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ORIGINAL ARTICLE
Year : 2020  |  Volume : 23  |  Issue : 9  |  Page : 1260-1265

The effect of kinesio taping with the web strip technique on pain, edema, and trismus after impacted mandibular third molar surgery


1 Ankara University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey
2 Ankara Yildirim Beyazit University, Faculty of Dentistry, Department of Oral and Maxillofacial Surgery, Ankara, Turkey

Date of Submission22-Jan-2020
Date of Acceptance07-Apr-2020
Date of Web Publication10-Sep-2020

Correspondence Address:
Dr. M E Yurttutan
Ankara Universitesi Dis Hekimligi Fakultesi, Besevler, 06500, Ankara
Turkey
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_23_20

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   Abstract 


Backgound: There are many methods used to alleviate edema, trismus, and pain after impacted third molar (3M) removal, one of which is Kinesio Taping (KT). Aims: This study aimed to evaluate the effectiveness of Kinesio Taping with Web Strip technique on postoperative morbidity after impacted mandibular 3M extraction. Methods: The study employed a split-mouth and controlled randomized clinical trial design. A total of 60 patients were scheduled for surgical extractions of bilateral lower 3Ms. They were randomly divided into two groups, and KT was applied to one group while the others was determined as a control group without KT application. Tape was applied directly after surgery and maintained for postoperative (post-op) 7 days. Pain intensity was recorded subjectively using a Visual Analogue Scale (VAS). Pain and analgesic usage were recorded on the post-op 1st, 2nd, 3rd, and 7th days. Trismus was evaluated before the surgery and on the post-op 2nd and 7th days. Facial edema was analyzed on the post-op 2nd and 7th days by VAS and by measuring the lengths of three lines using a flexible plastic tape measure. Results: VAS pain scores were statistically lower in the KT group on the post-op 1st, 3rd and 7th days. Total analgesic usage was also significantly lower in the KT group. On the post-op 2nd day, measurement of the lengths of three lines showed a statistically less edema in the KT group. Similar results were obtained from the measurement of edema using VAS. Maximum mouth opening was statistically higher in the KT group on the post-op 2nd and 7th day.
Conclusion: KT with the web strip technique should be considered more economic and less traumatic than other approaches, as it is free from systemic side effects and is a simple method to carry out to decrease morbidity.

Keywords: Edema, impacted third molar, kinesiologic tape, morbidity, pain


How to cite this article:
Yurttutan M E, Sancak K T. The effect of kinesio taping with the web strip technique on pain, edema, and trismus after impacted mandibular third molar surgery. Niger J Clin Pract 2020;23:1260-5

How to cite this URL:
Yurttutan M E, Sancak K T. The effect of kinesio taping with the web strip technique on pain, edema, and trismus after impacted mandibular third molar surgery. Niger J Clin Pract [serial online] 2020 [cited 2020 Sep 27];23:1260-5. Available from: http://www.njcponline.com/text.asp?2020/23/9/1260/294678




   Introduction Top


Extraction of an impacted third molar (3M) is one of the most common procedures in oral surgery.[1] Patients experience edema and pain as a result of the inflammatory response during the postoperative period and they affect their quality of life to varying degrees.[2],[3] Therefore, for many clinicians, a better control of pain, edema, and trismus is essential for patients after 3M surgery.[4],[5]

There are many methods to control edema and pain in maxillofacial surgery. However, there is a need for a method used to prevent the occurrence of these complications substantially, without possible undesirable side effects or significant costs.[5] Low-level laser therapy,[6] cryotherapy,[7] intraoperative Platelet Rich Fibrin (PRF) applications,[8] surgical drain placement,[9] including manual lymph drainage (MLD),[10] using drugs such as corticosteroids,[11],[12] and non-steroidal anti-inflammatory drugs[13] have been used in the control of postoperative morbidity in oral surgery.

