Abstract

Üçüncü molar diş çekiminden sonra ağrı, ödem ve daha nadir olarak enfeksiyon ve trismus görülebilir. Bu komplikasyonların riski kanser, diyabet ve HIV gibi immünosupresif durumları olan hastalarda artmaktadır. Bu vaka çalışmasının amacı, üçüncü molar diş çekimi sonrasında enfeksiyon, kalıcı ödem ve trismus gelişen metastatik meme kanserli bir hastayı ve manuel tedavinin etkisini rapor etmekti. Metastatik meme kanseri olan ve tip II diyabet öyküsü bulunan 60 yaşındaki hastada, kanser tanısı konulduktan sonraki 2. haftada 3 molar dişin cerrahi olarak çekilmesinden sonra sol mandibular ve derin boyun enfeksiyonu, ödem ve trismus gelişmiştir. Hasta, enfeksiyonun kaybolmasına ve ödem seviyesinin azalmasına rağmen ameliyat sonrası 85. günde ağrı, sert ödem ve trismus ile başvurdu. Hastaya, sınırlı ağız açma mesafesini artırmak için 6 haftalık manuel terapi ve ev egzersiz programı uygulandı. Bu tedaviden sonra ağrı, ödem, trismus, kraniyodasiyal ağrıya bağlı sakatlık ve mandibular disfonksiyon düzeyinde önemli iyileşmeler kaydedilmiştir. Belirli hasta gruplarında, molar cerrahi sonrası temporomandibular bölgede kalıcı ödem ve trismus gibi komplikasyonlar için manuel terapi temelli fizyoterapi etkili bir yaklaşım olarak düşünülebilir.

Keywords

• Trismus
• Fasyal ödem
• Temporomandibular bozukluk
• Fizyoterapi
• Manuel terapi

THE EFFECTS OF MANUAL THERAPY AND HOME EXERCISE IN A CANCER PATIENT WITH COMPLICATIONS AFTER THIRD MOLAR EXTRACTION: CASE REPORT

Abstract

Pain, oedema, and, more rarely, infection and trismus may occur after third molar extraction. The risk of these complications increases in patients with immunosuppressive conditions such as cancer, diabetes, and HIV.The aim of this case study was to report a patient with metastatic breast cancer who developed infection, persistent oedema and trismus following extraction of the third molar and the effect of manual therapy. A 60-year-old patient with a history of type II diabetes with metastatic breast cancer developed left mandibular and deep neck infection, oedema, and trismus after surgical extraction of 3 molars in the 2nd week after the diagnosis of cancer. The patient presented with pain, hard oedema, and trismus on the 85th postoperative day, although the infection had disappeared and the oedema level had decreasedThe patient underwent a 6-week manual therapy and home exercise programme to increase the limited mouth opening distance. After this treatment, significant improvements were noted in the level of pain, oedema, trismus, disability due to craniodacial pain, and mandibular dysfunction. In specific patient groups, manual therapy-based physiotherapy can be considered an effective approach for complications such as persistent oedema and trismus in the temporomandibular region after molar surgery.

Keywords

• Trismus
• Facial edema
• Temporomandibular disorder
• Physiotherapy
• Manual therapy

