Rehabilitation strategies in maxillofacial trauma: systematic review and meta-analysis

  • Karoline Weber dos SantosEmail author
  • Rafaela Soares Rech
  • Eliana Márcia Da Ros Wendland
  • Juliana Balbinot Hilgert
Review Article



This study aims to investigate rehabilitation strategies to reduce trismus, pain, and edema in patients with maxillofacial trauma.


An electronic search in main databases was performed, including studies published until November 2017. Clinical trials aiming to investigate therapeutic techniques to improve mandibular range of motion and to reduce pain and edema compared to other treatments were included.


Nine studies were included in the review with different therapy modalities: photobiomodulation, kinesiologic tape, hilotherapy, jaw exercises, and TENS. Only five studies had available data to be included in a meta-analysis. There were no differences between any of the proposed strategies and its controls to prevent trismus. Individuals treated with hilotherapy presented less pain compared to controls. Kinesiologic tape or hilotherapy reduced edema when compared to controls daily until postoperative day 3.


There is diversity among the proposed rehabilitation techniques, and types of fractures and there are few numbers of included participants in each study. The results obtained in this review do not promote evidence to guide the use of non-drug rehabilitation techniques in patients with maxillofacial trauma after surgical intervention.


Edema Maxillofacial injuries Oral rehabilitation Pain Trismus 



Juliana Balbinot Hilgert thanks CNPq (Brazilian National Research Council) for her productivity grant.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

10006_2019_808_MOESM1_ESM.docx (12 kb)
ESM 1 (DOCX 8 kb).


