Page 329 - Demo

Postoperative physiotherapy32712considered an additional analgesic tool to further aid a well-balanced schedule of pain medication, which promotes tissue healing and further decreases inflammation during the first phase.Although several studies(51–53) have reported good results using a CPM apparatus such as the TheraPacer (Denver, Co, USA), current up-to-date literature is lacking. Furthermore, current systematic reviews of the use of CPM after total knee arthroplasty are quite divided on the matter. A recent RCT by Lenssen et al.(54) stated that prolonged CPM can have a shortterm effect on the ROM, but that no beneficial long-term effects were found compared with physiotherapy alone.(54) A similar conclusion was stated in the meta-analysis by Milne et al.(55) As such, the authors cannot advise the use of CPM as a treatment modality, because of the cost versus limited benefit. Further research is needed for a sounder conclusion.Guarda-Nardini et al(56) and Sidebottom et al(57) found that the use of BTX-A in patients with masticatory muscle aches led to a significant improvement in pain and an increase in MMO and laterotrusion. Although both articles noted that further research is needed, the use of BTX-A on patients with myogenic complaints seemed relevant. As such, the use of BTX-A can be considered a postoperative treatment modality in patients with significant myogenic pain complaints. This was also clearly highlighted by Robiony(16), who used the muscle relaxant in 5 patients who were treated with TJR of the TMJ, yet showed rather poor postoperative results because of reactive muscle splinting of the masseter muscle. However, after administration of BTX-A, a significant increase in MMO was achieved, stressing the usefulness of BTX-A in a postoperative setting. However, because of the lack of research on the use of BTX-A for temporomandibular surgery, there is no clear consensus about what dosage should be used, resulting in dosages ranging between 25 and 150 units.(58) Further research is needed to provide a more standardized approach of BTX-A within TMJ surgery.Nikolas de Meurechy NW.indd 327 05-06-2024 10:15