Effect of flap design and duration of surgery on acute postoperative symptoms and signs after extraction of lower third molars: A randomized prospective study

Abstract

Background. Different surgical variables are assumed to play a role in postoperative course after lower third molar extraction. The aim of study was to assess whether flap design and duration of surgery can influence acute postoperative symptoms and signs after lower third molar extraction. Methods. Twenty-five patients scheduled for lower third molar extraction were included in this study and randomly assigned to two groups in terms of flap design: group A (envelope flap) and group B (triangular flap). Swelling and trismus were assessed before and after surgery on days 0, 2 and 7. Pain was assessed for seven days after surgery. Maximum postoperative pain was chosen as the main outcome variable. ANOVA was used to assess differences between the groups regarding maximum postoperative pain, trismus and swelling at 2- and 7-day intervals. Pearson's correlation coefficient was used to assess correlation between duration of surgery and postoperative symptoms and signs. Results. No significant difference was found between the two flap designs for any postoperative symptoms and signs. The duration of surgery was found to be correlated with both trismus (r = -0.44, P = 0.04) and swelling (r = 0.59, P = 0.004) as assessed 2 days after surgery. No associations were found between duration of surgery and maximum postoperative pain and trismus and swelling at 7-day interval. Conclusion. Within the limits of the present study, the duration of surgery, and not the flap design, affected the acute postoperative symptoms and signs after lower third molar extraction.

The influence of flap design on sequelae and quality of life following surgical removal of impacted mandibular third molars: A split‐mouth randomised clinical trial

“…3 Some studies have reported no significant differences in trismus between the two flap designs. 3,17,33 In contrast to earlier studies reporting greater trismus in the triangular flap, 9 our findings indicated a higher incidence of trismus in the envelope flap group.…”

“…Trismus following mandibular third molar surgery generally results from inflammation of the masticatory muscles, leading to spasm secondary to mucoperiosteal flap elevation . Some studies have reported no significant differences in trismus between the two flap designs . In contrast to earlier studies reporting greater trismus in the triangular flap, our findings indicated a higher incidence of trismus in the envelope flap group.…”

Comparison of three flap designs on postoperative complication after third molar surgery

“…Factors that affect the occurrence of swelling due to the addition of releasing incision so that it is assumed to produce edema due to an inflammatory process. 10,11 Similar results were also found by Mobilio et al (2017) comparing envelope incisions and conventional triangular incisions. 13 The mucosa will respond to tissue trauma by releasing antibodies and leukocytes present in the bloodstream, plasma exudation, protein, and neutrophils in the injury area resulting in inflammatory clinical symptoms of swelling.…”

“…10,11 Similar results were also found by Mobilio et al (2017) comparing envelope incisions and conventional triangular incisions. 13 The mucosa will respond to tissue trauma by releasing antibodies and leukocytes present in the bloodstream, plasma exudation, protein, and neutrophils in the injury area resulting in inflammatory clinical symptoms of swelling. 12 The occurrence of facial swelling in the first postoperative day in all treatment groups showed an increase in extracellular fluid and extravascular fluid accompanied by abnormal fluid accumulation in between tissue and facial serous cavity after third molar surgery.…”

Effect of Total Surgical Time on Patient’s Complaint of Mouth Opening After Transalveolar Removal of Impacted Mandibular Wisdom Teeth- A Randomised, Controlled, Clinical Trial

“…[18] The result of another study stated that skill of surgeon and surgical time greater than 30 minutes are risk factors for trismus. [19] In another study, it was found that duration of surgery and not flap design influence postoperative trismus. [20] In our study, we had divided patients into two groups: Group A consisted of patients in whom total surgical time was less than or equal to 15 minutes and Group B consisted of patients in whom surgical time was greater than 15 minutes.…”