Maitland Mobilization Versus Therapeutic Ultrasound on Trismus Following Third Molar Surgery

This randomized clinical study will investigate the effect of Maitland mobilization compared to therapeutic ultrasound on trismus following third molar (wisdom tooth) surgery.

Trismus, characterized by limited mouth opening, is a common postoperative complication after third molar extraction and can affect oral function and quality of life All patients of both groups received Standard Postoperative Care designed to promote natural recovery after third molar surgery. The standard care protocol includes the use of Cold Compresses/Ice Packs, Non-Steroidal Anti-Inflammatory Drugs (NSAIDs), basic jaw exercises at home to prevent further restriction of jaw movement.

Group A Maitland Mobilization group: Participants received Maitland mobilization therapy. The manual therapy involved graded oscillatory movements targeting the temporomandibular joint (TMJ), aimed at improving jaw mobility and reducing pain following third molar surgery. Each therapy session lasted approximately 15-20 minutes and was conducted three times a week over a period of four weeks. During each session, the physiotherapist applied different grades of mobilization depending on the patient's progress. Grade I and II movements-small, rhythmic oscillations-were used initially to reduce pain and relax the muscles. As the treatment progressed, Grade III and IV mobilizations were applied to stretch the joint capsule and further improve range of motion. Additionally, patients were instructed to perform home exercises to maintain the therapeutic gains between sessions, such as gentle jaw stretching and mouth-opening exercises .

Group B (Therapeutic Ultrasound group): The procedure involved using an ultrasound device , such as the Chattanooga Intelect Mobile 2, which operates at a 1 MHz frequency to target deep tissues like the temporomandibular joint (TMJ) and surrounding muscles. The therapy was conducted three times a week for four weeks, with each session lasting 10-15 minutes. A water-based conductive gel was applied to the skin to facilitate effective transmission of sound waves, and the intensity of the ultrasound was adjusted between 0.8 to 1.5 W/cm² based on patient tolerance. The transducer was moved in slow, circular motions over the TMJ and affected muscles, focusing on areas of pain or stiffness. Group C (Control group ): received traditional physical therapy program only. The outcomes measured included Maximum Interincisal Opening (MIO) via a Vernier Caliper. MIO was measured as the primary indicator of jaw mobility in patients experiencing postoperative trismus. MIO is the distance between the upper and lower central incisors when the patient opens their mouth fully, with the patient seated comfortably and properly supported. The MIO was recorded at baseline (before the intervention) and again at the end of the 4-week intervention period. Each measurement was repeated three times to ensure accuracy, with the average of the three readings used as the final recorded value. This process allows for consistent and precise tracking of improvements in jaw mobility over time.

Inclusion criteria

• Patients were included in this study have the following criteria

• Sixty patients had done third molar extraction surgery
• Patients suffering from postoperative trismus within 2 to 14 days post-surgery.
• Their age between 20 and 30 years old
• All patients are medically and clinically stable when attending the study 2.1.2. Exclusion criteria:

The study excluded the following patients:

• Pre-existing TMJ Disorders: Patients with a history of temporomandibular joint (TMJ) disorders or jaw-related conditions (e.g., TMJ dislocation, arthritis, or previous TMJ surgery).
• Neurological or Muscular Disorders: (e.g., facial palsy, stroke, muscular dystrophy).
• Previous Jaw Surgery or Trauma.
• Use of Muscle Relaxants or other form of Physical Therapy treatment.
• Chronic Pain Syndromes: such as fibromyalgia or chronic migraines
• Infections or abscesses post-Surgery.
• Patients have auditory and visual problems