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| ORIGINAL ARTICLE |
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| Year : 2019 | Volume
: 6
| Issue : 3 | Page : 74-75 |
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A modification of ward's incision for third molar surgery
Uday Kiran Uppada
Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana, India
| Date of Submission | 19-Nov-2019 |
| Date of Acceptance | 22-Nov-2019 |
| Date of Web Publication | 23-Dec-2019 |
Correspondence Address:
Dr. Uday Kiran Uppada
Department of Oral and Maxillofacial Surgery, Sri Sai College of Dental Surgery, Vikarabad, Telangana
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jdrr.jdrr_66_19
Considering the fact that surgical removal of third molars is the most commonly performed minor oral surgical procedure lot of emphasis is given to prevent complications associated with the procedure. Most distinguished complications are associated with the flap design and soft tissue handling. This short communication highlights the fact that the distal release for the Ward's incision is not always necessary and can be avoided in certain clinical scenarios.
Keywords: Flap design, third molars, ward's incision
How to cite this article:
Uppada UK. A modification of ward's incision for third molar surgery. J Dent Res Rev 2019;6:74-5 |
| Introduction | |  |
Due to the plethora of indications associated with the surgical removal of impacted third molars, it inevitably becomes the most frequently performed minor oral surgical procedure. As regards any surgical intervention, the surgical removal of impacted third molars is also associated with numerous complications. Most notable complications among them are associated with flap design and soft-tissue handling in the vicinity of the surgical area.
| Technique | | |
We put forth a technical modification of the ward's incision in which the requirement of the distal limb is excluded. Our modified incision has two limbs, as shown in [Figure 1]. Limb A curves forward from the distobuccal corner of the crown of the second molar involving the interdental papilla of the lower second and third molars, runs downward and forward along the attached gingiva toward the vestibule and ends with a small curvature in the vestibule coinciding with the mesiobuccal line angle of that tooth. Limb B starts at the distobuccal corner of the crown of the second molar and runs all along the cervix of the third molar without any distal extension. Mucoperiosteal flap can be raised using a Molt's periosteal elevator from the interdental papilla running downward and backward to expose the impacted tooth, as shown in [Figure 2]. Following surgical removal of the impacted third molar, two sutures are placed to close the wound. The first suture is placed by taking the interdental papilla and suturing it to the lingual soft tissue just distal to the second molar, and the second suture is place across the extraction socket (Limb B). The little curvature that is given on the distal aspect of Limb A facilitates the advancement of the flap across the socket. Limb A is not sutured to facilitate drainage. | Figure 1: Diagrammatic depiction of modified ward's incision without distal release
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 | Figure 2: Clinical representation of modified ward's incision without distal release
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| Discussion | | |
Pain, trismus, and facial swelling following surgical removal of the third molar tooth are routine sequel due to inflammation.[1],[2] Majority of the tissue injury during surgical removal of impacted third molars occurs while raising a mucoperiosteal flap to gain access to the tooth.[3] Our flap design is very conservative owing to a lesser degree of tissue reflection without compromising on the surgical exposure. It is simple to suture and allows for relatively tension-free closure in addition to the fact that the incision line lies only on sound bone.
Trismus after third molar surgery is usually caused by excess striping of the soft tissue, leading to the inflammation and spasm secondary to the raising of a mucoperiosteal flap with the aid of a distal release incision. It can be advocated that the surgical removal of third molars using our flap design eliminates this complication due to the absence of the distal extension and excessive soft-tissue stripping. Even though, on the other hand, postoperative pain is not directly influenced by flap design, considering the fact that the smaller incision used with lesser soft-tissue reflection in addition to good soft-tissue handling during the procedure can reduce the postoperative pain compared to the other flap designs.
Literature states that flap design does not play a critical role in determining the periodontal health of the second molar, particularly when the bone was not removed distal to second molar.[4] Thus, the effect of flap design has more relevance to the immediate postsurgical period rather than as a long-term concern. This flap design can be indicated for partially erupted teeth, which are mesioangular or vertical impactions and completely erupted third molars with bulbous roots or heavily restored tooth that require surgical intervention. However, it cannot be used for distoangular impactions, horizontal impactions, and teeth, which are completely impacted by both soft and hard tissues.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published, and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | | |
| 1. | Peñarrocha M, Sanchis JM, Sáez U, Gay C, Bagán JV. Oral hygiene and postoperative pain after mandibular third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2001;92:260-4.  |
| 2. | Mangla M, Rajput L, Kumar A, Rathi V, Jain H, Kumar S. lingual triangular flap vs. triangular flap: A pilot study. Int J Oral Health Med Res 2017;4:62-4. |
| 3. | Kirk DG, Liston PN, Tong DC, Love RM. Influence of two different flap designs on incidence of pain, swelling, trismus, and alveolar osteitis in the week following third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007;104:e1-6. |
| 4. | Bodh R, Jain A. The flap design of third molar surgery: An overview Int J Med Health Res 2015;1:32-5. |
[Figure 1], [Figure 2]
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