Commentary

The systematic review published in the International Journal of Oral Maxillofacial Surgery had the purpose of evaluating the use of hilotherapy compared to conventional facial cooling techniques such as cool compress or ice packs.

Postoperative ice packs (cryotherapy) to relieve pain and swelling after different surgical strategies have been used in medicine for many years. The rationale of the cooling technique is that the ice applied in the area reduces the blood circulation, creates vasoconstriction and reduces metabolism.1

What is known is that prolonged application of cold to the area may produce unwanted side effects such as iatrogenic cold injury and patient discomfort.

However, the effectiveness of ice pack use in oral surgery seems controversial due to the claim that the technique requires an optimal delivery method, an appropriate interval for application and total duration of treatment to attain the outcome desired for swelling and pain reduction.2

This new therapy uses a machine that delivers water at the right temperature via tubes in an adaptable facemask that can be applied to the area and deliver a controlled constant temperature, thus reducing the risk associated with the conventional cryotherapy. The cooling devices use ‘chilled water’ instead of ice to decrease the temperature of the area to which is applied.

The review included only studies that used a motorised unit known as Heliotherm.3 The website has information available about the product, the benefits of its use, the research supporting the use of the system (most of the studies are included in this review) and recommendations on how to use it for professionals and patients. The products are available for purchase for providers and clinics as well for patients for home use. The devices can be rented or purchased.

The review reported and analysed five randomised clinical trials with an unclear risk of bias. Some of the methodological limitations of the studies were described, such as blinding of the clinicians, blinding of the outcome assessors and reporting of power calculation (an important step and prerequisite in the methodology of randomised clinical trials to detect statistically significant results and with that detect a statistical difference among the groups). The meta-analysis performed shows a statistically significant result favouring the hilotherapy technique, especially for pain and swelling. The surgical procedures undertaken in each study included orthognathic surgeries, osteosynthesis for treatment of mandibular fracture, treatment for zygomatic bone fracture and third molar extraction with osteotomy.

In medicine, especially in orthopedic medicine, other similar products are available for the same purpose of continuous controlled cooling therapy. The evidence in general is still debatable.4 In spite of this the overall claim is that the therapy is generally safe and not associated with any serious adverse events (such as can be present with pharmacological therapies such as corticosteroids and anti-inflammatory drugs).

Another systematic review using the same articles concluded that hilotherapy was associated with significant reduction in facial pain on postoperative day two and oedema on days two and three.5

A newly published randomised clinical trial which was not included in the review concluded that the system is effective for controlling postoperative edema and pain in patients undergoing surgery for displaced unifocal fracture of the mandible.6

Despite some limitations of the review, the evidence supports the use of hilotherapy to reduce postoperative pain and swelling in patients undergoing more complicated orofacial surgeries. The price and availability of the machine is still something for consideration.