Immediate versus Delayed Physiotherapy Protocol after the Management of Temporomandibular Joint Ankylosis by Conservative Gap Arthroplasty

Abstract

Objective: The aim of this study was to evaluate the effect of immediate and delayed physiotherapy protocol on the maximum interincisal opening (MIO), pain magnitude during physiotherapy, and rate of re-ankylosis, following the release of temporomandibular joint ankylosis (TMJa) by conservative gap arthroplasty. Subjects and methods: Twenty four patients with TMJa were treated with conservative gap arthroplasty. They were divided into two equal groups: In group 1, physiotherapy was started 24 hours after surgery. In group 2, physiotherapy was initiated after one week postoperative. MIO, pain magnitude by visual analogue scale (VAS), and rate of re-ankylosis were recorded. The values of MIO and VAS of both groups were compared by paired sample t-test. Results: Both groups showed significant improvement in MIO. At one week and one month postoperative, MIO showed significant difference between the two groups (P-value ≤ 0.05). At the remaining follow-up period, no significant difference was observed. By comparing the VAS of the two groups, it was significant only at the first day of physiotherapy and at two weeks (P-value ≤ 0.05). The rate of re-ankylosis was non-significant between the two groups. Conclusion: Maintenance of MIO is less dependent on the starting time of physiotherapy and more indebted to the patient cooperation with a regular physiotherapy protocol. The reduction in the VAS encourages the patients to perform more comfortable TMJ exercises.