Transcutaneous electrical nerve stimulation versus virtual reality on temporomandibular disorder following maxillofacial surgery
DOI:
https://doi.org/10.47197/retos.v77.118506Keywords:
TENS, virtual reality (VR), manual therapy, maxillofacial oral surgery, temporomandibular joint disorders (TMJD)Abstract
Introduction: Temporomandibular disorder is very common postoperative complication following oral surgery. It is including several symptoms as pain, oedema, ROM restrictions and trismus.
Objective: The study compared the effect of TENS and virtual reality on temporomandibular disorder following maxillofacial surgery.
Methodology: Sixty patients (male and female) with ages ranged from 30-45 years with temporomandibular joint disorders post maxillofacial surgery randomized into two equivalent groups. Group A was given TENS in addition to traditional physiotherapy program which include (mobilizing exercises, ROM exercises, isometric contraction exercises, and massage) 3 times a week for four weeks, while Group B was given virtual reality plus the traditional physiotherapy program, 3 times a week for four weeks. Assessment of pain was done through a visual analogue scale (VAS) while maximum mouth opening (MMO) was determined in millimetres using a ruler at baseline and following the treatment program.
Results: The comparison between the two groups posttreatment exposed a significant improvement in both VAS and MMO for Group A while Group B showed significant improvements in (MMO) and non-significant pain reduction (p < 0.001).
Discussion: Findings from studies, including those by Carrougher, G., have provided valuable insights. J., et al., Esteban-Sopeña, J. et al., and Tejera, D. M. et al., conflicted with this study's conclusions.
Conclusions: Combining TENS therapy with and physical exercises alleviated temporomandibular pain after maxillofacial surgery, while integrating Virtual Reality with physical exercises showed greater improvements in maximum mouth opening.
References
Adrian, A. B., Terezinha, D., & Gisele, P. (2020). Temporomandibular disorders and their association with quality of life in adolescents and young adults: A systematic review. Journal of Oral Reha-bilitation, 47(3), 261–269.
Armijo-Olivo, S., Pitance, L., Singh, V., Neto, F., Thie, N., & Michelotti, A. (2016). Effectiveness of manual therapy and thera-peutic exercise for temporomandibular disorders: systematic review and meta-analysis. Physical therapy, 96(1), 9-25.
Armijo-Olivo, S., Pitance, L., Singh, V., Neto, F., Thie, N., & Michelotti, A. (2016). Effectiveness of manual therapy and thera-peutic exercise for temporomandibular disorders: Systematic review and meta-analysis. Physical Therapy, 96(1), 9–25. https://doi.org/10.2522/ptj.20140548
Boonstra, A. M., Schiphorst Preuper, H. R., Balk, G. A., & Stewart, R. E. (2014). Cut-off points for mild, moderate, and severe pain on the visual analogue scale for pain in patients with chronic muscu-loskeletal pain. Pain, 155(12), 2545–2550.
Carrougher, G. J., Hoffman, H. G., Nakamura, D., Lezotte, D., Soltani, M., Leahy, L., Engrav, L. H., & Patter-son, D. R. (2009). The effect of virtual reality on pain and range of motion in adults with burn in-juries. Journal of Burn Care & Research, 30(5), 785–791. https://doi.org/10.1097/BCR.0b013e3181b485d3
Dickerson, S. M., Weaver, J. M., Boyson, A. N., Thacker, J. A., Junak, A. A., Ritzline, P. D., & Donaldson, M. B. (2017). The effectiveness of exercise therapy for temporomandibular dysfunction: a syste-matic review and meta-analysis. Clinical reha-bilitation, 31(8), 1039-1048.
