Department of Oral Diagnostic and Surgical Sciences, University of Otago, Dunedin, New Zealand.
Int J Oral Maxillofac Surg. 2012 Mar;41(3):371-5. doi: 10.1016/j.ijom.2011.08.006. Epub 2011 Oct 26.
Pain, swelling, trismus, and alveolar osteitis often occur after removal of impacted third molar teeth. To minimize these complications a number of mucoperiosteal flap designs have been advocated, but, to date, a pedicle flap design has not been evaluated. In a randomized prospective split mouth study, 52 participants had bilateral symmetrically impacted mandibular third molars removed over two sessions. A buccal envelope or pedicle flap was randomly assigned to the left or right third molar site. Pre-and postoperative pain and swelling were recorded using a standardized visual analogue scale, trismus was measured as the maximum inter-incisal opening distance in millimetres and dry socket was assessed clinically. Greater continuous pain, pain on maximum opening, and oro-facial swelling were recorded with the pedicle flap design. Continuous pain resolved significantly faster with this flap design (p<0.05). Trismus was similar for both flap designs (p>0.05). Five cases of alveolar osteitis occurred with the envelope flap whilst no cases developed with the pedicle flap, but the incidence was too small for statistical analysis. The pedicle flap improved some aspects of postoperative pain experience and reduced the incidence of alveolar osteitis, but further investigation with a larger sample size is required to evaluate its significance.
拔牙后常出现疼痛、肿胀、牙关紧闭和牙槽骨炎。为了最大程度地减少这些并发症，已经提出了许多黏膜骨膜瓣设计，但迄今为止，尚未对带蒂瓣设计进行评估。在一项随机前瞻性分口研究中，52 名参与者在两次就诊时接受了双侧对称的下颌第三磨牙拔除。颊侧信封瓣或带蒂瓣随机分配到左侧或右侧第三磨牙部位。使用标准化视觉模拟量表记录术前和术后疼痛和肿胀，以毫米为单位测量张口度来评估牙关紧闭，并用临床方法评估干槽症。带蒂瓣设计记录到更大的持续疼痛、最大开口时的疼痛和口面部肿胀。与该瓣设计相比，持续疼痛显著更快地缓解（p<0.05）。两种瓣设计的张口度相似（p>0.05）。5 例发生牙槽骨炎，使用信封瓣，而带蒂瓣无一例发生，但病例太少，无法进行统计学分析。带蒂瓣改善了术后某些方面的疼痛体验，降低了牙槽骨炎的发生率，但需要更大的样本量进一步研究来评估其意义。
