Impact of Manual Lymphatic Drainage System on Post-Op Complications in Third Molar Surgery Patients
Introduction
Post-operative complications such as pain, swelling, and limited mouth opening are common in patients undergoing third molar surgery. Various techniques have been proposed for effective management of post-operative pain and inflammation. Use of manual lymphatic drainage (MLD) aids in manual drainage of blocked lymphatic fluid. MLD was originally introduced to manage lymphedema and reduce pain following cancer surgeries. The utility of MLD for the management of patients with oral and maxillofacial surgery has not been explored adequately till date.
Aim
To determine the impact of MLD on edema, pain and trismus after impacted mandibular third molar surgery.
Patient Profile
- Patients with bilateral impacted mandibular third molar teeth (N=46).
Methods
Study Design
- A split-mouth, single-blinded, controlled randomized clinical trial.
Treatment Strategy
The patients were randomized in study group and control group. Patients in the study group were administered MLD, following the surgery.
Assessments
- Edema, pain and trismus parameters were evaluated on the 3rd and 7th days after the extractions.
Outcomes
Primary Outcome
- Incidence of swelling
Secondary Outcomes
Incidence of pain [evaluated using the Visual Analog Scale (VAS)] and trismus (assessed with a digital caliper)
Results
- The mean age of the study population was 18.71 yrs. Of the entire study population, 30.4% were males and 69.6% were females.
- Patients in the MLD group had significantly lesser edema on days 3 (T0-T1) and 7 (T0-T2), as compared to the patients in the control group (Table 1).
Table 1: Swelling in the study population during the study period
|
Group |
Mean |
P value |
|
MLD T0-T1 |
1692550 |
< 0.001 |
|
MLD T0-T2 |
278674 |
|
|
C T0-T1 |
2633267 |
< 0.001 |
|
C T0-T2 |
1060857 |
|
|
MLD T0-T1 |
1692550 |
< 0.001 |
|
C T0-T1 |
2633267 |
|
|
MLD T0-T2 |
278674 |
< 0.001 |
|
C T0-T1 |
1060857 |
- The maximum mouth opening (MMO) on days 3 and 7 was significantly greater in the study group vs. the control group (Table 2).
Table 3: Difference in maximum mouth opening in the study population during the study period
|
Group |
Mean MMO |
P value |
|
MLD T0-T1 |
316957 |
< 0.001 |
|
MLD T0-T2 |
385652 |
|
|
C T0-T1 |
223478 |
< 0.001 |
|
C T0-T2 |
294783 |
|
|
MLD T0-T1 |
316957 |
< 0.001 |
|
C T0-T1 |
223478 |
|
|
MLD T0-T2 |
385652 |
< 0.001 |
|
C T0-T2 |
294783 |
- The post-operative pain levels in patients in the study group were lower on days 1, 2, 3, and 7, as compared to the patients in the control groups (Table 3).
Table 2: VAS score distribution in the study population during the study period
|
VAS |
MLD Group VAS Scores |
Control Groups VAS Scores |
||||||
|
Day 1 |
Day 2 |
Day 3 |
Day 7 |
Day 1 |
Day 2 |
Day 3 |
Day 7 |
|
|
Min |
0 |
0 |
0 |
0 |
1 |
0 |
0 |
0 |
|
Max |
10 |
7 |
7 |
2 |
10 |
10 |
10 |
7 |
|
Mean |
5 |
2 |
1 |
0 |
7 |
5 |
3 |
0 |
Conclusions
- The study found MLD technique to be useful for reducing postoperative morbidity after impacted third molar extraction.
- MLD provides a simple technique,
- free from undesirable side effects and may be more effective than classical methods in reducing edema, pain and trismus after third molar extraction.
BMC Oral Health. 2025;25:438: doi. 10.1186/s12903-025-05817-6.
