conditions. The usage of unconventional methods, such as KT in recent times has emerged as a feasible alternative. Its application is self-effacing, less traumatic, economical, and free from adverse consequences and aids in recovery following surgical lower third molar removal, hence the usage of KT appears promising and thus should be studied further with regard to appropriate technique and usefulness. Besides, it can be seen as an adjunct/alternative to steroids or supplementary medicines.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Colorado-Bonnin M, Valmaseda-Castellón E, Berini-Aytés L, Gay-Escoda C. Quality of life following lower third molar removal. Int J Oral Maxillofac Surg 2006;35:343-7.
Pasqualini D, Cocero N, Castella A, Mela L, Bracco P. Primary and secondary closure of the surgical wound after removal of impacted mandibular third molars: a comparative study. Int J Oral Maxillofac Surg. 2005;34:52-57.
Sortino F, Cicciù M. Strategies used to inhibit postoperative swelling following removal of impacted lower third molar. Dental Res J (Isfahan) 2011;8:162-71. doi: 10.4103/1735-3327.86031.
Carrillo JS, Calatayud J, Manso FJ, Barberia E, Martinez JM, Donado M. A randomized double-blind clinical trial on the effectiveness of helium-neon laser in the prevention of pain, swelling and trismus after removal of impacted third molars. Int Dent J 1990;40:31-36.
Szolnoky G, Szendi-Horváth K, Seres L, Boda K, Kemény L. Manual lymph drainage efficiently reduces postoperative facial swelling and discomfort after removal of impacted third molars. Lymphology 2007;40:138-42.
Kinesio Taping Association, Kase K, Hashimoto T, Okane T. Kinesio taping perfect manual: amazing taping therapy to eliminate pain and muscle disorders. Kenʼi-Kai Information; 1996.
Kase K, Wallis J, Kase T. Clinical therapeutic applications of the Kinesio Taping Method. 2nd edn. Tokyo: Ken'i-kai Information, 2003.
Garcı́a AG, Sampedro FG, Rey JG, Vila PG, Martin MS. Pell-Gregory classification is unreliable as a predictor of difficulty in extracting impacted lower third molars. Br J Oral Maxillofac Surg 2000;38:585-7.
Ristow O, Pautke C, Kehl V et al.
Influence of kinesiologic tape on postoperative swelling, pain and trismus after zygomatico-orbital fractures. J Cranio-Maxillofac Surg 2014;42:469-76.
Ristow O, Hohlweg-Majert B, Stürzenbaum SR et al.
Therapeutic elastic tape reduces morbidity after wisdom teeth removal—a clinical trial. Clin Oral Invest 2014;18:1205-12.
Ristow O, Hohlweg-Majert B, Kehl V, Koerdt S, Hahnefeld L, Pautke C. Does elastic therapeutic tape reduce postoperative swelling, pain, and trismus after open reduction and internal fixation of mandibular fractures? J Oral Maxillofac Surg 2013;71:1387-96.
McGrath C, Comfort MB, Lo EC, Luo Y. Changes in life quality following third molar surgery-the immediate postoperative period. Brit Dent J 2003;194:265-8.
Rana M, Gellrich NC, Ghassemi A, Gerressen M, Riediger D, Modabber A. Three-dimensional evaluation of postoperative swelling after third molar surgery using 2 different cooling therapy methods: a randomized observer-blind prospective study. J Oral Maxillofac Surg 2011;69:2092-8.
Williams S, Whatman C, Hume PA, Sheerin K. Kinesio taping in treatment and prevention of sports injuries. Sports Med 2012;42:153-64.
Stockheimer KR. Kinesio taping and lymphoedema. Adv Heal 2006;3:22-23.
Yoshida A, Kahanov L. The effect of kinesio taping on lower trunk range of motions. Res Sports Med 2007;15:103-12.
Sijmonsma J, Trompert R, van der Veen T. Lymph taping: theory, technique, practice. Fysionair VOF, Oost. 2010. 1-44.
Thelen MD, Dauber JA, Stoneman PD. The clinical efficacy of kinesio tape for shoulder pain: a randomized, double-blinded, clinical trial. J Orthop Sports Phys Ther 2008;38:389-95.
Kase K. Until today from birth of Kinesio taping method. Albuquerque, NM: KMS, LLC. 2001: p. 7-30.
[Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]