Facial cooling (cryotherapy) is a traditional approach to minimising pain, swelling and discomfort following trauma or surgery. However, there are concerns that it may affect microvascular blood flow and lymph drainage causing damage. Contoured facial masks have been developed to channel a current of cool, sterile water adjacent to the skin to provide regulated cryotherapy. Although studies have provided conflicting evidence of it efficacy.
The aim of this review to assess the evidence for the use of perioperative cryotherapy after facial surgery.
Methods
Searches were conducted in Medline/PubMed, Embase, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials (CENTRAL) and ClinicalTrials.gov and the national research register for completed, discontinued, and ongoing trials.
Randomised controlled trials (RCTs) comparing facial cooling by hilotherapy with standard dressings or cold compression after facial reconstructive or aesthetic procedures in both adults and children were considered. The primary outcome measures were oedema and pain. Secondary outcome measures were tolerance, haematoma, and ecchymosis.
Risk of bias was assessed using the Cochrane tool. Mean differences and 95% CI were calculated for continuous outcomes, risk ratios (RR) and 95% CI for dichotomous outcomes.
Results
- 6 RCTs involving a total of 286 patients were included.
- All trials used Hilotherm® (Hilotherm GmbH, Ludwigshafen, Germany) Hilotheraphy was instated immediately postoperatively but regimens varied.
- 5 trials evaluated facial oedema
- Hilotherapy was associated with significant reductions in facial pain on postoperative day 2 (p < 0.00001), and facial oedema on days 2 (p = 0.0004) and 3 (p = 0.02)
| Number of studies in meta-analysis | Mean difference | (95%CI) | |
| Facial Pain – day 2 | 4 | -2.37 | (-3.24 to -1.50) |
| Oedema – day 2 | 4 | -22.39 | (-34.82 to -9.96) |
| Oedema – day 3 | 3 | -26.53 | (-49.54 to -3.53) |
| Oedema – day 28 | 3 | -0.77 | (-2.53 to -0.99) |
- 4 trials evaluated patient satisfaction with hilotherapy being significantly more satisfied with hilotherapy than with cold compression.
Conclusions
The authors concluded
when applied after bony facial surgery, hilotherapy is well tolerated by patients and it reduces swelling and pain in the early postoperative period. There are insufficient data at present to support the use of hilotherapy to reduce ecchymosis and haematoma formation, features that also reflect surgical technique, tumescent infiltration, and the use of drains. Well-designed randomised controlled trials of the use of hilotherapy after aesthetic and soft tissue facial surgery are required.
Comments
The authors have conducted a broad database search for trials to address this question. However, they have not reported whether duplicate and independent study selection, data abstraction and risk of bias assessment has been carried out. None of the included studies are at low risk of bias and 3 of the 5 have been conducted by the same lead author. The included studies are relatively small and the meta-analysis only includes 146 patients a point noted by the authors. All of the included studies used the same device to apply the cryotherapy and there is no indication of whether the trials had received manufactures support. An earlier review of this topic by Bates et al (Dental Elf – 29th Oct 2015) included 5 of the same RCTs and had similar findings.
Links
Primary paper
Glass GE, Waterhouse N, Shakib K. Hilotherapy for the management of perioperative pain and swelling in facial surgery: a systematic review and meta-analysis. Br J Oral Maxillofac Surg.2016Oct;54(8):851-856. doi:10.1016/j.bjoms.2016.07.003. Review. PubMed PMID: 27516162.
Other references
Dental Elf – 29th Oct 2015
Hilotherapy improved levels of facial pain and oedema after maxillofacial surgery suggests review