Kinesiologic tape (KT) is a flexible, latex-free adhesive therapeutic tape, that can stretch up to 40-60% of its normal length. It was developed by Kenzo Kase in 1970.[14] The band is thin at the epidermis and is not affected by sensory stimuli.[15],[16] Tapes that maintain their elasticity for 3-7 days consist of polymer elastic fibers wrapped in 100% cotton fibers.[15] KT was first used in sports injuries as it reduces pain in muscles and joints. KT lifts the skin and guides fluids to move from higher pressure to lower pressure areas. The working mechanism of KT is based on the regulation of lymph and blood flow by reducing hemorrhage and congestion of the lymph flow.[15] Many clinical studies suggest that the use of kinesiotape is effective in the management of postoperative complications after head and neck surgery due to its benefits.[9],[17]

Also, kinesio taping has been investigated to control edema and pain in maxillofacial surgery, such as after mandibular fracture, mid-face fractures, and 3M extraction.[17],[18],[19] However, the research on the effect of kinesio taping after 3M extraction is limited.

The investigators hypothesized that the use of KT application with the web strip technique would provide successful outcomes for the improvement of postoperative patient comfort. The present study aimed to evaluate postoperative morbidity such as edema, pain and trismus after impacted mandibular 3M extraction with or without KT application.


   Methods Top


Study design

This study was designed as a split-mouth and controlled randomized clinical trial and included 60 patients who had indication to undergo bilateral symmetric 3M extraction under local anesthesia in the Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Ankara University. All the patients provided written informed consent before beginning the study, which was performed in accordance with the Declaration of Helsinki. The Ankara University Ethical Committee approved the research protocol (Protocol no: 36290600/71, 22-07-2016).

The inclusion criteria were an age of 18 to 35, the presence of bilateral, symmetric, impacted lower 3Ms (Pell and Gregory classification: class I-B and II-B[20]), no history of facial trauma, no other medical condition, non-smoking, no pericoronitis or pain before surgery and an operation time between 20 and 30 minutes.

Patients younger than 18, pregnant or lactating women, patients who are sensitive to tape adhesives, patients who did not want to shave their face, patients with any drug allergy, patients who had an operation time shorter than 20 minutes or longer than 30 minutes, and patients who showed inflammatory reactions after surgery were excluded from the study.

A total of 60 patients were included in this randomized, open-label prospective study for surgical extractions of bilateral lower 3Ms based on the inclusion criteria. The side of the mandible to be included in the KT group was determined by flipping coins. The KT was applied to the face at the end of the operation at the surgical site.

Surgical procedure

A single surgeon (MEY) performed the surgical procedure using local anesthesia in a maxillofacial surgery clinic under sterile conditions following the standard surgical protocol. Mucoperiosteal envelope flap was raised after local anesthesia for inferior alveolar nerve blockade and buccal local infiltration with articaine hydrochloride + epinephrine [1:100,000]. Osteotomy was performed using a round burr, and the tooth was sectioned (when required) with a fissure burr under constant irrigation with physiological saline. The tooth was removed with an elevator, and flap closure was performed with 3–0 silk suture (Doǧsan®, Turkey). Amoxicillin/clavulanic acid (1 g twice a day for 5 days) and paracetamol (500 mg, when needed) were prescribed postoperatively. The patients did not apply facial ice packs after extraction. All patients received routine postoperative instructions. The second surgery was scheduled for four weeks later.

Taping

The same certified K-Taping therapist (YE) performed all taping procedures. The tape was applied immediately after the surgical 3M removal. The skin was cleaned, shaved if necessary, and any residual moisture and oil were removed. The therapist used the skin-colored Kinesio Tex Gold Finger Print, 5 cm × 5 m (Kinesio Holding Corporation, NM, USA) for all tape applications.

KT was applied to the masseteric region, where the most severe edema was observed and where the measurements were performed. The therapist applied the web strip method, where the tape has solid ends and four longitudinal cuts through the center section [Figure 1]. Each strip was separated from the center and applied to the middle of the treatment area. The purpose of this application was to regulate lymph drainage by lifting the skin to reduce edema and pain.
Figure 1: Kinesiotape application of web strip

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The tape was gently rubbed to activate the medical grade acrylic adhesive, and it remained in place for 7 days. During the therapy, a change of tape was not necessary.

