Marcin Kozakiewicz

The assessment of the early rehabilitation’s impact on the level of disorders occurring and the process of reinnervation, on the example of facial twigs of the motor nerve in patients with craniofacial injuries

Szymon Tyszkiewicz, Patrycja Ujma, Dominik Szczeciński, Klaudia Szczygieł, Marcin Kozakiewicz

Szymon Tyszkiewicz, Patrycja Ujma, Dominik Szczeciński, Klaudia Szczygieł, Marcin Kozakiewicz – The assessment of the early rehabilitation’s impact on the level of disorders occurring and the process of reinnervation, on the example of facial twigs of the motor nerve in patients with craniofacial injuries. Fizjoterapia Polska 2022; 22(4); 128-141

DOI: https://doi.org/10.56984/8ZG1A6t5I

Abstract
Introduction. Lymphoedema of the skull’s facial part is one of the main complications observed in a patient after surgical treatment of disorders of this area. Another noticeable and frequently reported complication by the patient is irregularities in facial expression muscles’ work. A relationship between them and reducing edema performed in patients in the first days after surgery will reduce the noted disturbances in motor branches’ function.
Aim. To investigate the impact of early swelling reduction on the extent of nervous system disorders and its reinnervation rate.
Materials and methods. Patients of the Maxillofacial Surgery Clinic of the University Clinical Hospital of the Military Medical Academy in Łódź were enrolled in the study. The study was conducted on 60 people who underwent maxillofacial surgery procedures from February to December 2019. Lymphatic drainage and dynamic taping were used to reduce patients’ edema. Forty-five people were divided into three equal groups. Fifteen patients constituted the comparative group. The research tools were a survey created following the author’s idea, linear measurements for measuring edema, and the Pietruski scale for assessing the state of reinnervation imaged by mimic muscle motility. On the first day after surgery, patients were examined four times, then on the third and seventh day after surgery, and finally four months after surgery.
Results. The use of anti-edema therapy noticeably (from 2-5 points on the Pietruski scale) reduces the disturbances in facial expression muscles’ function. The difference has been visible already on the third day after surgery. Regarding the patient’s pain, the lack of manual lymphatic system development resulted in pain sensations remaining in each of the three tests performed. The occurrence of edema, pain level, and level of facial expression muscle disorders were similar between groups and made the following research objective in terms of observed relationships.
Conclusions. The level of disturbances in the area of the mobility of expressive facial muscles (based on Pietruski scale) indicates that the implementation of anti edematous therapy, and thus the reduction of excess lymph, already in the first days after surgery provides a reduction of disorders of conduction of efferent impulses of motor fibers, appearing already in the first days after surgery. Increased drainage rate also accelerates the reinnervation process, shortens it by several weeks, and reduces pain symptoms.

Key words:
reinnervation, facial nerve, lymphatic oedema, dental physiotherapy

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Fractures of the condylarprocess of the mandible – the use of comprehensive manual therapy in the reduction of postoperative complications

Szymon Tyszkiewicz, Dominik Szczeciński, Anna Lichnowska, Marta Tyndorf, Marcin Kozakiewicz

Szymon Tyszkiewicz, Dominik Szczeciński, Anna Lichnowska, Marta Tyndorf, Marcin Kozakiewicz – Fractures of the condylarprocess of the mandible – the use of comprehensive manual therapy in the reduction of postoperative complications. Fizjoterapia Polska 2022; 22(3); 80-87

Abstract
Condyloid process fractures are a serious injury to the temporomandibular joints, and the surgical supply of tissues intensifies the occurrence of certain disorders.
These Rehabilitation performed was proposed as a result of complications following surgical reconstruction of broken condyloid process of the mandible. The rate and amount of edema reduction were assessed. Changes in the movement of temporomandibular joints and complex movement of the cervical spine were measured. The rate and extent of reinnervation and the level of pain were controlled.
Mobility of joints and functional abilities of the surrounding systems have significantly improved. The function of the facial nerve has been restored to a small sensory-motor disorder.

Key words:
condyloid process, facial nerve, manual therapy, dental physiotherapy, postoperative disorders

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Evaluation of the effectiveness of manual techniques and dynamic taping in the reduction of postoperative complications after surgical treatment of orthognathic defects

Szymon Tyszkiewicz, Marcin Kozakiewicz, Marta Tyndorf, Dorota Kościelniak

S. Tyszkiewicz, M. Kozakiewicz, M. Tyndorf, D. Kościelniak – Evaluation of the effectiveness of manual techniques and dynamic taping in the reduction of postoperative complications after surgical treatment of orthognathic defects. Fizjoterapia Polska 2019; 19(3); 146-157

