marie de boutray - Academia.edu (original) (raw)

Papers by marie de boutray

European Journal of Clinical Microbiology & Infectious Diseases, Mar 7, 2018

This work aims at describing the diversity of osteomyelitis of the jaw (OJ) and at assessing the ... more This work aims at describing the diversity of osteomyelitis of the jaw (OJ) and at assessing the relevance of a new method designed to avoid salivary contamination during bone sampling in order to improve microbiological analysis and clinical decision-making. We reviewed medical and microbiological data of patients with a suspected OJ based on clinical and/or CTscan signs and at least one bone sample made for microbiological analysis. During the study period, a new procedure for intraoral bone sampling was elaborated by surgeons and infectious diseases specialists authoring this article (based on stratified samples, cleaning of the surgical site and change of instruments between each sample). A comparison of the microbiological analyses between the two procedures was performed. From 2012 to 2017, 56 patients were included. Median age was 58 years (11-90), sex ratio: 1.24. Main risk factors were having a dental disease (n = 24) or cancer (n = 21). Nineteen patients with the new sample procedure were compared to 37 patients with standard procedure, especially non-cancer patients (n = 16 and 19, respectively). With the new procedure, a median of 3 (1-7) microorganisms per sample was recovered, vs. 7 (1-14) with the former (p < 0.001), a significant decrease of the microbial density was observed for all types of microbes, especially in deeper samples and cultures were more frequently sterile. The way sampling is managed deeply influences microbiological analysis. This strategy facilitates the distinction between pathogens and contaminants and should constitute the first step toward an evidence-based antimicrobial strategy for OJ.

European Annals of Otorhinolaryngology, Head and Neck Diseases, 2020

Planning of free fibula flaps for mandibular reconstruction improves the quality of conformation ... more Planning of free fibula flaps for mandibular reconstruction improves the quality of conformation and reduces the operating time. Many methods based on modeling and 3D printing have been described with excellent results, but planning and production of custom-made guides and/or plates are often timeconsuming and expensive. In this article, we describe our 3D printing-assisted free fibula flap planning method, routinely performed exclusively by the surgical team in less than 72 hours, compatible with urgent cancer management. Fibula and mandible models were printed by using preoperative CT data. The mandibular resection, the length of fibula and the number of osteotomies and their angles were planned on the printed models. Titanium fixation plates were then conformed on the printed model and sterilized prior to surgery and templates were made to guide fibula osteotomies. Preliminary analysis based on 7 cases shows a reduction of conformation time with good clinical and radiological results. This 3D printing-assisted planning technique is simple, cost-effective and readily reproducible, allowing mandibular reconstruction with good cosmetic and functional results.

International Journal of Oral and Maxillofacial Surgery, May 1, 2022

Otolaryngology-Head and Neck Surgery, May 3, 2022

Plastic and Reconstructive Surgery, Apr 5, 2022

BACKGROUND De-epithelialized flaps have been used in gluteal contouring over the last three decad... more BACKGROUND De-epithelialized flaps have been used in gluteal contouring over the last three decades, but most improve the projection rather than the upper quadrants. The authors provide a detailed description of their method of gluteal augmentation using parasacral perforator-pedicled propeller flaps. This technique achieves a volumetric increase and maximal buttock projection at the midlevel and in the medial half of the buttocks. METHODS Between January and December of 2019, a series of 18 patients on whom a lower body lift with a parasacral perforator-pedicled propeller flap had been performed by the senior author (F.B.) were prospectively evaluated. Postoperatively, the satisfaction rate was assessed using a 10-point analog scale (1 = unsatisfied, 10 = very satisfied) by the patient and by two independent surgeons based on photographs taken 1 year after surgery. RESULTS Eighteen patients underwent this procedure. Their mean age was 32.2 ± 5.6 years (range, 24 to 40 years). The mean flap length was 20.3 cm, their mean width was 10.4 cm, and the mean thickness was 3.4 cm. The authors noted only two minor complications, one seroma and two skin dehiscences that healed without surgery. The rate of satisfaction as assessed by the patients was 8.3 out of 10 (±1.1) and by surgeons was 7.9 and 8.1. CONCLUSION This article describes a gluteal autoaugmentation flap technique using parasacral perforator-pedicled propeller flaps to increase projection and volume in the inferomedial gluteal region after lower body lift. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.

