Sensory retraining: burden in daily life related to altered sensation after orthognathic surgery, a randomized clinical trial

Abstract

Objective: Assess the long-term effect of sensory retraining exercises, age, gender, type of surgery, and pre-surgical psychological distress on patients' perception of the interference related to altered sensation 2 years after orthognathic surgery.

Setting and sample population: A total of 186 subjects with a developmental dentofacial disharmony were enrolled in a multicenter randomized clinical trial: one center was a community-based practice and the other a university-based center.

Methods and materials: Subjects were randomly allocated to two groups: standard of care mouth opening exercises after BSSO or a progressive series of sensory retraining facial exercises in addition to the opening exercises. At 1, 3, 6, 12, and 24 months after surgery, subjects scored unusual feelings on the face, numbness, and loss of lip sensitivity from 'no problem (1)' to 'serious problem (7)'. A marginal proportional odds model was fit for each of the ordinal outcomes.

Results: Up to 2 years after surgery, the opening exercise only group had a higher likelihood of reporting interference in daily activities related to numbness and loss of lip sensitivity than the sensory retraining exercise group. The difference between the two groups was relatively constant. Older subjects and those with elevated psychological distress before surgery reported higher burdens related to unusual facial feelings, numbness, and loss of lip sensitivity (p < 0.02).

Conclusion: The positive effect of sensory retraining facial exercises observed after surgery is maintained over time. Clinicians should consider the patient's age and psychological well-being prior to providing pre-surgical counseling regarding the impact on daily life of persistent altered sensation following a mandibular osteotomy.

Figures

Figure 1

Estimated Likelihood of “No Problem” related to Unusual Feelings by Exercise Group

Figure 2

Estimated Likelihood of “No Problem” related to Unusual Feelings for Three Age Groups

Figure 3

Estimated Likelihood of No “Problem” related to Unusual Feelings for Subjects who self-reported Below Average, Average, and Elevated Psychological Distress before Surgery

Figure 4

Estimated Likelihood of “No Problem” related to Numbness by Exercise Group

Figure 5

Estimated Likelihood of “No Problem” related to Numbness for Three Age Groups

Figure 6

Estimated Likelihood of “No Problem” related to Numbness for Subjects who self-reported Below Average, Average, and Elevated Psychological Distress before Surgery

Figure 7

Estimated Likelihood of “No Problem” related to Loss of Lip Sensitivity by Exercise Group

Figure 8

Estimated Likelihood of “No Problem” related to Loss of Lip Sensitivity for Three Age Groups

Figure 9

Estimated Likelihood of “No Problem” related to Loss of Lip Sensitivity for Subjects who self-reported Below Average, Average, and Elevated Psychological Distress before Surgery