The application of ice to the site of an injury to reduce local oedema and pain (cryotherapy) is widely used in orthopaedic injuries and sports medicine. Hilotherapy, which delivers cooled water through a contoured face mask to the site of pathological or surgical injury, provides a potential alternative that may reduce the risks of cryotherapy such as iatrogenic cold injury, patient-reported discomfort, and reduced compliance. The aim of this review was to assess the effects of hilotherapy following oral and maxillofacial surgery.
Methods
Searches were conducted in the Medline/PubMed, Embase, CINHAL, CAB Abstracts, The Cochrane Library and Google Scholar databases. Two reviewers independently selected studies. English language papers that include patients using hilotherapy after oral and maxillofacial surgery were considered. Postoperative pain, facial oedema, trismus, neurological scores, and patient-reported outcome were recorded and meta-analysis conducted.
Results
- 5 studies involving a total of 206 patients were included.
- Average age of patients age was 29.4 years.
- Follow up period for all studies was 10 days.
- Postoperative pain was reduced by hilotherapy on:-
- day 2 SMD = 2.43(95% CI; 4.10 to 0.77: P = 0.004) and
- day 4, SMD= 1.33(95% CI; 2.64 to 0.02: P = 0.046)
- Postoperative facial oedema was reduced by hilotherapy on
- day 2, SMD =1.74 (95% CI; 2.49 to 1.00: P < 0.001) and
- day 3 SMD = 2.08 (95% CI; 3.40 to 0.76, P = 0.002).
- Postoperative neurological scores were improved by hilotherapy, with SMD = 0.76 (95% CI; 1.19 to 0.32: P < 0.001).
- Patient-reported satisfaction with the cooling intervention undergone was in favour of hilotherapy.
Conclusions
The authors concluded:
the present analysis suggests hilotherapy might provide patients with a significant reduction in postoperative facial pain and oedema. Outcomes for trismus, neurological score, and patient- reported satisfaction were also found to be beneficial in comparison to conventional ice-cooling therapy.
Comments
A wide range of databases were searched for this review although the restricting the inclusion criteria to those published in English may have resulted in eliminating some relevant studies. 5 studies were included in the review and all were randomised; however this, a number of quality concerns were raised by the review authors and none of the included studies had performed a power calculation. The available studies did suggests some small benefit from hilotherapy but it is worth noting that a 2012 Cochrane review by Adie et al of cryotherapy for total knee replacement surgery concluded:-
Potential benefits of cryotherapy on blood loss, postoperative pain, and range of motion may be too small to justify its use, and the quality of the evidence was very low or low for all main outcomes. This needs to be balanced against potential inconveniences and expenses of using cryotherapy. Well-designed randomised trials are required to improve the quality of the evidence.
And another Cochrane review by Bleakley et al of cold-water immersion for preventing and treating muscle soreness after exercise was able to find some evidence,
that cold-water immersion reduces delayed onset muscle soreness after exercise compared with passive interventions involving rest or no intervention’
While there reviews do not involve the head an neck and are both limited by the quality of the evidence and clearly more high quality research is clearly need to clarify whether any benefit accrues from hilotherapy.
Links
Bates AS, Knepil GJ. Systematic review and meta-analysis of the efficacy of hilotherapy following oral and maxillofacial surgery. Int J Oral Maxillofac Surg. 2015 Sep 8. pii: S0901-5027(15)01295-3. doi: 10.1016/j.ijom.2015.08.983. [Epub ahead of print] PubMed PMID: 26362489.
Adie S, Kwan A, Naylor JM, Harris IA, Mittal R. Cryotherapy following total knee replacement. Cochrane Database of Systematic Reviews 2012, Issue 9. Art. No.: CD007911. DOI: 10.1002/14651858.CD007911.pub2.
Bleakley C, McDonough S, Gardner E, Baxter GD, Hopkins JT, Davison GW. Cold-water immersion (cryotherapy) for preventing and treating muscle soreness after exercise. Cochrane Database of Systematic Reviews 2012, Issue 2. Art. No.: CD008262. DOI: 10.1002/14651858.CD008262.pub2.