Journal of Stomatology, Oral and Maxillofacial Surgery, Jun 16, 2021

We report comparative results, over three months, of the impact of SARS-CoV2 in our patients inje... more We report comparative results, over three months, of the impact of SARS-CoV2 in our patients injected with botulinum toxin for functional purposes, compared to the general population. Botulinum neurotoxin type A (BoNT/A) is known to block acetylcholine (ACh) as well as many other neuroreceptors and neuromodulators. The recent mention of a potential protective effect of nicotine in Covid 19, by blocking ACh, attracted our attention and guided the present study. Our results show a significant difference between the number of infected individuals in the general population and the number of patients injected with BoNT/A who showed signs of Covid 19.

65ème Congrès de la SFCO, 2017

Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, 2020

Resume La planification de lambeaux libres fibulaires en reconstruction mandibulaire permet d’ame... more Resume La planification de lambeaux libres fibulaires en reconstruction mandibulaire permet d’ameliorer la qualite de la conformation et de diminuer le temps operatoire. De nombreux procedes bases sur la modelisation et l’impression 3D ont ete decrits avec d’excellents resultats. Cependant, le temps de planification et de fabrication des guides et/ou plaques sur mesure est souvent long et leur cout reste eleve. L’objectif de notre etude etait de decrire une methode de planification des lambeaux libres fibulaires, pouvant etre realisee de facon autonome et rapide par l’equipe chirurgicale, afin d’etre compatible avec des delais de prise en charge en oncologie. Les modeles fibulaires et mandibulaires etaient imprimes. La resection mandibulaire, la longueur et le nombre de fragments fibulaires et les angles des osteotomies etaient planifies sur les modeles imprimes. Les plaques d’osteosynthese etaient conformees sur le montage imprime puis sterilisees pour la chirurgie et des calques etaient realises pour guider les osteotomies fibulaires. L’etude preliminaire sur 7 cas montre une diminution du temps de conformation et un bon resultat clinique et radiologique. Cette technique de planification est simple, peu couteuse et reproductible. Elle permet une anticipation de la reconstruction avec de bons resultats esthetiques et fonctionnels.

Journal of Stomatology, Oral and Maxillofacial Surgery, 2018

Tessier clefts are a very rare entity. Number 4 Tessier cleft is describe like an orbito-facial c... more Tessier clefts are a very rare entity. Number 4 Tessier cleft is describe like an orbito-facial cleft with trajectory between the lower eyelid and the lip. We report management of a bilateral number 4 Tessier cleft with amniotic band syndrome with 22 years of follow-up. After reviewing literature, we talk about difficulty to manage these kinds of rare Tessier clefts.

International Journal of Oral and Maxillofacial Surgery, 2021

The coronavirus disease 2019 (COVID-19) outbreak has had a major impact on medical and surgical a... more The coronavirus disease 2019 (COVID-19) outbreak has had a major impact on medical and surgical activities. A decline in facial trauma incidence was noticed during the lockdown period. The aim of this study was to evaluate the decline in maxillofacial trauma in France during this particular period. A retrospective multicentre comparative study was initiated in 13 major French public hospital centres. The incidence of facial trauma requiring surgery during the first month of lockdown was compared to that during equivalent periods in 2018 and 2019. Differences in the types of trauma were also analysed. Thirteen maxillofacial departments participated in the study. A significant decline in maxillofacial trauma volumes was observed when compared to equivalent periods in 2018 and 2019 (106 patients compared to 318 and 296 patients, respectively), with an average reduction of 65.5% (P = 0.00087). The proportion of trauma due to sports and leisure was reduced when compared to reports in the literature. As a consequence, in the context of a pandemic, the material and human resources related to this activity could be reallocated to the management of other pathologies that cannot be postponed.

