Sortino Francesco, Cicciù Marco
Department of Oral Surgery, University of Catania, Azienda Policlinico, Via Santa Sofia, Catania, Italy.
Dent Res J (Isfahan). 2011 Oct;8(4):162-71. doi: 10.4103/1735-3327.86031.
Postoperative swelling following different surgical strategies is an area of great interest. The main part of literature on the topic deals with swelling after extraction of low impacted third molar. In this review, we have analyzed publications of the last 20 years with a pubmed search using the following key words: impacted third molar, swelling third molar, wisdom tooth, edema jaw, corticosteroids and extraction third molar, antibiotic prophylaxis and tooth extraction. Attention has often been focused on corticosteroid therapy administered by diverse routes (orally, IV, IM, topically) and at different time schedules (before or after surgery or both). This investigation revealed how the use of different molecules and dosages makes the obtained results hardly comparable. Similar conclusions can be drawn from studies aimed at evaluating the efficacy of antibiotic therapy administered either before or after surgery. A complete review has also to take into account different surgical strategies used including various flaps, no traumatic osteothomy, and primary or secondary closure. The use of pharmacological therapy and application of an ice pack is critical in the postoperative period and has always provided positive results. However, even if it is difficult to come to definite conclusions, due to the variability of the design of studies analyzed, the postoperative discomfort identified with edema, pain and trismus following wisdom tooth removal is influenced by various factors such as the difficulty of the surgical procedure involved, age and gender of the patient, and experience of the surgeon. The pharmacological therapy when performed with corticosteroids seems to improve control of the postoperative swelling related with this kind of surgeries.
不同手术策略后的术后肿胀是一个备受关注的领域。关于该主题的文献主要部分涉及低位阻生第三磨牙拔除后的肿胀。在本综述中，我们使用以下关键词在PubMed上搜索了过去20年的出版物：阻生第三磨牙、第三磨牙肿胀、智齿、颌骨水肿、皮质类固醇与第三磨牙拔除、抗生素预防与拔牙。人们常常将注意力集中在通过不同途径（口服、静脉注射、肌肉注射、局部用药）和在不同时间安排（手术前、手术后或两者皆有）给予的皮质类固醇治疗上。这项调查揭示了不同分子和剂量的使用如何使得所获得的结果难以比较。从旨在评估手术前或手术后给予抗生素治疗效果的研究中也可以得出类似的结论。完整的综述还必须考虑所使用的不同手术策略，包括各种瓣、无创截骨术以及一期或二期缝合。在术后阶段，药物治疗和使用冰袋至关重要，并且一直都能产生积极的效果。然而，即使由于所分析研究设计的变异性难以得出明确结论，但智齿拔除后与水肿、疼痛和牙关紧闭相关的术后不适受到多种因素的影响，例如所涉及手术操作的难度、患者的年龄和性别以及外科医生的经验。使用皮质类固醇进行的药物治疗似乎有助于改善对此类手术相关术后肿胀的控制。
