Postoperative swelling and pain following impacted mandibular third molar surgery

Background: Surgical removal of impacted mandibular third molars is frequently associated with postoperative morbidity, particularly facial swelling and pain. The extent to which surgical difficulty and operative time influence these outcomes remains incompletely understood. Objective: To objectively evaluate postoperative facial swelling and pain following impacted mandibular third molar surgery and to investigate their association with surgical difficulty and operative time. Methods: This prospective observational study included 45 patients who underwent surgical extraction of impacted mandibular third molars between September and December 2025. Surgical difficulty was assessed preoperatively using a modified Pedersen difficulty index and categorized as low, moderate, or high. Facial swelling was measured using standardized linear facial measurements obtained at baseline and on post-operative days 2 and 7. Pain intensity was assessed using a 10-cm Visual Analog Scale (VAS) on postoperative days 1, 2, and 7. Associations between surgical variables and postoperative outcomes were analyzed using Spearman correlation and multivariable linear regression. Results: The mean operative time was 28.4 ± 8.6 minutes and increased significantly with surgical difficulty (p < 0.001). Facial swelling peaked on postoperative day 2 and decreased significantly by day 7 (p < 0.001). Surgical difficulty was positively correlated with swelling on day 2 (r = 0.52, p = 0.001) and pain on postoperative days 1 (r = 0.46, p = 0.002) and 2 (r = 0.41, p = 0.006). Operative time was also positively associated with swelling and pain during the early postoperative period. Multivariable regression identified surgical difficulty (β = 0.42, p = 0.002) and operative time (β = 0.31, p = 0.021) as independent predictors of post-operative swelling. Conclusions: Postoperative swelling and pain following impacted mandibular third molar surgery are significantly influenced by surgical difficulty and operative time. Preoperative difficulty assessment may help predict postoperative morbidity and improve patient counseling and treatment planning.