Does Simultaneous 3rd Molar Extractions during Orthognathic Surgery Increase Complications? A follow-up

Introduction:

Prior to orthognathic surgery, most surgeons recommend interval 3^rd molar extraction.  Espoused reasons include potential risk for infection, untoward osteotomies, and worsened postoperative discomfort.  However, in addition to being another procedure for the patient, this may necessitate a longer pre-orthognathic surgery phase to allow for bone healing.  The purpose of this study is to compare the outcomes and complications of orthognathic surgery comparing staged versus simultaneous 3^rd molar extractions.      

Methods:

This was a retrospective analysis of patients who underwent orthognathic surgery at Yale by the senior author (DMS) from 2013-2014, with at least a 1-year follow-up period. Patients were stratified into two groups: 1. Extraction of 3rds molars at the time of orthognathic surgery and 2. Prior extraction of 3^rd molars. Primary outcomes  measured included the occurrence of unfavorable splits, infection, bleeding, malocclusion and hardware failure. Secondary outcome variables were procedure time, post-operative pain and length of stay. Pearson’s chi-squared tests were performed to determine if there was an association between the simultaneous removal of third molars and the primary outcome measures. Two tailed unpaired t-tests were performed to determine the effect of extractions on the secondary outcome measures. Statistical significance was determined to be p<0.05.

Results:

One hundred patients were included in the study. Forty-nine (49) patients had their third molars extracted at the time of surgery and fifty-one (51) did not. Only one patient had an unfavorable split. This occurred in the PE3M group. There were no cases of uncontrolled bleeding, inferior alveolar nerve transection, or anesthesia complications.

One patient in the E3M group and no patients in the PE3M group experienced a post-operative infection requiring incision and drainage. Mild post-operative bleeding, controlled with local measures, was encountered in 1 patient in each group. One patient in each group also had post-operative malocclusion. There was one case of hardware failure in the PE3M group. There was no statistically significant difference in the incidence of complications in both groups. Procedure time was not considerably increased when third molars were extracted. There was no statistically significant difference in post-operative pain or length of stay in the hospital between both groups.

Conclusions:

Removing 3^rd molars concurrently with orthognathic surgery does not increase risk of adverse outcomes or complications, nor does it significantly influence hospital course.