Journal List > J Korean Acad Nurs > v.48(1) > 1003305

Jang and Kim: Effects of Active Mandibular Exercise for Mouth Opening Limitation Patients after Maxillomandibular Fixation Release: A Non-Randomized Controlled Trial

Abstract

Purpose

The aim of this study was to evaluate the effects of active mandibular exercise (AME) in patients with limited mouth opening after maxillomandibular fixation (MMF) release.

Methods

The study used a quasi-experimental, nonequivalent control group and a pre test-post test design. Sixty-two patients with Maxillomandibular Fixation Release were assigned to the experimental (n=31) or control group (n=31). The AME was performed in the experimental group for 4 weeks. The exercise AME consisted of maximal mouth opening, lateral excursion and protrusive movement. These movements were repeated ten times a day. After the final exercise of the day, the number of tongue blades used for mouth opening was noted. The effect of AME was evaluated after MMF release at different time intervals: a) immediately, b) after 1 week, c) after 2 weeks, d) after 4 weeks, and e) after 12 weeks. The exercise was assessed using the following criteria: a) mandibular movements, b) pain scores associated with maximal mouth opening, c) discomfort scores associated with range of movement, and d) daily life activities that involve opening the mouth.

Results

The experimental group showed significant improvement regarding the range of mandibular movements (maximal mouth opening (F=23.60, p<.001), lateral excursion to the right side (F=5.25, p=.002), lateral excursion to the left side (F=5.97, p=.001), protrusive movement (F=5.51, p=.001)), pain score (F=39.59, p<.001), discomfort score (F=9.38, p<.001). Daily life activities that involve opening the mouth were more favorable compared to those in the control group.

Conclusion

The AME in patients after MMF release is helpful for increasing mandibular movement range, decreasing pain and discomfort, and improving day life activities that involve opening the mouth. Therefore, AME is highly recommended as an effective nursing intervention.

References

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Figure 1.
Flow of the study.
jkan-48-26f1.tif
Table 1.
Homogeneity Tests for Subject’s Characteristics and Study Variables (N=62)
Characteristics Categories Exp. (n=31) Cont. (n=31) χ2 or z p
M±SD or n (%) M±SD or n (%)
Gender Male 20 (64.5) 22 (71.0) 0.29 .786
Female 11 (35.5) 9 (29.0)
Age (yr) 10~19 3 (9.6) 7 (22.6) 0.14 .890
20~29 18 (58.2) 14 (45.2)
30~39 3 (9.6) 3 (9.6)
40~49 3 (9.6) 2 (6.4)
50~59 3 (9.6) 2 (6.4)
≥60 1 (3.2) 3 (9.6)
Median (IQR) 23 (19.00) 25 (11.00)
Education Elementary 1 (3.2) 2.57 .767††
Middle 3 (9.7) 4 (12.9)
High 21 (67.7) 17 (54.8)
College 7 (22.6) 9 (29.0)
Fx. side Right 6 (19.4) 6 (19.4) 0.80 .705
Left 10 (32.3) 7 (22.6)
Both 15 (48.3) 18 (58.0)
Operation type Mn. Fx. Reduction (ORIF) 18 (58) 20 (64.5) 0.70 .902††
Orthognathic Surgery (1jaw) 11 (35.5) 9 (29.0)
Orthognathic Surgery (2jaw) 2 (6.5) 2 (6.5)
MMF period (day) ≤7 14 (45.2) 14 (45.2) 0.42 .673
8~14 16 (51.6) 16 (51.6)
≥15 1 (3.2) 1 (3.2)
Median (IQR) 8 (4.00) 8 (4.00)
Range of mandibular movements (mm)
Maximal mouth opening 12.85±5.92 13.14±6.42 0.18 .852
Lateral excursive movement to right side 1.00 (2.18) 1.12 (2.04) −0.50 .613
Lateral excursive movement to left side 0.96 (2.05) 0.81 (2.13) −0.08 .932
Protrusive movement −0.83 (2.31) −0.23 (2.20) −0.76 .444
Pain when maximal mouth opening 5.00±1.06 5.29±0.58 1.32 .189
Discomfort when measuring movements range 8.70±2.23 9.45±1.92 1.40 .166

Exp.=Experimental group; Cont.=Control group; M±SD=Mean±standard deviation; IQR=Interquartile range; Fx.=Fracture; Mn.=Mandible; ORIF=Open reduction internal fixation; MMF=Maxillomandibular fixation.