Measurements

A non-blinded independent investigator (KTS) collected the data. Pain intensity was recorded subjectively using a Visual Analogue Scale (VAS), where 0 indicated no pain, 5 indicated moderate pain, and 10 indicated the worst pain. Pain and analgesic usage were recorded on the postoperative (post-op) 1st, 2nd, 3rd, and 7th days. Trismus was evaluated by measuring the maximum mouth opening (MMO) between the incisal edges of the upper and lower central incisors using a caliper before the surgery and on the post-op 2nd and 7th days [Figure 2].
Figure 2: Inter-incisor distance was measured using a caliper

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The facial edema was analyzed using the VAS and by measuring the lengths of the following three lines using a flexible plastic tape measure on the post-op 2nd and 7th days [Figure 3].
Figure 3: Three-line measurement

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Line 1: The most posterior point of the tragus to the most lateral point of the lip commissure.

Line 2: The lateral canthus of the eye to the most inferior point angle of the mandible.

Line 3: The most inferior point angle of the mandible to the most lateral point of the lip commissure.

Statistical analysis

The data was analyzed using SPSS for Windows, version 20 (SPSS, Chicago, IL, USA). The results were presented in percentages, means, and standard deviations. Pvalues less than 0.05 were considered significant. Power analysis revealed a probability of less than 0.05 with a power of 95% for 60 patients in the study. The Pearson's Chi-squared test, dependent samples t-test, one-way repeated measures analysis of variance test (One-Way ANOVA), Mann Whitney-U test, and post-hoc Tukey test were used for statistical analysis. Bonferroni's correction was performed to check for type I errors in all possible multiple comparisons.


   Results Top


No patients reported any complications such as alveolar osteitis or surgical site infection, or any adverse effects related to KT during the treatment period. The study was completed with 60 patients aged between 18 and 32 (mean age = 24.66 ± 3.96). Of them, 27 were male (45%) and 33 were female (55%).

VAS pain scores were statistically lower in the KT group on the post-op 1st, 2nd, 3rd and 7th days (P < 0.00001) [Table 1].
Table 1: Mean VAS scores on the post-op 1st, 2nd, 3rd and 7th days

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Total analgesic usage (P < 0.00001) and analgesic usage were significantly lower in the KT group on the post-op 1st, 2nd, 3rd and 7th days (P < 0.00001, P = 0.00059, P = 0.00188, and P = 0.04679, respectively) [Table 2].
Table 2: The number of analgesic (paracetamol) tablets used on the post-op 1st, 2nd, 3rd and 7th days

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All edema measurements were presented as the mean of all three-line measurements (lines 1–3) for all patients (in centimeters) before the operation, on the post-op 2nd day, and on the post-op 7th day. In both groups, the edema level on the post-op 7th day was the same as the preoperative values, and the maximal edema was seen on the post-op 2nd day. Statistically less edema was observed in the KT group on the post-op 2nd and 7th days, (P < 0.00001) [Table 3].
Table 3: Mean scores of facial swelling (mm), VAS edema and Maximum Mouth Opening (MMA) in the pre-op period and on the post-op 2nd and 7th days

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Edema was also evaluated using the VAS on the post-op 2nd 7th days, and similar results were obtained from the three-line measurements (P < 0.00001 and P = 0.00216, respectively) [Table 3].

MMO was statistically higher in the KT group on the post-op 2nd and 7th days (P < 0.00001 and P = 0.00011, respectively) [Table 3].


   Discussion Top


KT has many different clinical applications, such as treatment of sports injuries, osteoarthritis, carpal tunnel syndrome, and reduction of lymphedema. Although extensive research on KT is available, new research on the maxillofacial region are recently increasing.[21] Ristow et al. investigated the efficacy of KT on zygomatico-orbital fractures and mandibular fractures.[18],[19] Tozzi et al. also mentioned the advantages of using KT after orthognathic surgery.[22] Keskinruzgar et al. observed less muscle pain and increased mouth opening in patients with sleep bruxism treated with KT.[23] KT, which is similar to epidermis, has recently gained popularity, as it regulates hemorrhage and lymph flow by lifting skin.[15],[24] Ristow et al. concluded in their pooled analysis that patients with KT group have lower morbidity than non-KT group.[5] This study examined the effects of KT with Web Strip technique on edema, MMO, and pain after 3M extraction.