Abstract
Aim of the study. Evaluation of the effectiveness of manual techniques and dynamic taping in the reduction of postoperative complications after surgical treatment of orthognathic defects.
Material and methods.50 people were qualified for the tests. These people were between the ages of 16 and 39. They were rehabilitated as a result of the surgical treatment of orthognathic defects. These patients were hospitalized due to postoperative complications such as tissue contractures, adhesions and scars, disturbances in joint mobility of the temporomandibular region and the cervical spine, lymphatic edema and nerve conduction disorders in the facial area. In a few people, additional blood bruising was found.
Dynamic taping was performed for two weeks postoperatively, treatments with massage and manual therapy twice a week (45-60 min. – time of a particular visit) for a period of 3 months, starting from the first week after surgery. The results of the therapy were supported by patients performing the recommended exercises. The rate and amount of edema reduction were assessed. Changes in the movement of temporomandibular joints and complex movement of the cervical spine were measured. The rate and extent of reinnervation and the level of pain were controlled. The Pietruski’s, House and Brackmann’s scales, VAS and linear measurements were used for the assessment.
Results.The average range of mobility in the field of temporomandibular joints and the cervical spine was improved in all examined spatial axes. The edema was significantly reduced, remaining after 3 months of therapy only at the averaged value of 8% of the baseline value.Sensory as well as motor fibers in the reinnervation process regained their functions. Their average state described by Pietruski’s scale results is about 26 points, which in the descriptive assessment corresponds to a small paresis.Post-operative haematomas were absorbed within two weeks of the operation.Pain in patients decreased from 7 points at the beginning of therapy, to 3 points after three weeks (average values). The total reduction occurred on average after 5 weeks.
Conclusions. The therapeutic process carried out had a significant influence on the results achieved. These data are comparable with the results presented in the scientific literature, describing similar issues. The results achieved are statistically significant (p <0.05), referring them to the results of people in the comparative group. As a result of the implemented comprehensive therapy, biomechanics and mobility in temporomandibular joints and spine joints were restored to physiological conditions. The performance of the lymphatic system has increased. The pain sensations have been reduced. There were no significant disturbances in the area of facial expressions and the work of sensory branches on the face. Fascial adhesions and scars have been released, to a condition that does not hinder the return to normal daily activity.

Key words:
orthognathic defects, dental physiotherapy, manual therapy, dynamic taping

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Metoda limfatyczna plastrowania dynamicznego w walce z obrzękiem twarzy po operacjach na szkielecie części twarzowej czaszki – doniesienie wstępne

Marta Tyndorf, Marcin Kozakiewicz, Jakub Winerowicz

M. Tyndorf, M. Kozakiewicz, J. Winerowicz – Lymphatic kinesiology taping technique as the method of treatment against the swelling of a face after surgeries in the craniofacial area – preliminary report. FP 2016; 16(1); 88-98

Streszczenie
Współczesna chirurgia szczękowo-twarzowa za cel nie stawia sobie wyłącznie przywracania funkcji układu stomatognatycznego i twarzy, ale również przywracanie ich harmonii i poprawę estetyki. Stale narastające tempo życia oraz chęć pacjentów do jak najszybszego powrotu do pełnej sprawności wymusza na członkach zespołu terapeutycznego szukanie nowych możliwości skrócenia czasu rehabilitacji, a w tym sposobów na redukcję obrzęków. Istnieje szereg metod walki z zastojem chłonki, ale często nie dość, że nie są wystarczająco skuteczne, to obarczone są ryzykiem szeregu poważnych działań ubocznych. W związku z tym nieustannie poszukuje się nowych metod redukowania obrzęku, jedną z nich jest metoda limfatyczna plastrowania dynamicznego.
Cele. Ocena wpływu metody limfatycznej plastrowania dynamicznego na dynamikę obrzęku twarzy u pacjentów operowanych z powodu urazów i wad części twarzowej czaszki.
Materiał i metoda. Do badania włączeni zostali pacjenci Kliniki Chirurgii Szczękowo-Twarzowej Uniwersyteckiego Szpitala Klinicznego im. WAM-CSW w Łodzi leczeni z powodu urazów oraz wad gnatycznych w okresie od 31.08.2013 do 30.06.2014. Na podstawie randomizacji utworzono 22 osobową grupę badawczą i 19 osobowoą grupę kontrolną. W grupie badanej stosowano aplikację metodą limfatyczną plastrowania dynamicznego, a następnie w obu grupach dokonywano pomiarów obrzęku twarzy w 1,2,5 oraz 10 dobie po zabiegu. Wyniki poddano analizie statystycznej.
Wyniki. W grupie chorych przeważali mężczyźni (68%) w średnim wieku 34,2 lata. Wykazano znaczący wpływ plastrowania dynamicznego na dynamikę powstawania obrzęku pooperacyjnego. Powodowało ono jego stopniową redukcję do uzyskania 75% poprawy w 10 dobie po zabiegu, podczas, gdy w grupie kontrolnej początkowo obserwowano narastanie obrzęku i znacznie mniejszą jego redukcje w końcowej fazie badania.
Wnioski. Metoda limfatyczna plastrowania dynamicznego wykazuje pozytywny wpływ na redukcję obrzęku pooperacyjnego twarzy i wskazane jest dalsze badanie wpływu tej metody na rehabilitacje pacjentów operowanych w obrębie części twarzowej czaszki.