For physiotherapists specializing in temporomandibular joint (TMJ) disorders and oro-facial rehabilitation, the postoperative management of maxillofacial surgeries presents a significant clinical window. Surgical extraction of the impacted mandibular third molar is one of the most common procedures in oral surgery, yet it is notoriously associated with an inflammatory triad: pain, swelling (edema), and trismus (restricted mouth opening). While pharmacological interventions are standard, recent evidence published in January 2026 highlights the significant utility of Transcutaneous Electrical Nerve Stimulation (TENS) as a potent, non-invasive adjunct for recovery.
Investigating Non-Pharmacological Analgesia
A recent Randomized Controlled Trial (RCT) titled Role of transcutaneous electric nerve stimulation (TENS) in the mandibular third molar surgery, conducted by Rajan et al., sought to evaluate the specific efficacy of TENS in mitigating perioperative and postoperative sequelae. The study utilized a robust prospective, comparative, double-blind design involving 23 patients requiring bilateral surgical extraction of impacted mandibular third molars.
The study design effectively controlled for inter-patient variability by utilizing the bilateral nature of the extractions. Sites were randomly allocated to either a study group or a control group. The intervention protocol was notable for its timing; a physio track TENS appliance was applied at three distinct intervals:
- Preoperatively
- Immediately postoperatively
- On the third postoperative day
Outcomes: Edema, Pain, and Range of Motion
For rehabilitation professionals, the primary interest lies in the restoration of function. Post-extraction trismus is often the result of inflammation tracking into the masticatory muscles, specifically the medial pterygoid and masseter, leading to protective muscle splinting. The results of this RCT were compelling across all measured variables.
The authors reported that the application of TENS resulted in statistically significant improvements in pain control compared to the control sites. Perhaps more relevant to manual therapists, the TENS group demonstrated decreased facial swelling and, crucially, an early return to normal mouth opening. This suggests that the analgesic and circulatory effects of TENS helped mitigate the spasm-pain-spasm cycle that typically limits mandibular depression following surgery.
Clinical Relevance for Rehabilitation Professionals
The mechanism of action implied here aligns with the Gate Control Theory of pain, but also suggests benefits regarding local circulation and reduced muscle hypertonicity. By applying TENS preoperatively, the protocol may have utilized a preemptive analgesic strategy, desensitizing the peripheral nociceptors before the surgical insult occurred.
For physiotherapists, this study reinforces the value of electrotherapy modalities in the acute phase of facial rehabilitation. It suggests that TENS is not merely a palliative measure for chronic TMD but a functional tool for acute postoperative recovery. Integrating TENS immediately following mandibular trauma or surgery can facilitate a quicker return to functional mastication and prevent the development of chronic restrictions or compensatory motor control patterns in the craniocervical mandibular complex.
As interdisciplinary collaboration between oral surgeons and physiotherapists grows, these findings provide a strong evidence base for recommending early physiotherapy intervention—specifically TENS—following third molar extractions.
References
Rajan, R., Thota, E., Kumar, J. D., Potturi, A., Reddy, N. V. V., Bharath, Y. W., & Yeredla, R. K. R. (2026). Role of transcutaneous electric nerve stimulation (TENS) in the mandibular third molar surgery: a clinical study. Oral surgery, oral medicine, oral pathology and oral radiology. https://pubmed.ncbi.nlm.nih.gov/40885610/
