Clinical and Radiographic Characteristics as Predictive Factors of Swelling and Trismus after Mandibular Third Molar Surgery: A Longitudinal Approach

Abstract

Introduction Factors that contribute to swelling and trismus are complex, and they are originated by surgical trauma. The aim of the present study was to determine whether clinical and radiographic factors could predict the level of swelling and trismus after lower third molar surgery, through longitudinal approach. Methodology A prospective longitudinal trial was carried out. Forty-five patients of both genders with clinical and radiographic diagnosis of asymptomatic mandibular impacted third molar and with no intake of analgesic or anti-inflammatory drugs 12 h prior to surgery were recruited and evaluated in a 72 h follow-up period. A mixed repeated measures model and backward and restricted maximal likelihood methods were used to analyze the data. Results Male gender, body mass index (BMI), the relation to the lingual and buccal walls, and age were determinants for predicting postoperative swelling and for exerting a significant influence (P < 0.05). Conclusions This study suggests the association of male gender, the relation to lingual and buccal walls, BMI, and age with measurement of swelling.

Edema Management in Oral and Maxillofacial Surgery

“…The BMI consists in the division of ratio of body weight per height of the individual. Despite there is no consensus in the literature, some studies have related BMI with the severity of postoperative edema [4,[9][10][11].…”

“…The relation between BMI and the facial edema occurs because adipose tissue is responsible for most of the pro-inflammatory cytokines. So people with a higher BMI have more adipose tissue, more inflammatory biomarkers and, consequently, greater inflammation and greater edema [11,12].…”

“…In the literature, a positive correlation between BMI values and developed edema is observed. Thus, individuals with higher BMI develop greater edema, but their rate of reduction is faster in the first postoperative days [10,11]. However, individuals with lower BMI develop smaller edema, and although the rate of reduction in the first postoperative days is slower, the total resolution of edema occurs before than in people with a high BMI [10].…”

“…It is expected that a major difficulty surgery occurs in a longer surgical time and causes a more intense and extensive surgical trauma. Therefore, the inflammatory process will be bigger, as well as the postoperative edema [4,11,14,16,19].…”

“…Some factors can contribute to the increasing of the surgery difficulty level, such as denser bones, teeth with roots formed and consolidated in the bone by masticatory stimuli, quantity of procedures, and unfavorable dental position [9,11,14].…”