Journal of Stomatology, Oral and Maxillofacial Surgery, 2018

Introduction: The omental free flap is an effective tool for craniofacial reconstruction. However... more Introduction: The omental free flap is an effective tool for craniofacial reconstruction. However it is generally under-utilised by a large number of practitioners. This paper's goal is to increase awareness of this free flap's accessibility and to demonstrate that it can be an attractive option for reconstructive surgery. Clinical report: This article outlines the details of a 57-year-old patient who required coverage of a fronto-parietal wound with dura mater exposure. After previous failed conventional free flap attempts, a procedure using the omental free flap was finally performed on this severe wound. The omentum was harvested via a 8cm laparotomy and anastomosed to the temporal vessels. The final result was successful, with a favorable aesthetic result. Discussion: The omental free flap has many advantages: the pedicle length is long, it allows coverage of a large wound, it can be applied to a wound bed previously irradiated and infected, it has a low morbidity rate to the donor site, the surgical technique of harvesting is easy, the aesthetic result is satisfactory. However, the absence of skin slice is a disadvantage of the omental free flap because it makes monitoring difficult and it requires a skin graft in a second procedure. Laparoscopic harvest of omentum free flaps is a safe and effective tool in the reconstructive armamentarium. Every maxillofacial and plastic surgeon should aim to master and use this method as a legitimate option in some infrequent but appropriated cases.

Médecine et Maladies Infectieuses, 2018

Médecine et maladies infectieuses xxx (2017) xxx-xxx Lettre à la rédaction Dirofilariose autochto... more Médecine et maladies infectieuses xxx (2017) xxx-xxx Lettre à la rédaction Dirofilariose autochtone intra-musculaire temporale Autochthonous dirofilariasis in the temporal muscle

Journal of Stomatology, Oral and Maxillofacial Surgery, 2020

Journal of Stomatology, Oral and Maxillofacial Surgery, 2019

Médecine et Maladies Infectieuses, 2017

Médecine et maladies infectieuses 47S (2017) S82-S87 18 es Journées nationales d'infectiologie Po... more Médecine et maladies infectieuses 47S (2017) S82-S87 18 es Journées nationales d'infectiologie Posters : infections ostéoarticulaires IOA-01 Apport du test moléculaire multiplex ITI G2 au diagnostic des infections ostéoarticulaires (IOA)

Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, 2021

International Journal of Computer Assisted Radiology and Surgery

Fibula free flap is currently used in mandibular reconstruction. The main difficulties involved i... more Fibula free flap is currently used in mandibular reconstruction. The main difficulties involved in this surgery concern mandible shaping and therefore, osteotomy positioning on the fibula. The use of navigation could help in osteotomy positioning, but accurate registration is required. We assess a surface-matching method for fibula registration that relies on an iterative closest point (ICP) algorithm. Since the fibula shape is landmark free, a robust registration initialization approach is used to avoid non-optimal local minimums in the ICP. Bone surface-matching registration was evaluated on a 3D printed fibula and compared to its virtual reference model. The registration initialization relied on 3 initialization points placed on the surgically exposed area, geometrically remote from the fibular distal extremity. The bone surface was digitized, and the obtained point clouds were registered to the virtual reference model. The position of 3 assessment points engraved on the 3D printed fibula was then compared to that of the equivalent points on the virtual model. The registration procedure was performed 24 times by an expert surgeon. Seventy-two target registration errors (TRE) were computed, corresponding to the distance between the paired assessment points. Most TRE (86.1%) were less than 1 mm, with a maximum of 1.552 mm. The overall mean value was 0.759 ± 0.302 mm. This study illustrates a surface-matching approach for fibula registration, with an initialization method based on points remote from the fibula distal extremity. This registration technique gave promising results and should be considered as a valid registration method for straight bones like the fibula. These findings indicate that navigation can be used for fibula flap shaping for mandibular reconstruction, with a noninvasive and accurate registration method.

Journal of Stomatology, Oral and Maxillofacial Surgery

Background: Although wisdom-tooth extraction is a routine intervention, the postoperative period ... more Background: Although wisdom-tooth extraction is a routine intervention, the postoperative period remains marked by local inflammation classically manifesting as pain, edema and trismus. Furthermore, there is no consensus on the best operative techniques, particularly for the mucosal closure stage on impacted mandibular wisdom teeth. Methods: This parallel, randomized, non-blinded study compared pain following removal of impacted third molars, with and without sutures. Patients were electronically allocated 1:1 to extraction with versus without sutures. Patients ≥14 years’ old scheduled for extraction of four impacted wisdom teeth under general anesthesia at three French hospitals were eligible for inclusion. Exclusion criteria included taking antiplatelet agents or anticoagulants, coagulation disorders or immunosuppression, and planned orofacial surgical procedures or emergency pain/infection. The primary objective was pain evaluated by Visual Analogue Scale on Day 3. Secondary outc...

