Читать книгу Management of Complications in Oral and Maxillofacial Surgery - Группа авторов - Страница 67

 Etiology: surgical trauma, duration of surgery

 Management: good surgical technique, steroids, analgesics, local anesthesia

Postoperative pain and swelling following third molar surgery are an expected and inevitable consequence of the inflammatory process of healing. The onset of swelling and pain is directly related to an increase in local levels of prostaglandins, leukotrienes, and thromboxane A2. Pain usually reaches its peak in three to five hours following surgery. On the other hand, edema reaches its peak in 24–48 hours, and then generally begins to decline on postoperative day 3 or 4. Contributing factors in the development of pain and swelling include increased operating time, difficulty in extraction, excessive retraction, surgeon experience, and the degree of surgical trauma [3, 4].

“Treatment” of swelling and pain can begin prophylactically prior to surgery. Preoperative IV steroids have been shown in multiple studies to decrease postoperative edema and pain, and improve health‐related quality of life [23]. During surgery, good surgical technique, copious irrigation, and the use of long‐lasting local anesthetics such as bupivacaine have been shown to decrease pain and swelling. Postoperative scheduled use of nonsteroidal anti‐inflammatory drugs (NSAIDs) has been shown more effective in pain reduction than narcotic medications, and as such, narcotics are more appropriately reserved for breakthrough pain [3, 4].