Balamurugan R, Zachariah Thomas
Department of Oral and Maxillofacial Surgery, Meenakshi Ammal Dental College and General Hospital, Meenakshi Academy of Higher Education and Research (Deemed to be University), Alapakkam Main Road, Maduravoyal, Chennai, Tamil Nadu, 600095, India.
Oral Maxillofac Surg. 2020 Mar;24(1):37-43. doi: 10.1007/s10006-019-00814-w. Epub 2019 Nov 15.
The purpose of this study was to compare primary and secondary wound closure with a buccal mucosal-advancement flap technique on the postoperative course after mandibular impacted third molar surgery.
The study was conducted on 150 patients who required surgical removal of impacted mandibular third molars under local anesthesia. The study subjects were divided into three groups of 50 patients each, based on the type of closure over the third molar socket. Patients in group I underwent primary closure of the socket with hermetic suturing of the flap, including the vertical release. In group II, a secondary closure was performed, leaving the socket communicating with the oral cavity. In group III, a buccal mucosal-advancement flap technique was employed to achieve primary closure of the flap over the socket while leaving the anterior vertical release, generously patent. All the patients were assessed for pain using the visual analogue scale (VAS), swelling, and mouth opening at postoperative intervals of 2, 4, and 7 days. The wound healing was assessed on day 7.
Patients in the buccal mucosal-advancement flap group had significantly less pain and swelling and increased mouth opening compared with primary and secondary closure. Wound dehiscence was seen in 18 patients and alveolar osteitis in 4 patients in primary closure. Delayed wound healing with food accumulation was seen in 6 patients in secondary closure. No complications of flap dehiscence or breakdown were observed in the buccal mucosal-advancement flap group.
This study concludes that the buccal mucosal-advancement flap technique was a superior closure technique with less pain, swelling, trismus, and satisfactory wound healing compared with both primary and secondary closure after mandibular third molar surgery.
本研究旨在比较在下颌阻生第三磨牙手术后，采用颊黏膜推进瓣技术进行一期和二期伤口闭合对术后病程的影响。
对150例在局部麻醉下需要手术拔除下颌阻生第三磨牙的患者进行研究。根据第三磨牙牙槽窝的闭合类型，将研究对象分为三组，每组50例患者。第一组患者对牙槽窝进行一期闭合，皮瓣严密缝合，包括垂直松弛切口。第二组进行二期闭合，使牙槽窝与口腔相通。第三组采用颊黏膜推进瓣技术，实现牙槽窝上方皮瓣的一期闭合，同时使前方垂直松弛切口保持宽大开放。在术后第2、4和7天，对所有患者进行视觉模拟评分（VAS）评估疼痛、肿胀情况以及开口度。在第7天评估伤口愈合情况。
与一期和二期闭合相比，颊黏膜推进瓣组患者的疼痛和肿胀明显减轻，开口度增加。一期闭合中有18例患者出现伤口裂开，4例患者出现干槽症。二期闭合中有6例患者出现伤口愈合延迟伴食物积聚。颊黏膜推进瓣组未观察到皮瓣裂开或破溃的并发症。
本研究得出结论，在下颌第三磨牙手术后，与一期和二期闭合相比，颊黏膜推进瓣技术是一种更优的闭合技术，具有疼痛轻、肿胀轻、张口受限少以及伤口愈合满意的特点。