Mann-Whitney U test; ††Fisher’s exact test.

Table 2.
Range of Mandibular Movements after MMF Release (N=62)
Variable Period Exp. (n=31) Cont. (n=31) Source F p Period Exp. (n=31) Cont. (n=31) t p
M±SD M±SD Differences
Maximal Immediate 12.85±5.92 13.14±6.42 Group 15.06 <.001 1w-Im. 16.29±4.62 7.97±4.52 7.15 <.001
mouth 1 week 29.14±5.90 21.12±7.72 Time 772.63 <.001 2w-Im. 22.67±4.71 14.25±5.03 6.80 <.001
opening 2 weeks 35.53±5.60 27.40±8.34 G*T 23.60 <.001 4w-Im. 30.89±5.79 20.79±4.71 7.51 <.001
4 weeks 43.74±4.73 33.94±7.61 12w-Im. 33.32±6.23 30.69±5.21 1.80 .077
12 weeks 46.18±5.28 43.84±6.38
Lateral Immediate 1.97±2.02 2.02±2.12 Group 0.93 .339 1w-Im. 3.54±1.97 1.57±1.94 3.96 <.001
excursive 1 week 5.52±3.27 3.59±2.79 Time 130.34 <.001 2w-Im. 4.38±2.55 3.29±2.64 1.64 .105
movement 2 weeks 6.36±3.48 5.32±3.33 G*T 5.25 .002 4w-Im. 4.98±2.04 4.48±2.65 0.82 .411
to right 4 weeks 6.96±2.99 6.51±2.77 12w-Im. 5.60±2.07 5.84±2.53 0.40 .689
side 12 weeks 7.58±2.82 7.87±2.60
Lateral Immediate 1.47±1.63 1.85±2.71 Group 2.69 .106 1w-Im. 3.03±1.76 1.19±1.58 4.31 <.001
excursive 1 week 4.51±2.56 3.04±3.13 Time 137.32 <.001 2w-Im. 4.63±2.04 2.56±3.23 3.00 .004
movement 2 weeks 6.11±2.76 4.41±3.00 G*T 5.97 .001 4w-Im. 5.42±1.80 3.59±2.56 3.24 .002
to left side 4 weeks 6.90±2.59 5.44±2.34 12w-Im. 5.79±1.48 5.06±2.90 1.25 .216
12 weeks 7.27±2.17 6.91±2.27
Protrusive Immediate 1.97±1.88 1.58±1.53 Group 5.51 .022 1w-Im. 2.61±1.60 1.19±1.76 3.29 .002
movement 1 week 4.37±2.52 2.67±1.99 Time 147.13 <.001 2w-Im. 3.77±1.47 2.21±1.71 3.85 <.001
2 weeks 5.48±2.74 3.70±2.06 G*T 5.51 .001 4w-Im. 4.23±1.49 2.97±1.88 2.88 .005
4 weeks 5.88±2.84 4.47±2.14 12w-Im. 4.70±1.38 4.15±1.75 1.37 .173
12 weeks 6.05±2.11 5.24±1.88
Pain scores Immediate 5.00±1.06 5.29±0.58 Group 97.91 <.001 1w-Im. 3.32±1.16 1.45±1.12 6.44 <.001
1 week 1.38±0.91 3.83±1.12 Time 566.50 <.001 2w-Im. 4.32±1.22 2.83±1.00 5.22 <.001
2 weeks 0.38±0.55 2.45±0.96 G*T 39.59 <.001 4w-Im. 4.61±1.28 4.38±1.02 0.76 .446
4 weeks 0.10±0.30 0.90±0.87 12w-Im. 4.70±1.18 5.29±0.58 2.43 .019
12 weeks 0.00±0.00 0.00±0.00
Discomfort Immediate 8.70±2.23 9.45±1.92 Group 27.87 <.001 1w-Im. 4.12±1.55 2.54±2.11 3.35 .001
scores 1 week 4.58±1.63 6.90±2.10 Time 239.77 <.001 2w-Im. 5.35±1.92 3.90±2.02 2.89 .005
2 weeks 3.35±0.75 5.54±1.87 G*T 9.38 <.001 4w-Im. 5.70±2.23 5.33±2.07 0.67 .501
4 weeks 3.00±0.00 4.11±1.13 12w-Im. 5.70±2.23 6.35±1.93 1.21 .229
12 weeks 3.00±0.00 3.09±0.39

