Fracturas mandibulares asociadas a extracción de terceros molares: una revisión sistemática

Abstract

This study aims to analyze the association between third molar surgery and mandibular fractures to provide information that can help surgeons prevent these fractures and offer guidance on the most appropriate treatments if they occur. A systematic review was conducted following PRISMA 2020 guidelines. A literature search was performed in PubMed and ScienceDirect using specific MeSH terms. Studies were selected based on the PICO model, focusing on human subjects and fractures related to TMS. Data were collected on various parameters including the type of fracture, symptoms, treatment, and timing of the fracture relative to the surgery. The initial search yielded 595 articles, which were narrowed down to 17 studies involving 106 patients. Postoperative fractures were more common (66 cases) compared to intraoperative fractures (40 cases). The average interval between surgery and fracture was 14 days, with the highest incidence in the first postoperative week. The most common symptoms were cracking sounds, pain, edema, and changes in occlusion. Fractures were mainly caused by mastication postoperatively and by the use of the Winter elevator intraoperatively. The most common treatments were intermaxillary fixation and open reduction internal fixation. When performing TMS, trans and postoperative risk factors should be evaluated, without applying excessive force and avoiding the use of the winter elevator. If there is a risk of fracture, the soft diet should be extended for up to 6 weeks. When a fracture occurs, its displacement should be assessed by HCT and according to this determine the most appropriate treatment option, which may be soft diet, IMF or ORIF.