3M removal is one of the procedures most commonly used in oral surgery. However, it causes edema, pain, and trismus in the postoperative period. Reduction of the postoperative morbidity after 3M removal is important both economically and in terms of patients' quality of life. The literature includes many studies on various methods to reduce postoperative edema and pain. Approaches such as low-level laser treatment, cryotherapy, use of PRF, use of drugs, MLD, and drains are suggested to control postoperative pain. Cryotherapy is a practical, inexpensive and easy method, and shows its effect through vasoconstriction. However, the effects of cryotherapy on edema are still controversial.[25],[26] Low-level laser treatment, one of the methods used to relieve postoperative edema and pain, has been found to effectively decrease postoperative complaints.[27] The literature includes many studies regarding the use of NSAIDs and corticosteroids to relieve edema and pain after 3M removal. In addition, alternative methods are now preferred due to drugs' side effects, allergic reactions to drugs, and concerns about elimination of drugs.

Szolonoky et al. showed that MLD can reduce postoperative edema and pain after 3M removal.[10] MLD improves lymph circulation, and its positive effects on edema and pain support the studies conducted on KT in the maxillofacial region. The mechanism of KT is that it creates a gap under the skin and guides the desired direction of the drainage of fluids from the high-pressure areas into the low-pressure areas.[15] With the clinical benefit of KT thanks to this mechanism, patients are expected to have less pain and edema postoperatively. However, further controlled published research is needed in the future.

The maximum edema occurs within 48-72 hours after surgery and may completely resolve within 5-7 days in a routine recovery procedure.[28] KT is considered to have its effect by raising the skin and regulating lymphatic circulation. Ristow et al.[17] evaluated the efficacy of KT on edema, pain, and mouth opening after 3M removal. They found that the maximum edema was observed more quickly in the KT group than in the no-KT group, and the KT group had less edema after 3M removal. In the present study, less edema was seen in the KT group than in the control group.

Patients' mouth-opening ability improved faster in the KT group than in the control group. This might be due to the rapid disappearance of edema. Ristow et al. found in two studies that the improvement in mouth opening was faster in the KT group.[5],[17]

Some researchers advocate that KT has a positive effect on pain as it reduces the pressure on nociceptors,[14],[17] while some studies support the opposite.[19],[22] Ulu et al. observed that less pain in their KT group compared to their no-KT group after surgically assisted rapid palatal expansion.[29] However, Tozzi et al. found that KT had no superiority in terms of reducing pain after orthognathic surgery.[22] In the present study, there was a significant difference between groups in terms of pain on the post-op 1st, 3rd, and 7th days.

Many methods are available to measure the changes in face volume such as photographs, ultrasound, and three-dimensional optical scanning.[9] Some methods do not yield exact results, while others are either expensive or complex.[18],[19] In this study, linear measurement was used to measure facial volume. Measurements were performed by one of the researchers to ensure a more consistent measurement variance.

Genc et al. and Ristow et al. placed the tape between the clavicle and the tragus-commissura line after impacted mandibular third molar surgery. The researchers used the web strip technique and taped only the masseter muscle, where the maximum edema occurs after 3M surgery. This means that they taped a smaller area compared to the previous studies.[9],[17] Thus, the aesthetic disadvantage was minimized and the possibility of irritation exposure was reduced to a smaller skin area. In the present study, there was no allergic reactions due to the adhesives in the band, and no adverse effects were observed.

The present study had some limitations. Firstly, no flat tape was used in the control group as it might have caused a placebo effect. Secondly, a no-blind design was used since there was no placebo group. It may even be considered that the decrease in morbidity in KT application is caused by the placebo effect. The results obtained from the VAS may be affected, but placebo cannot affect the edema and trismus data measured by objective evaluations.

The postoperative period affects patients' social and working life. Reducing or eliminating the negative effects during this period both provides financial gain and increases the quality of life.[30] Although many methods are available to reduce postoperative morbidity, there is no single and accurate way, and each method has its advantages and disadvantages. KT with the web strip technique should be considered as a more economic, less traumatic way of avoiding postoperative morbidity, as it is a simple method free from systemic side effects.

Acknowledgements

The authors thank PT. Yasin Ekinci for the application of Kinesio Taping.

Ethical statement

The study was approved by the Ethical Committee of the Ankara University, Ankara, Turkey.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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