Continuous cooling mask devices reduce patient discomfort and postoperative pain and swelling in patients undergoing orofacial surgery.

Data sourcesThe resources searched included: Medline, PubMed, Embase, CINAHL, CAB Abstracts, the Cochrane Library and Google Scholar. The PRISMA guidelines for reporting systematic reviews were followed. Study selection was limited to the English language. Hand searching for additional references was performed. An intensive search was conducted for published articles describing the use of hilotherapy following oral and maxillofacial surgery.Study selectionInclusion criteria involved patients using hilotherapy after oral and maxillofacial surgery. Non-human studies were excluded. All articles were evaluated for study design, perioperative data, ethical suitability, follow-up data and surgical data reporting.Data extraction and synthesisTwo authors independently judged articles for suitability for the review. A kappa statistic test was used to calculate and to measure concordance in the author's final decisions to include studies. The agreement was 83% and considered moderate. Following data extraction a meta-analysis was conducted. Heterogeneity was calculated due to the variability among the studies (different number of surgical procedures, patient age, duration of the device application, different methods of postoperative pain measurement and analgesics protocol). Standard mean differences (SMD) with 95% confidence interval (CI) were calculated for the continuous measurements. The studies were assessed and rated using the Oxford Centre for Evidence-Based Medicine Levels of Evidence criteria (all studies were rated as 2b). Publication bias was assessed.ResultsThe initial search identified 552 results. Twelve papers were included in the review, and five with a total of 206 patients were used for the meta-analysis. The studies analysed were prospective comparative studies of patients undergoing oral maxillofacial surgery. Hilotherapy reduced pain (ten point visual analogue scale) at 48 hrs (P <0.010) and 72 hrs (P<0.050) as well as postoperative facial oedema (P <0.010) compared to ice-cooling treatment. Trismus and facial neurological scores were also improved (P<0.08). Patients preferred hilotherapy to other cooling methods (P< 0.010).ConclusionsHilotherapy appears to be effective in reducing postoperative facial pain, oedema and trismus and in improving patient-reported outcomes.