J Korean Assoc Oral Maxillofac Surg.  2023 Apr;49(2):91-95. 10.5125/jkaoms.2023.49.2.91.

Effect of a vertical incision on postoperative swelling after an impacted mandibular third molar extraction: two cases with split-mouth designed magnetic resonance imaging analysis

• Ku JK
• Baik SH
• Kim JY
• Huh JK

• KMID: 2542215
• DOI: http://doi.org/10.5125/jkaoms.2023.49.2.91

Abstract

This study examined the effects of a vertical incision on postoperative edema after third molar extraction. The study design was that of a comparative split-mouth approach. Evaluation was performed via magnetic resonance imaging (MRI). Two patients with homogeneous bilateral impacted mandibular third molars were enrolled. These patients underwent facial MRI within 24 hours after simultaneous extraction surgery. Modified triangular flap and enveloped flap incisions were made. Postoperative edema was evaluated by MRI and was assessed according to anatomical space. The two pairs of homogeneous extractions demonstrated that vertical incisions were associated qualitatively and quantitatively with extensive postoperative edema. The edema associated with these incisions spread toward the buccal space, beyond the buccinator muscle. In conclusion, a vertical incision with mandibular third molar extraction was related to edema in the buccal space and the fascial space, which contributed to clinical facial swelling.

Keyword

Flap design; Incision; Mandibular third molar; Postoperative outcome

Figure

• 

  Fig. 1 Intraoperative images for third molar surgical extraction with or without a vertical incision. After mesial vertical incision (A; arrow) or mesial enveloped incision (B; arrow), extractions were performed (C, D). After collagen sponge packing, the incision areas were sutured (E, F).

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  Fig. 2 Preoperative radiography and postoperative magnetic resonance imaging (MRI). A. Preoperative radiographs of patient No. 1 showed homogenecity of the impacted mandibular third molars. B, C. Axial and coronal T2-weighted MRI of patient No. 1, performed seven hours after surgery, revealed more postoperative edema on the right side. Regarding the classification according to anatomic space, T2 hyperintense regions of edema were noted along the buccinator muscle on the left side (arrows), while edema was observed in the buccal space beyond the buccinator muscle on the right side. D. Preoperative radiographs of patient No. 2 showed homogenecity of the impacted mandibular third molars. E, F. Axial and coronal T2-weighted MRI of patient No. 2, performed five hours after surgery, revealed more postoperative edema on the left side than the right side. Regarding classification by anatomic space, edema was observed only in the buccinator muscle on the right side, while the edema spread to the buccal space beyond the buccinator muscle on the left side (arrows).

Reference

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