Trismus and pain after removal of a lower third molar. Effects of raising a mucoperiosteal flap.

OBJECTIVE: To investigate the effect of raising a mucoperiosteal flap on trismus and pain after extraction of an impacted lower third molar. STUDY DESIGN: We studied a consecutive series of 218 patients, all of whom underwent removal of an impacted lower third molar. Of the 218 patients, 52 (group A) underwent simple extraction without raising a mucoperiostal flap, 17 (group B) underwent extraction with raising of a mucoperiostal flap but without ostectomy, and 149 (group C) underwent extraction with both raising of a mucoperiostal flap and ostectomy (C). Trismus was evaluated as maximum interincisal distance (MID), determined before surgery and 1 and 5 days after surgery (MID0, MID1 and MID5 respectively). Pain was evaluated on the basis of reported analgesic use, likewise 1 and 5 days after surgery. RESULTS: In group A (no flap), there was no significant diference between MID0 and MID5; however MID1 was significantly lower than MID0. In groups B and C (flap), the difference between MID0 and MID1 was more marked, and in addition MID5 remained significantly lower than MID0. Neither MID0 nor MID5 differed significantly between group B (flap, no ostectomy) and group C (flap plus ostectomy). The proportion of group A subjects reporting analgesic use was significantly lower than the corresponding proportions in groups B and C on both day 1 and day 5, and again there were no significant differences between groups B and C.

Eosinophilic granuloma as a form of inflammatory reaction. A case report.

Eosinophilic granuloma consists of the proliferation and/or accumulation of Langerhans cells in the bones, generally of the cranium and face, as a uni- or multifocal cystic lesion. It is considered to be a localized chronic form of Langerhans cell disease. The most frequent oral location is the posterior part of the mandible, where the bone lesion often gives rise to lesions of the overlying soft tissues. We report a case showing bilateral involvement of the upper jaw and unilateral involvement of the mandible. The eosinophilic granulomas arose in association with odontogenic periapical infectious processes, suggesting that this disorder may be a form of inflammatory response.