European Journal of Clinical Microbiology & Infectious Diseases, Mar 7, 2018

This work aims at describing the diversity of osteomyelitis of the jaw (OJ) and at assessing the ... more This work aims at describing the diversity of osteomyelitis of the jaw (OJ) and at assessing the relevance of a new method designed to avoid salivary contamination during bone sampling in order to improve microbiological analysis and clinical decision-making. We reviewed medical and microbiological data of patients with a suspected OJ based on clinical and/or CTscan signs and at least one bone sample made for microbiological analysis. During the study period, a new procedure for intraoral bone sampling was elaborated by surgeons and infectious diseases specialists authoring this article (based on stratified samples, cleaning of the surgical site and change of instruments between each sample). A comparison of the microbiological analyses between the two procedures was performed. From 2012 to 2017, 56 patients were included. Median age was 58 years (11-90), sex ratio: 1.24. Main risk factors were having a dental disease (n = 24) or cancer (n = 21). Nineteen patients with the new sample procedure were compared to 37 patients with standard procedure, especially non-cancer patients (n = 16 and 19, respectively). With the new procedure, a median of 3 (1-7) microorganisms per sample was recovered, vs. 7 (1-14) with the former (p < 0.001), a significant decrease of the microbial density was observed for all types of microbes, especially in deeper samples and cultures were more frequently sterile. The way sampling is managed deeply influences microbiological analysis. This strategy facilitates the distinction between pathogens and contaminants and should constitute the first step toward an evidence-based antimicrobial strategy for OJ.

European Annals of Otorhinolaryngology, Head and Neck Diseases, 2020

Planning of free fibula flaps for mandibular reconstruction improves the quality of conformation ... more Planning of free fibula flaps for mandibular reconstruction improves the quality of conformation and reduces the operating time. Many methods based on modeling and 3D printing have been described with excellent results, but planning and production of custom-made guides and/or plates are often timeconsuming and expensive. In this article, we describe our 3D printing-assisted free fibula flap planning method, routinely performed exclusively by the surgical team in less than 72 hours, compatible with urgent cancer management. Fibula and mandible models were printed by using preoperative CT data. The mandibular resection, the length of fibula and the number of osteotomies and their angles were planned on the printed models. Titanium fixation plates were then conformed on the printed model and sterilized prior to surgery and templates were made to guide fibula osteotomies. Preliminary analysis based on 7 cases shows a reduction of conformation time with good clinical and radiological results. This 3D printing-assisted planning technique is simple, cost-effective and readily reproducible, allowing mandibular reconstruction with good cosmetic and functional results.

International Journal of Oral and Maxillofacial Surgery, May 1, 2022

Otolaryngology-Head and Neck Surgery, May 3, 2022

Plastic and Reconstructive Surgery, Apr 5, 2022

BACKGROUND De-epithelialized flaps have been used in gluteal contouring over the last three decad... more BACKGROUND De-epithelialized flaps have been used in gluteal contouring over the last three decades, but most improve the projection rather than the upper quadrants. The authors provide a detailed description of their method of gluteal augmentation using parasacral perforator-pedicled propeller flaps. This technique achieves a volumetric increase and maximal buttock projection at the midlevel and in the medial half of the buttocks. METHODS Between January and December of 2019, a series of 18 patients on whom a lower body lift with a parasacral perforator-pedicled propeller flap had been performed by the senior author (F.B.) were prospectively evaluated. Postoperatively, the satisfaction rate was assessed using a 10-point analog scale (1 = unsatisfied, 10 = very satisfied) by the patient and by two independent surgeons based on photographs taken 1 year after surgery. RESULTS Eighteen patients underwent this procedure. Their mean age was 32.2 ± 5.6 years (range, 24 to 40 years). The mean flap length was 20.3 cm, their mean width was 10.4 cm, and the mean thickness was 3.4 cm. The authors noted only two minor complications, one seroma and two skin dehiscences that healed without surgery. The rate of satisfaction as assessed by the patients was 8.3 out of 10 (±1.1) and by surgeons was 7.9 and 8.1. CONCLUSION This article describes a gluteal autoaugmentation flap technique using parasacral perforator-pedicled propeller flaps to increase projection and volume in the inferomedial gluteal region after lower body lift. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, IV.