References

1. 1. Peterson LJ. Contemporary oral and maxillofacial surgery. (No Title). 2003.
2. 2. Zhang Y, Zhuang P, Jia B, Xu J, Cui Q, Nie L, et al. Persistent trismus following mandibular third molar extraction and its management: A case report and literature review. World Academy of Sciences Journal. 2021;3(1):1-.
3. 3. Osborn TP, Frederickson G, Jr., Small IA, Torgerson TS. A prospective study of complications related to mandibular third molar surgery. J Oral Maxillofac Surg. 1985;43(10):767-9.
4. 4. Goldberg MH, Nemarich AN, Marco WP, 2nd. Complications after mandibular third molar surgery: a statistical analysis of 500 consecutive procedures in private practice. J Am Dent Assoc. 1985;111(2):277-9.
5. 5. De Menezes SA, Cury PR. Efficacy of nimesulide versus meloxicam in the control of pain, swelling and trismus following extraction of impacted lower third molar. Int J Oral Maxillofac Surg. 2010;39(6):580-4.
6. 6. Dijkstra PU, de Bont LG, Stegenga B, Boering G. Angle of mouth opening measurement: reliability of a technique for temporomandibular joint mobility assessment. J Oral Rehabil. 1995;22(4):263-8.
7. 7. Schultze-Mosgau S, Schmelzeisen R, Frolich JC, Schmele H. Use of ibuprofen and methylprednisolone for the prevention of pain and swelling after removal of impacted third molars. J Oral Maxillofac Surg. 1995;53(1):2-7; discussion -8.
8. 8. Gabka J, Matsumura T. [Measuring techniques and clinical testing of an anti-inflammatory agent (tantum)]. Munch Med Wochenschr. 1971;113(6):198-203.

9. 9. Arikan H, Citaker S, Ucok C. Cross-cultural adaptation, reliability, and validity of the Turkish version of the Craniofacial Pain and Disability Inventory (CF-PDI/T) for individuals with temporomandibular disorders. Disabil Rehabil. 2023;45(3):523-33.
10. 10. Kılınç HE, Çelik Hİ, Ünver B, Hocaoğlu TP. Further Validity and Reliability of Turkish Version of the Mandibular Functional Impairment Questionnaire in Patients with Temporomandibular Dysfunction. Journal of Basic and Clinical Health Sciences. 2022;7(1):214-22.
11. 11. Stegenga B, de Bont LG, de Leeuw R, Boering G. Assessment of mandibular function impairment associated with temporomandibular joint osteoarthrosis and internal derangement. J Orofac Pain. 1993;7(2):183-95.
12. 12. Yildiz NT, Alkan A, Kulunkoglu BA. Validity and Reliability of the Turkish Version of Mandibular Function Impairment Questionnaire. Cranio. 2024;42(2):160-70.
13. 13. Hong CH, Napenas JJ, Hodgson BD, Stokman MA, Mathers-Stauffer V, Elting LS, et al. A systematic review of dental disease in patients undergoing cancer therapy. Support Care Cancer. 2010;18(8):1007-21.
14. 14. Peterson LJ. Rationale for removing impacted teeth: when to extract or not to extract. J Am Dent Assoc. 1992;123(7):198-204.
15. 15. Hinds EC, Frey KF. Hazards of retained third molars in older persons: report of 15 cases. J Am Dent Assoc. 1980;101(2):246-50.
16. 16. Tai CC, Precious DS, Wood RE. Prophylactic extraction of third molars in cancer patients. Oral Surg Oral Med Oral Pathol. 1994;78(2):151-5.
17. 17. Fisher SE, Frame JW, Rout PG, McEntegart DJ. Factors affecting the onset and severity of pain following the surgical removal of unilateral impacted mandibular third molar teeth. Br Dent J. 1988;164(11):351-4.
18. 18. Nurmikko TJ, Eldridge PR. Trigeminal neuralgia--pathophysiology, diagnosis and current treatment. Br J Anaesth. 2001;87(1):117-32.
19. 19. Benoliel R, Zadik Y, Eliav E, Sharav Y. Peripheral painful traumatic trigeminal neuropathy: clinical features in 91 cases and proposal of novel diagnostic criteria. J Orofac Pain. 2012;26(1):49-58.
20. 20. Tsuda K, Takahira N, Sakamoto M, Shinkai A, Kaji K, Kitagawa J. Intense Triceps Surae Contraction Increases Lower Extremity Venous Blood Flow. Prog Rehabil Med. 2017;2:20170009.
21. 21. Gianesini S, Tessari M, Bacciglieri P, Malagoni AM, Menegatti E, Occhionorelli S, et al. A specifically designed aquatic exercise protocol to reduce chronic lower limb edema. Phlebology. 2017;32(9):594-600.
22. 22. Mortimer P. Therapy approaches for lymphedema. Angiology. 1997;48(1):87-91.