ABSTRACT
AIM: To compare the acute effects of a standardized physiotherapy protocol versus a typical non-standardized physiotherapy protocol on pain and performance of patients undergoing alveolar bone graft (ABG). METHOD: Sixteen patients (9 males; 12 [11-13] years) with cleft lip and palate undergoing ABG were allocated into two groups: (1) experimental group--EG (standardized physiotherapy protocol); and (2) control group--CG (typical, non-standardized physiotherapy treatment). Range of motion, muscle strength, gait speed, and pain level were assessed prior to surgical intervention (PRE), as well as on the first, second, and third post-operative days (1st, 2nd, and 3rd PO, respectively). RESULTS: Recovery with respect to range of motion of hip flexion was more pronounced in the EG (64.6 ± 11.0°) in comparison to the CG (48.5 ± 17.7° on the 3rd PO; p < 0.05). In addition, less pain was observed in the EG (0 [0-0.2] versus 2 [0.7-3] in the CG on the 3rd PO; p < 0.05). CONCLUSION: A standardized physiotherapy protocol appears to be better than a non-standardized physiotherapy protocol for acute improvement of range of motion of hip flexion and for reducing pain in patients undergoing ABG.
Subject(s)
Alveolar Bone Grafting/adverse effects , Cleft Lip/surgery , Cleft Palate/surgery , Ilium/surgery , Pain, Postoperative/therapy , Physical Therapy Modalities , Tissue and Organ Harvesting/adverse effects , Adolescent , Alveolar Bone Grafting/methods , Biomechanical Phenomena , Brazil , Child , Cleft Lip/diagnosis , Cleft Lip/physiopathology , Cleft Palate/diagnosis , Cleft Palate/physiopathology , Female , Gait , Hip Joint/physiopathology , Humans , Ilium/physiopathology , Male , Muscle Strength , Pain Measurement , Pain, Postoperative/diagnosis , Pain, Postoperative/etiology , Pain, Postoperative/physiopathology , Pilot Projects , Prospective Studies , Range of Motion, Articular , Recovery of Function , Time Factors , Tissue and Organ Harvesting/methods , Treatment OutcomeABSTRACT
Objective: To determine the effectiveness of standardized manual lymphatic drainage in reducing facial edema, interincisal distance and pain after alveolar bone grafting surgery in patients with cleft lip and palate.Methods: In this randomized open controlled parallel trial, 51 patients with cleft lip and palate submitted to after alveolar bone grafting were randomlydivided into two groups: 1) routine group (n=22): manual lymphatic drainage performed by the patient, pumping and sliding maneuvers, for10 minutes, 3 times/day, on the operated hemiface, and, 2) drainage group (n=29): manual lymphatic drainage performed by the physical therapist, pumping, sliding and stationary cycles maneuvers, for 30 minutes, on both sides of the face. Interincisal distance and lines formed between the nasal ala and tragus (L1) and between the nasal ala and inferior region of the ear (L2) were assessed on the operated hemiface, preoperatively, two (PO2) and four days postoperatively (PO4). Pain analog scale was applied on PO1, PO2, PO3 and PO4. Results: A significant reduction in facial edema from PO2 to PO4 was observed in drainage group (L1:11.50 to 11.38cm; L2:11.06 to 10.85cm) compared to routine group; interincisal distance increased significantly in both groups from PO2 to PO4 (routine group: 1.91 to 3.14cm; drainage group: 1.99 to 3.17cm, respectively). Drainage group patients reported absence of pain on PO3 while routine group patients only on PO4. Conclusion: The proposed manual lymphatic drainage procedure provided significant reduction in facial edema reduction, in pain, and interincisal distance increase, reinforcing the hypothesis that this technique was effective in accelerating the recovery of patients with cleft lip and palate undergoing alveolar bone grafting surgery. Brazilian Register of Clinical Trials: RBR-4z7cnh.
Objetivo: Determinar a eficácia da drenagem linfática manual na redução do edema facial, da distância interincisal e da dor após cirurgia de enxertoósseo alveolar em pacientes com fissura labiopalatina. Métodos: Estudo paralelo controlado randomizado aberto de 51 indivíduos com fissura labiopalatina, submetidos ao enxerto ósseo alveolar, divididos aleatoriamente em 2 grupos: 1) grupo rotina (n=22), realizada pelo paciente, utilizando manobras de bombeamento e deslizamento, por 10minutos, 3 vezes/dia, na hemiface operada, e, 2) grupo drenagem padronizada (n=29), realizada pelo fisioterapeuta, utilizando manobras debombeamento, deslizamento e círculos estacionários, por 30 minutos, nos dois lados da face. Distância interincisal e as linhas formadas pelaunião de pontos localizados na asa nasal e tragus (L1) e asa nasal e região inferior do ouvido (L2) foram aferidas na hemiface operada no préoperatório, nos pós-operatórios de dois (PO2) e quatro dias (PO4). Aplicou-se Escala Analógica de Dor nos PO1, PO2, PO3 e PO4.Resultados: Observou-se redução significativa do edema no grupo drenagem padronizada entre PO2 e PO4 (L1: 11,50 para 11,38cm; L2: 11,06 para 10,85cm) e aumento significativo na distância interincisal nos 2 grupos entre PO2 e PO4 (RG: 1,91 para 3,14cm; drenagem padronizada: 1,99 para 3,17cm, respectivamente). Ausência de dor foi relatada pelo grupo drenagem padronizada no PO3 e pelo grupo rotina no PO4.Conclusão: A drenagem linfática manual proposta reduziu significantemente o edema facial, a dor e aumentou a distância interincisal quando comparado ao grupo rotina, reforçando a hipótese que a técnica proposta acelerou a recuperação de pacientes com fissura labiopalatina submetidos à cirurgia de enxerto ósseo alveolar. Registro Brasileiro de Ensaios Clínicos: RBR-4z7cnh.
