Dexamethasone injection into the pterygomandibular space in lower third molar surgery.

The objective of this study was to evaluate the effects of 8mg dexamethasone injection into the pterygomandibular space on the postoperative sequelae of lower third molar surgery. A prospective, randomized, controlled, split-mouth study was designed involving 62 lower third molar extractions (31 patients). Prior to surgery, the study group received 2ml of 4mg/ml (8mg) dexamethasone injection through the pterygomandibular space following local anaesthesia; the control group received 2ml normal saline injection. Facial swelling, mouth opening, pain on a visual analogue scale (VAS), and the number of analgesics consumed were assessed. Descriptive statistics and the independent-samples t-test were used to compare the two groups at P<0.05. There was a significant reduction in swelling on day 2 postoperative in the dexamethasone group. Mouth opening was also significantly greater on day 2 in the dexamethasone group. The VAS pain score was significantly lower on the day of the operation and first postoperative day in the dexamethasone group, but did not differ significantly between the groups on the other postoperative days. The injection of 8mg dexamethasone into the pterygomandibular space was effective in reducing postoperative swelling, limited mouth opening, and pain following impacted lower third molar extraction.

Mandibular third molar surgery with primary closure and tube drain.

The insertion of a small surgical tube drain with primary wound closure (drain group) was compared to a simple primary wound closure (no drain group) after removal of impacted third molars. Surgery was performed on 23 patients in a randomized cross-over fashion. The operation time was found to be significantly longer and mouth opening significantly wider in the immediate postoperative period in the drain group subjects as compared to the no drain group (P > or = 0.01). There was no significant difference in the severity of pain between the two groups. Facial swelling was found to be significantly less in the drain group subjects (P > or = 0.01). The number of patients with wound breakdown, edema, and bleeding was found to be less in the drain group than in the no drain group. Thus, the postoperative problems, in general, were less in the small surgical drain group as compared to the no drain group.

Clinically significant oroantral communications--a study of incidence and site.

The incidence of clinically significant oroantral communications (OACs) after simple tooth extraction during the period 1980-9, at the Faculty of Dentistry, Mahidol University, Bangkok, Thailand, was studied retrospectively. The total number of OACs was 87. The tooth most frequently involved was the upper first molar, followed by the second and third molars. The difference, however, was not statistically significant (P > 0.05). The sockets of the palatal roots of the first and the second molars were most frequently involved. There was no statistically significant difference between the incidence of OACs on the right and the left sides (P > 0.05).

Area extent anaesthesia from buccal nerve block.

This study investigated the extent of complete anaesthesia from buccal nerve block. 40 healthy Thai patients (20 males; 20 females) requiring buccal nerve block for surgery were studied. After the buccal nerve was blocked, the buccal mucosa was explored using a sharp probe to map out the extent of anaesthesia. The operation was carried out after inferior alveolar and lingual nerve block. The extent of the anaesthesia was mainly from the retromolar area to the second molar, followed by the first molar to the second premolar, whilst the first premolar to the central incisor was the area least affected. An important finding of this study was that the anaesthetized extent of some patients extended to the anterior region on the same quadrant. This study showed the affected areas of buccal nerve anaesthesia extended through the buccal mucosa from the first premolar to the central incisor in some patients. It can serve as another informative indication for lower anterior surgery.