Jitpreeda Nongpanga, Chinkrua Chonatee
Residency Training Program, Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chiang Mai University, Chiang Mai, Thailand.
Department of Oral and Maxillofacial Surgery, Faculty of Dentistry, Chiang Mai University, Suthep Rd, Muang Chiang Mai District, Chiang Mai, 50200, Thailand.
Oral Maxillofac Surg. 2025 Jun 18;29(1):124. doi: 10.1007/s10006-025-01420-9.
Delayed-onset infection (DOI) is an uncommon postoperative complication of lower third molar surgery, typically occurring around one month after the procedure. This study aimed to identify risk factors for DOI to support improved prevention and management.
A retrospective case-control study was conducted using records from patients who underwent lower third molar surgery between January 2015 and December 2022. Seventy-four cases of DOI were identified and matched to 296 controls in a 1:4 ratio. Univariable and conditional multivariable logistic regression analyses were employed to identify significant risk factors.
The incidence of DOI was 0.66%, with a mean onset of 36.5 days postoperatively. Univariable analysis revealed nine potential risk factors, mesioangular and horizontal impaction, including Pell & Gregory classification Class III, Position B and C, Nolla's stage ≤ 8, Ganss ratio ≤ 0.5, bone retention, and postgraduate/experienced operator. However, multivariable analysis identified three independent predictors: Pell & Gregory classification Class III (OR = 5.89, 95% CI: 1.52-22.79), Pell & Gregory classification Position B (OR = 4.19, 95% CI: 1.70-10.31), and postgraduate/experienced operator (OR = 4.54, 95% CI: 1.59-12.98).
Postgraduate/experienced operator, Pell & Gregory class III, and position B were identified as significant risk factors for DOI in our institution. Although the incidence is low, the potential impact on patient quality of life highlights the importance of early recognition, risk stratification, and close postoperative follow-up in high-risk individuals.
延迟性感染（DOI）是下颌第三磨牙手术一种不常见的术后并发症，通常在手术后约一个月发生。本研究旨在确定延迟性感染的危险因素，以支持改进预防和管理措施。
采用2015年1月至2022年12月期间接受下颌第三磨牙手术患者的记录进行回顾性病例对照研究。确定了74例延迟性感染病例，并按1:4的比例与296例对照进行匹配。采用单变量和条件多变量逻辑回归分析来确定显著的危险因素。
延迟性感染的发生率为0.66%，平均发病时间为术后36.5天。单变量分析揭示了九个潜在危险因素，包括近中角和水平阻生、佩尔&格雷戈里分类III类、位置B和C、诺拉分期≤8、甘斯比率≤0.5、骨存留以及研究生/经验丰富的手术医生。然而，多变量分析确定了三个独立预测因素：佩尔&格雷戈里分类III类（OR = 5.89，95%CI：1.52 - 22.79）、佩尔&格雷戈里分类位置B（OR = 4.19，95%CI：1.70 - 10.31）以及研究生/经验丰富的手术医生（OR = 4.54，95%CI：1.59 - 12.98）。
在我们机构中，研究生/经验丰富的手术医生、佩尔&格雷戈里III类以及位置B被确定为延迟性感染的显著危险因素。尽管发生率较低，但对患者生活质量的潜在影响凸显了早期识别、风险分层以及对高危个体进行密切术后随访的重要性。