  1. 1.
    Melione LPR, Mello-Jorge MHP (2008) Unified National Health System costs in São José dos Campos, São Paulo State, Brazil, for hospital admissions due to external causes. Cad Saúde Pública 24(8):1814–1824. CrossRefPubMedGoogle Scholar
  2. 2.
    Mijiti A, Ling W, Tuerdi M, Maimaiti A, Tuerxun J, Tao YZ, Saimaiti A, Moming A (2014) Epidemiological analysis of maxillofacial fractures treated at a university hospital, Xinjiang, China: A 5-year retrospective study. J Craniomaxillofac Surg 42(3):227–233. CrossRefPubMedGoogle Scholar
  3. 3.
    Ellis E 3rd. (2014) An algorithm for the treatment of noncondylar mandibular fractures. J Oral Maxillofac Surg 72(5):939–949. CrossRefPubMedGoogle Scholar
  4. 4.
    Choi KY, Yang JD, Chung HY, Cho BC (2012) Current concepts in the mandibular condyle fracture management part II: open reduction versus closed reduction. Arch Plast Surg 39(4):301–308. CrossRefPubMedPubMedCentralGoogle Scholar
  5. 5.
    Ellis E 3rd. (2009) Management of fractures through the angle of the mandible. Oral Maxillofac Surg Clin North Am 21(2):163–174. CrossRefPubMedGoogle Scholar
  6. 6.
    Jensen T, Jensen J, Nørholt SE, Dahl M, Lenk-Hansen L, Svensson P (2006) Open reduction and rigid internal fixation of mandibular condylar fractures by an intraoral approach: a long-term follow-up study of 15 patients. J Oral Maxillofac Surg 64(12):1771–1779. CrossRefPubMedGoogle Scholar
  7. 7.
    Silva AP, Sassi FC, Andrade CRF (2016) Oral-motor and electromyographic characterization of patients submitted to open and closed reductions of mandibular condyle fracture. Codas 28(5):558–566. CrossRefPubMedGoogle Scholar
  8. 8.
    Gasperini G, Rodrigues de Siqueira IC, Rezende Costa L (2014) Does low-level laser therapy decrease swelling and pain resulting from orthognathic surgery? Int J Oral Maxillofac Surg 43(7):868–873. CrossRefPubMedGoogle Scholar
  9. 9.
    Vega LG (2011) Reoperative mandibular trauma: management of posttraumatic mandibular deformities. Oral Maxillofac Surg Clin North Am 23:47–61. CrossRefPubMedGoogle Scholar
  10. 10.
    Seifi M, Ebadifar A, Kabiri S, Badiee MR, Abdolazimi Z, Amdjadi P (2017) Comparative effectiveness of low level laser therapy and transcutaneous electric nerve stimulation on temporomandibular joint disorders. J Lasers Med Sci 8(Suppl 1):S27–S31. CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Flay BR (1986) Efficacy and effectiveness trials (and other phases of research) in the development of health promotion programs. Prev Med 15(5):451–474. CrossRefPubMedGoogle Scholar
  12. 12.
    Higgins JPT, Green S, eds. Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration, 2011 [on-line]. Available at
  13. 13.
    Lauriti L, de Cerqueira Luz JG, Agnelli Mesquita-Ferrari R, Fernandes KPS, Deana AM, Tempestini Horliana ACR, Costa-Santos L, Brugnera Junior A, Bussadori SK (2018) Evaluation of the effect of phototherapy in patients with mandibular fracture on mandibular dynamics, pain, edema, and bite force: a pilot study. Photomed Laser Surg 36(1):24–30. CrossRefPubMedGoogle Scholar
  14. 14.
    Ristow O, Pautke C, Victoria K, Koerdt S, Schwärzler K, Hahnefeld L, Hohlweg-Majert B (2014) Influence of kinesiologic tape on postoperative swelling, pain and trismus after zygomatico-orbital fractures. J Craniomaxillofac Surg 42(5):469–476. CrossRefPubMedGoogle Scholar
  15. 15.
    Modabber A, Rana M, Ghassemi A, Gerressen M, Gellrich NC, Hölzle F, Rana M (2013) Three-dimensional evaluation of postoperative swelling in treatment of zygomatic bone fractures using two different cooling therapy methods: a randomized, observer-blind, prospective study. Trials 14:238. CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Ristow O, Hohlweg-Majert B, Kehl V, Koerdt S, Hahnefeld L, Pautke C (2013) Does elastic therapeutic tape reduce postoperative swelling, pain, and trismus after open reduction and internal fixation of mandibular fractures? J Oral Maxillofac Surg 71(8):1387–1396. CrossRefPubMedGoogle Scholar
  17. 17.
    Rana M, Gellrich NC, von See C, Weiskopf C, Gerressen M, Ghassemi A, Modabber A (2013) 3D evaluation of postoperative swelling in treatment of bilateral mandibular fractures using 2 different cooling therapy methods: a randomized observer blind prospective study. J Craniomaxillofac Surg 41(1):e17–e23. CrossRefPubMedGoogle Scholar
  18. 18.
    Feng Z, Chen R, Zhang Y, Yang M, Lin Y, Tian W, Liu LJ (2009) Outcome of postsurgical sequential functional exercise of jaw fracture. Craniofac Surg 20(1):46–48. CrossRefGoogle Scholar
  19. 19.
    Fagade OO, Oginni FO, Obilade TO (2005) Comparative study of the therapeutic effect of a systemic analgesic and transcutaneous electrical nerve stimulation (TENS) on post-IMF trismus and pain in Nigerian patients. Niger Postgrad Med J 12(2):97–101PubMedGoogle Scholar
  20. 20.
    Ferraresi C, Hamblin MR, Parizotto NA (2012) Low-level laser (light) therapy (LLLT) on muscle tissue: performance, fatigue and repair benefited by the power of light. Photonics Lasers Med 1(4):267–286. CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Aras MH, Güngörmüş M (2010) Placebo-controlled randomized clinical trial of the effect two different low-level laser therapies (LLLT)--intraoral and extraoral--on trismus and facial swelling following surgical extraction of the lower third molar. Lasers Med Sci 25(5):641–645. CrossRefPubMedGoogle Scholar
  22. 22.
    Santos MT, Diniz MB, Gouw-Soares SC, Lopes-Martins RA, Frigo L, Baeder FM (2016) Evaluation of low-level laser therapy in the treatment of masticatory muscles spasticity in children with cerebral palsy. J Biomed Opt 21(2):28001. CrossRefPubMedGoogle Scholar
  23. 23.
    Machado BC, Mazzetto MO, Da Silva MA, de Felício CM (2016) Effects of oral motor exercises and laser therapy on chronic temporomandibular disorders: a randomized study with follow-up. Lasers Med Sci 31(5):945–954. CrossRefPubMedGoogle Scholar
  24. 24.
    Marchionni AM, Medrado AP, Silva TM, Fracassi LD, Pinheiro AL, Reis SR (2010) Influence of laser (λ670 nm) and dexamethasone on the chronology of cutaneous repair. Photomed Laser Surg. 28(5):639–646. CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Faculty of DentistryFederal University of Rio Grande do Sul (UFRGS)Porto AlegreBrazil
  2. 2.Public Health DepartmentFederal University of Health Sciences of Porto Alegre (UFCSPA)Porto AlegreBrazil

Personalised recommendations