What Is the Aim of Post-Operative Treatment in Oral and Maxillofacial Surgery?
The aim of any physician or dental or maxillofacial surgeon in the cases of orofacial pain is to not only just control pain but also effectively address the individual needs of the patient and improve the overall well-being of the whole. Therefore, in the long term, after any oral surgical procedure, the oral surgeon needs to keep in mind that post-operative pain control is extremely crucial to the psychosocial life of the patient. Preventing the recurrence of pain and regular follow-ups with the patient are also standard goals in postoperative pain management of a patient post oral surgical procedures. An inadequate or ineffective pain control post oral surgery can result in patient distress and also increase the number of visits to the doctor, thereby increasing the dental chair time. For oral surgical procedures that are to be performed under general anesthesia such as the excavation of large cysts, tumors, surgical or orthognathic jaw procedures, or facial reconstruction surgeries, one of the most common causes for an increased length of hospital stay for the patient tends to be lack of relief from pain after the surgical procedure.
Why Does Post Operative Pain Exist?
-
The International Association for the Study of Pain (IASP) has defined the phenomenon of pain in an individual as ‘the unpleasant sensory as well as emotional individual experience that is associated with either the actual or the potential tissue damage, which can be described precisely in terms of the tissue damage happening or occurring.” Hence, pain is one of the major as well as the fundamentally debilitating postoperative symptoms experienced by individuals.
-
The postoperative pain can be either inflammatory or it can be a temporary healthy phenomenon that persists until the oral wound healing takes place. When the patients repeatedly experience moderate to severe pain symptoms of an acute, repetitive onset, that is the major cause of psychosocial distress and mental anxiety.
-
Furthermore, current dental research indicates that when postoperative pain or inflammatory pain post oral surgical procedures tends to last for long periods, it can only predispose the patients to experience pain as a chronic existing symptom in their life and would further lead to conditions like allodynia (pain due to stimulus that does not usually cause it, as in healthy individuals) and hyperalgesia (frequent experience of severe pain).
-
One of the most common complications that are encountered postoperatively by patients who undergo major orthognathic surgeries is that they may continue to feel the pain, even after one year post-surgery. This hence shows as well as establishes the need that appropriate pain management is extremely critical to dental or maxillofacial surgeons for achieving successful post-surgical outcomes in patients.
-
The key principle that most oral and maxillofacial surgeons often follow is that the prevention of pain is more efficient than the actual treatment of pain in patients. Hence, all dental or maxillofacial surgeons need to have a thorough understanding of the basic pathophysiology behind oral pain and can explain the same repercussions that would occur often, as a course of oral wound healing to their patients.
What Is the Pathophysiology of Post-Operative Surgical Pain?
-
When surgical instrumentation happens in the orofacial regions, this invokes a clear tissue trauma that is bound to initiate a chain of inflammatory events. There is a release of chemical substances that trigger the excitation of nociceptors, or the pain-perceiving cells.
-
Surgical trauma, for example, while eliminating a cyst or a tumor, can release several tissue phospholipids, that get converted into arachidonic acid (polysaturated omega-6 fatty acid). Further, several substances of the arachidonic acid pathway would include its conversion into prostaglandins, prostacyclins, and leukotrienes (by the action of cyclooxygenase and lipoxygenase enzyme reactions).
-
These are known to be one of the main reasons for limited mouth opening or trismus post-maxillofacial surgery procedures. The eventual sequelae of postoperative edema (swelling caused by fluid accumulation) around the masticator or chewing muscles (an integral part of the oral cavity) are aggravated by the pain pathway.
-
The physiological responses to tissue trauma, pain, and edema, can be hence possible by inhibiting the pathways that lead to surgical trauma by the surgeon prescribing effective analgesic drugs. In some patients, either due to dental fears or fear of the oral surgical procedure, they can experience increased pain due to their psychological stress and anxiety. Therefore, oral surgeons need to address these concerns.
Is There a General Rule of Thumb for Patients Indicated for Oral Surgeries?
Numerous studies have demonstrated the beneficial effects of the preoperative administration of Ibuprofen with Paracetamol and Parecoxib, and Dexamethasone with Rofecoxib, Piroxicam, Ketorolac, and Meloxicam for pain control management in patients indicated for major oral and maxillofacial surgical procedures.
There have also been contradictory medical reports as per research, that show a lack of any clear benefits of prescribing painkillers before surgery itself. Hence, it usually depends upon the judgment of the maxillofacial surgeon or the dental operator, as it is not a general rule of thumb to follow the precautionary intake of analgesics before oral surgical procedures.
Therefore, oral surgeons should prescribe painkillers as and when required, especially for individuals who are more sensitive to the pain phenomenon or if it would help alleviate the mental stress or anxiety of patients afflicted.
Conclusion:
Whether oral and maxillofacial surgery procedures involve local or general anesthetics, the need for clear post-operative pain control management has been strongly advised by surgical experts around the world for achieving successful operative outcomes. This can significantly improve the psychosocial health of all individuals who undergo oral or maxillofacial surgeries.
