title: Influence of two different flap designs on incidence of pain, swelling, trismus, and alveolar osteitis in the week following third molar surgery.
abstract: OBJECTIVE
  To investigate the influence of flap design on postoperative trismus, pain, and swelling.
  
  
  METHODS
  Thirty-two patients with bilateral symmetrically impacted mandibular third molars participated in a randomized prospective split mouth study. Two flap designs were used: a buccal envelope flap and a modified triangular flap. Postoperative pain was recorded using a standardized visual analog scale. Postoperative swelling was evaluated using laser scans of models of the patient's cheek taken before and two days after surgery, with the scan area being calculated using MatLab software.
  
  
  RESULTS
  There were no statistical differences between the flap designs in terms of severity of postoperative pain or trismus. A statistically significant difference was observed in postoperative swelling at 2 days, with the modified triangular flap design being associated with increased swelling. The envelope flap design was associated with a higher incidence of alveolar osteitis.
  
  
  CONCLUSIONS
  The flap designs used in this study did not adversely affect patients in terms of postoperative pain and trismus, and although greater extraoral swelling was seen with the modified triangular flap design, the clinical relevance is debatable.
authors.affiliation: New Zealand Defence Force, Linton, New Zealand. glennk@ihug.co.nz <glennk@ihug.co.nz>
authors.forename: D Glenn
authors.initials: DG
authors.lastname: Kirk
authors.forename: Peter N
authors.initials: PN
authors.lastname: Liston
authors.forename: Darryl C
authors.initials: DC
authors.lastname: Tong
authors.forename: Robert M
authors.initials: RM
authors.lastname: Love
mesh_terms: D000293:Adolescent; D000328:Adult; D000539:Alveolar Process / Q000601:surgery*; D002610:Cheek / Q000601:surgery; D004487:Edema / Q000209:etiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008964:Molar, Third / Q000601:surgery*; D010000:Osteitis / Q000453:epidemiology / Q000209:etiology*; D010147:Pain Measurement; D010149:Postoperative Pain / Q000209:etiology; D013524:Surgical Flaps / Q000009:adverse effects*; D014081:Tooth Extraction / Q000009:adverse effects*; D014095:Tooth, Impacted / Q000601:surgery*; D014313:Trismus / Q000209:etiology