Esteban-Sopeña, J., Beltran-Alacreu, H., Terradas-Monllor, M., Avendaño-Coy, J., & García-Magro, N. (2024). Effectiveness of virtual reality on postoperative pain, disability and range of movement after knee replacement: A systematic review and meta-analysis. Life, 14(3), 289. https://doi.org/10.3390/life14030289
Garrido-Ardila, E. M., Santos-Domínguez, M., Rodríguez-Mansilla, J., Torres-Piles, S. T., Rodríguez-Domínguez, M. T., Gonzá-lez-Sánchez, B., & Jiménez-Palomares, M. (2022). A systematic review of the effectiveness of virtual reality-based interven-tions on pain and range of joint movement associated with burn injuries. Journal of Personalized Medicine, 12(8), 1269. https://doi.org/10.3390/jpm12081269
Gopi, I., Maragathavalli, G., & Uma Maheshwari, T. (2021). Efficacy of transcutaneous electric nerve stimulation over sys-temic pharmacotherapy in the management of temporomandibular joint disorders – A systematic review and meta-analysis. Journal of Indian Academy of Oral Medicine and Radiology, 33(3), 321–327. https://doi.org/10.4103/jiaomr.jiaomr_131_21
Herrera-Valencia, A., Ruiz-Muñoz, M., Martin-Martin, J., Cuesta-Vargas, A., & González-Sánchez, M. (2020). Efficacy of man-ual therapy in temporomandibular joint disorders and its medium- and long-term effects on pain and maximum mouth opening: A systematic review and meta-analysis. Journal of Clinical Medicine, 9(11), 3404.
Kalaivanan, V., Muruppel, A., Deepthi, A., Ranjitha, E. G., Deepak, J., & Murugan, K. (2024). Comparing the efficacy of transcutaneous electric nerve stimulation (TENS) and low-level laser therapy (LLLT) in the management of temporoman-dibular joint disorders: A pilot study. Journal of In-dian Academy of Oral Medicine & Radiology, 36(4), 412–416.
Meneses-Santos, D., Costa, M. D. M. A., Inocêncio, G. S. G., Almeida, A. C., Vieira, W. A., Lima, I. F. P., & Pa-ranhos, L. R. (2022). Effects of low-level laser therapy on reducing pain, edema, and trismus af-ter oral surgery: A systematic review. Lasers in Medical Science, 37(3), 1471–1485.
Mennaallah, M., Amal, M., Mahmoud, A., & Hussein, G. (2025). Virtual reality and pain of temporoman-dibular joint after cervicofacial burn: A randomized controlled trial. International Journal of Environmental Sciences, 3102–3110. https://doi.org/10.64252/md27x151
Moger, G., Shashikanth, M., Sunil, M., & Shambulingappa. (2011). Transcutaneous electrical nerve stimu-lation therapy in temporomandibular disorder: A clinical study. Journal of Indian Academy of Oral Medicine and Radiology, 23(1), 46–50. https://doi.org/10.5005/jp-journals-10011-1090
Müller, L., van Waes, H., Langerweger, C., Molinari, L., & Saurenmann, R. K. (2013). Maximal mouth ope-ning capacity: Per-centiles for healthy children 4–17 years of age. Pediatric Rheumatology, 11(1), 17.
Pedersen, B. K., & Saltin, B. (2006). Evidence for prescribing exercise as therapy in chronic disease. Scandinavian Journal of Medicine & Science in Sports, 16(Suppl 1), 3–63. https://doi.org/10.1111/j.1600-0838.2006.00520
Pizzoli, S. F. M., Mazzocco, K., Triberti, S., Monzani, D., Alcañiz Raya, M. L., & Pravettoni, G. (2019). User-centered virtual reality for promoting relaxation: An innovative approach. Frontiers in Psycho-logy, 10, 479. https://doi.org/10.3389/fpsyg.2019.00479
Tejera, D. M., Beltran-Alacreu, H., Cano-de-la-Cuerda, R., Leon Hernández, J. V., Martín-Pintado-Zugasti, A., Calvo-Lobo, C., Gil-Martínez, A., & Fernández-Carnero, J. (2020). Effects of virtual reality ver-sus exercise on pain, functional, somatosenso-ry and psychosocial outcomes in patients with non-specific chronic neck pain: A randomized clinical trial. International Jour-nal of Environ-mental Research and Public Health, 17(16), 5950. https://doi.org/10.3390/ijerph17165950
Yang, X. (2009). Virtual reality technology for pain management and rehabilitation. Journal of Compu-ter Science and Tech-nology, 24(1), 42–45.
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