Comparison of Ward’s and Comma-shaped Incisions in Mandibular Third Molar Surgery: Impact on Postoperative Mouth Opening

Abstract

Background: An impacted tooth is defined as one that fails to erupt within the expected time frame of normal dental development. Evidence synthesized from a recent systematic review and meta-analysis indicates that tooth impaction is highly prevalent globally, with overall rates nearing 90% in the general population, and nearly one- third of individuals exhibiting at least one impacted third molar.

Objectives: This study aimed to compare the effect of Ward’s incision and the comma-shaped incision on postop- erative limitation of mouth opening (trismus) following surgical removal of impacted mandibular third molars.

Materials and Methods: A comparative interventional study was conducted at the Department of Oral and Maxil- lofacial Surgery, PIMS, Islamabad, over one year. A total of 114 patients aged 17–45 years requiring mandibular third molar extraction were randomly allocated into two groups: Group A (Ward’s incision, n=57) and Group B (comma-shaped incision, n=57). Standardized surgical protocols were followed, and patients were assessed for mouth opening (inter-incisal distance) on postoperative days 1, 3, and 7. Trismus was defined as <35 mm. Data were analyzed using SPSS version 25, and Chi-square tests determined statistical significance.

Result: The mean age of participants was 30.4 ± 6.8 years; females constituted 62.28% of the sample. On day 1, restricted mouth opening was more frequent in the Ward’s group, with 22.81% measuring 25–29 mm compared to only 5.26% in the comma group (p=0.001). By day 3, 54.39% of comma group patients achieved 40–44 mm versus 43.86% in Ward’s group (p=0.047). On day 7, significantly more patients in the comma group (29.82%) reached 55–50 mm compared to 7.02% in Ward’s group (p=0.00078). Overall, trismus was consistently less severe in the comma-shaped incision group.

Conclusions: The comma-shaped incision demonstrated superior outcomes, with reduced postoperative trismus and faster recovery of mouth opening compared to Ward’s incision. Careful flap selection, favoring the comma- shaped design, can significantly enhance patient recovery and minimize functional disability after third molar surgery.

Keywords: Impaction, Third Molar, Trismus, Postoperative Complications