Complicaciones De Cordales

Oral Maxillofacial Surg Clin N Am 15 (2003) 177 – 186

Third molar surgery and associated complications
Srinivas M. Susarla, BSa, Bart F. Blaeser, DMD, MDb,*, Daniel Magalnick, DMDa,b
b a Harvard School of Dental Medicine, 188 Longwood Avenue, Boston, MA 02115, USA Department of Oral and Maxillofacial Surgery, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, USA

Thirdmolar surgery is the most common procedure performed by oral and maxillofacial surgeons. A thorough understanding of the complications associated with this procedure will enable the practitioner to identify and counsel high-risk patients, appropriately manage more common complications, and be cognizant of less common sequelae and the most effective methods of management. Surgical extraction of thirdmolars is often accompanied by pain, swelling, trismus, and general oral dysfunction during the healing phase. Careful surgical technique and scrupulous perioperative care can minimize the frequency of complications and limit their severity. Although this article discusses complications and management, it is by no means an exhaustive appraisal of the current body of literature.

Mild bleeding,surgical edema, trismus, and postoperative pain Complications such as pain, swelling, and trismus are anticipated after the removal of third molars. Although transitory, these conditions can be a source of anxiety for the patient. Much of this anxiety can be alleviated if there is a preoperative discussion of the expected perioperative course. Mild bleeding can be managed effectively with localmeasures. Most bleeding can be managed by applying gauze packing over the extraction site with

* Corresponding author. North Shore Medical and Dental Center, Salem Peabody Oral Surgery Inc., 6 Essex Center Drive, Peabody, MA 01960.

direct focused pressure. Persistent intraoperative bleeding commonly can be controlled with additional sutures to the wound. Other surgical adjuncts include theapplication of topical thrombin to the wound or the use of a packing medium, such as Gelfoam or Surgicel. Arterial bleeding, if identified, is best treated with vessel identification and subsequent ligation or cautery. Surgical edema is an expected sequela of removal of impacted teeth. Swelling usually reaches a maximum level 2 to 3 days postoperatively and should subside by 4 days and be completelyresolved by 7 days [1]. The use of ice and head elevation in the perioperative period may limit postoperative swelling and improve patient comfort [1]. The preoperative use of systemic corticosteroids has been advocated to reduce immediate swelling, but debate still exists as to their efficacy [2,3]. Trismus is often the result of surgical trauma and is secondary to masticatory muscle and fascialinflammation. As with surgical edema, there is evidence to support the preoperative use of steroids in reducing postoperative trismus [2]. No current agreement exists as to the most beneficial dose, type, or timing of its administration, however. Measurement of interincisal opening preoperatively and at followup ensures that the patient returns to the preoperative level of function. Pain caused bythird molar surgery usually begins after the anesthesia from the procedure subsides and reaches peak levels 6 to 12 hours postoperatively. Pain is anticipated, and the use of numerous analgesics, including nonsteroidal antiinflammatory drugs and narcotics, has been advocated for management. Selected studies have suggested a role for the pre-

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S.M. Susarla et al. / Oral Maxillofacial Surg Clin N Am 15 (2003) 177–186

operative use of nonsteroidal antiinflammatory drugs to decrease postoperative pain [4].

Common complications and their management Alveolar osteitis Alveolar osteitis is one of the most common complications associated with third molar surgery [5,6]....