Journal of Stomatology, Oral and Maxillofacial Surgery, Jun 16, 2021

We report comparative results, over three months, of the impact of SARS-CoV2 in our patients inje... more We report comparative results, over three months, of the impact of SARS-CoV2 in our patients injected with botulinum toxin for functional purposes, compared to the general population. Botulinum neurotoxin type A (BoNT/A) is known to block acetylcholine (ACh) as well as many other neuroreceptors and neuromodulators. The recent mention of a potential protective effect of nicotine in Covid 19, by blocking ACh, attracted our attention and guided the present study. Our results show a significant difference between the number of infected individuals in the general population and the number of patients injected with BoNT/A who showed signs of Covid 19.

65ème Congrès de la SFCO, 2017

Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, 2020

Resume La planification de lambeaux libres fibulaires en reconstruction mandibulaire permet d’ame... more Resume La planification de lambeaux libres fibulaires en reconstruction mandibulaire permet d’ameliorer la qualite de la conformation et de diminuer le temps operatoire. De nombreux procedes bases sur la modelisation et l’impression 3D ont ete decrits avec d’excellents resultats. Cependant, le temps de planification et de fabrication des guides et/ou plaques sur mesure est souvent long et leur cout reste eleve. L’objectif de notre etude etait de decrire une methode de planification des lambeaux libres fibulaires, pouvant etre realisee de facon autonome et rapide par l’equipe chirurgicale, afin d’etre compatible avec des delais de prise en charge en oncologie. Les modeles fibulaires et mandibulaires etaient imprimes. La resection mandibulaire, la longueur et le nombre de fragments fibulaires et les angles des osteotomies etaient planifies sur les modeles imprimes. Les plaques d’osteosynthese etaient conformees sur le montage imprime puis sterilisees pour la chirurgie et des calques etaient realises pour guider les osteotomies fibulaires. L’etude preliminaire sur 7 cas montre une diminution du temps de conformation et un bon resultat clinique et radiologique. Cette technique de planification est simple, peu couteuse et reproductible. Elle permet une anticipation de la reconstruction avec de bons resultats esthetiques et fonctionnels.

Journal of Stomatology, Oral and Maxillofacial Surgery, 2018

Tessier clefts are a very rare entity. Number 4 Tessier cleft is describe like an orbito-facial c... more Tessier clefts are a very rare entity. Number 4 Tessier cleft is describe like an orbito-facial cleft with trajectory between the lower eyelid and the lip. We report management of a bilateral number 4 Tessier cleft with amniotic band syndrome with 22 years of follow-up. After reviewing literature, we talk about difficulty to manage these kinds of rare Tessier clefts.

International Journal of Oral and Maxillofacial Surgery, 2021

The coronavirus disease 2019 (COVID-19) outbreak has had a major impact on medical and surgical a... more The coronavirus disease 2019 (COVID-19) outbreak has had a major impact on medical and surgical activities. A decline in facial trauma incidence was noticed during the lockdown period. The aim of this study was to evaluate the decline in maxillofacial trauma in France during this particular period. A retrospective multicentre comparative study was initiated in 13 major French public hospital centres. The incidence of facial trauma requiring surgery during the first month of lockdown was compared to that during equivalent periods in 2018 and 2019. Differences in the types of trauma were also analysed. Thirteen maxillofacial departments participated in the study. A significant decline in maxillofacial trauma volumes was observed when compared to equivalent periods in 2018 and 2019 (106 patients compared to 318 and 296 patients, respectively), with an average reduction of 65.5% (P = 0.00087). The proportion of trauma due to sports and leisure was reduced when compared to reports in the literature. As a consequence, in the context of a pandemic, the material and human resources related to this activity could be reallocated to the management of other pathologies that cannot be postponed.