MMF=Maxillomandibular fixation; Exp.=Experimental group; Cont.=Control group; Im.=Immediate; w=week; M±SD=Mean±standard deviation.

Independent t-test: significant differences with one another by Bonferroni correction p<.01.

Table 3.
Correlations between Range of Maximum Mouth Opening and Tongue Blade Counts in the Experimental Group (N=31)
Period Maximal mouth opening Tongue blade counts r p
M±SD M±SD
Immediate 12.85±5.92 6.97±3.81 .97 <.001
1 week 29.14±5.90 17.77±3.85 .97 <.001
2 weeks 35.53±5.60 22.65±3.88 .97 <.001
4 weeks 43.74±4.73 28.55±3.20 .96 <.001

M±SD=Mean±standard deviation.

Table 4.
Daily Life Activities That Involve Opening the Mouth after MMF Release (N=62)
Categories Exp. (n=31) Cont. (n=31)
n (%) n (%)
1 week 2 weeks 4 weeks 12 weeks 1 week 2 weeks 4 weeks 12 weeks
Meals type
   Liquid diet 28 (90.3) 13 (41.9) 28 (90.3) 14 (45.2) 3 (9.7)
   Solid diet 3 (9.7) 18 (58.1) 31 (100.0) 31 (100.0) 3 (9.7) 17 (54.8) 28 (90.3) 31 (100.0)
Eating tools
   Syringe 9 (29.0) 7 (22.6) 2 (6.5)
   Spoon 31 (100.0) 31 (100.0) 31 (100.0) 31 (100.0) 22 (71.0) 24 (77.4) 29 (93.5) 31 (100.0)
Diet limitation
   Yes 18 (58.1) 12 (38.7) 28 (90.3) 25 (80.6) 16 (51.6)
   No 13 (41.9) 19 (61.3) 31 (100.0) 31 (100.0) 3 (9.7) 6 (19.4) 15 (48.4) 31 (100.0)
Toothbrush type
   Child brush 3 (9.7) 5 (16.1) 4 (12.9) 3 (9.7)
   Adult brush 28 (90.3) 31 (100.0) 31 (100.0) 31 (100.0) 26 (83.9) 27 (87.1) 28 (90.3) 31 (100.0)
Pain
   Mastication 18 (58.1) 14 (45.2) 30 (96.8) 27 (87.1) 17 (54.8)
   Toothbrushing 18 (58.1) 4 (12.9) 30 (96.8) 24 (77.4) 16 (51.6)
   Conversation 12 (38.7) 5 (16.1) 19 (61.3) 15 (48.4) 5 (16.1)
Awkward facial expression
   Yes 7 (22.6) 2 (6.5) 13 (41.9) 7 (22.6) 1 (3.2)
   No 24 (77.4) 29 (93.5) 31 (100.0) 31 (100.0) 18 (58.1) 24 (77.4) 30 (96.8) 31 (100.0)

MMF=Maxillomandibular fixation; Exp.=Experimental group; Cont.=Control group.

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