Journal of Stomatology, Oral and Maxillofacial Surgery, 2018

Introduction: The omental free flap is an effective tool for craniofacial reconstruction. However... more Introduction: The omental free flap is an effective tool for craniofacial reconstruction. However it is generally under-utilised by a large number of practitioners. This paper's goal is to increase awareness of this free flap's accessibility and to demonstrate that it can be an attractive option for reconstructive surgery. Clinical report: This article outlines the details of a 57-year-old patient who required coverage of a fronto-parietal wound with dura mater exposure. After previous failed conventional free flap attempts, a procedure using the omental free flap was finally performed on this severe wound. The omentum was harvested via a 8cm laparotomy and anastomosed to the temporal vessels. The final result was successful, with a favorable aesthetic result. Discussion: The omental free flap has many advantages: the pedicle length is long, it allows coverage of a large wound, it can be applied to a wound bed previously irradiated and infected, it has a low morbidity rate to the donor site, the surgical technique of harvesting is easy, the aesthetic result is satisfactory. However, the absence of skin slice is a disadvantage of the omental free flap because it makes monitoring difficult and it requires a skin graft in a second procedure. Laparoscopic harvest of omentum free flaps is a safe and effective tool in the reconstructive armamentarium. Every maxillofacial and plastic surgeon should aim to master and use this method as a legitimate option in some infrequent but appropriated cases.

Médecine et Maladies Infectieuses, 2018

Médecine et maladies infectieuses xxx (2017) xxx-xxx Lettre à la rédaction Dirofilariose autochto... more Médecine et maladies infectieuses xxx (2017) xxx-xxx Lettre à la rédaction Dirofilariose autochtone intra-musculaire temporale Autochthonous dirofilariasis in the temporal muscle

Journal of Stomatology, Oral and Maxillofacial Surgery, 2020

Journal of Stomatology, Oral and Maxillofacial Surgery, 2019

Médecine et Maladies Infectieuses, 2017

Médecine et maladies infectieuses 47S (2017) S82-S87 18 es Journées nationales d'infectiologie Po... more Médecine et maladies infectieuses 47S (2017) S82-S87 18 es Journées nationales d'infectiologie Posters : infections ostéoarticulaires IOA-01 Apport du test moléculaire multiplex ITI G2 au diagnostic des infections ostéoarticulaires (IOA)

Annales françaises d'Oto-rhino-laryngologie et de Pathologie Cervico-faciale, 2021

International Journal of Computer Assisted Radiology and Surgery

Fibula free flap is currently used in mandibular reconstruction. The main difficulties involved i... more Fibula free flap is currently used in mandibular reconstruction. The main difficulties involved in this surgery concern mandible shaping and therefore, osteotomy positioning on the fibula. The use of navigation could help in osteotomy positioning, but accurate registration is required. We assess a surface-matching method for fibula registration that relies on an iterative closest point (ICP) algorithm. Since the fibula shape is landmark free, a robust registration initialization approach is used to avoid non-optimal local minimums in the ICP. Bone surface-matching registration was evaluated on a 3D printed fibula and compared to its virtual reference model. The registration initialization relied on 3 initialization points placed on the surgically exposed area, geometrically remote from the fibular distal extremity. The bone surface was digitized, and the obtained point clouds were registered to the virtual reference model. The position of 3 assessment points engraved on the 3D printed fibula was then compared to that of the equivalent points on the virtual model. The registration procedure was performed 24 times by an expert surgeon. Seventy-two target registration errors (TRE) were computed, corresponding to the distance between the paired assessment points. Most TRE (86.1%) were less than 1 mm, with a maximum of 1.552 mm. The overall mean value was 0.759 ± 0.302 mm. This study illustrates a surface-matching approach for fibula registration, with an initialization method based on points remote from the fibula distal extremity. This registration technique gave promising results and should be considered as a valid registration method for straight bones like the fibula. These findings indicate that navigation can be used for fibula flap shaping for mandibular reconstruction, with a noninvasive and accurate registration method.

Journal of Stomatology, Oral and Maxillofacial Surgery

Background: Although wisdom-tooth extraction is a routine intervention, the postoperative period ... more Background: Although wisdom-tooth extraction is a routine intervention, the postoperative period remains marked by local inflammation classically manifesting as pain, edema and trismus. Furthermore, there is no consensus on the best operative techniques, particularly for the mucosal closure stage on impacted mandibular wisdom teeth. Methods: This parallel, randomized, non-blinded study compared pain following removal of impacted third molars, with and without sutures. Patients were electronically allocated 1:1 to extraction with versus without sutures. Patients ≥14 years’ old scheduled for extraction of four impacted wisdom teeth under general anesthesia at three French hospitals were eligible for inclusion. Exclusion criteria included taking antiplatelet agents or anticoagulants, coagulation disorders or immunosuppression, and planned orofacial surgical procedures or emergency pain/infection. The primary objective was pain evaluated by Visual Analogue Scale on Day 3. Secondary outc...