Effectiveness of dexamethasone injection in the pterygomandibular space before and after lower third molar surgery

Efficacy of Dexamethasone Injection at Different Sites on Postoperative Sequelae After Extracting Mandibular Impacted Third Molars: A Randomized Controlled Trial

BACKGROUND

Dexamethasone, an efficacious anti-inflammatory agent, is widely used after tooth extraction. However, its optimal injection site is yet to be investigated.

PURPOSE

We compare the efficacy of dexamethasone injection at different sites on postoperative sequelae after extracting mandibular impacted third molars (MITMs).

STUDY DESIGN, SETTING, AND SAMPLE

A prospective randomized controlled trial was conducted. Healthy adults with fully MITMs scheduled for extraction were included. Exclusion criteria were 1) patients with the systemic alteration that prevented the surgical procedure; 2) pregnancy, breastfeeding, and premenstrual period; 3) hypersensitivity to the drug under test; and 4) those who did not return for postoperative follow-up at 1, 3, and 7 days.

EXPOSURE VARIABLE

The subjects were randomized to 3 groups. An online randomization plan generator assigned each subject to a single treatment by randomly permuting blocks. Different sites for postoperative dexamethasone injections included the buccal side of the adjacent second molar and extraction sockets. Dexamethasone injection (4 mg) on the buccal side of the adjacent second molar (group 1), an injection on the buccal side of extraction sockets (group 2), and an injection of physiological saline (0.8 mL) on the buccal side of the adjacent second molar (control).

MAIN OUTCOME VARIABLES

The outcome variables were postoperative facial swelling, limitation of the mouth opening, postoperative pain, and postoperative quality of life evaluation. The pain was assessed using a visual analog scale at 1, 3, and 7 days, postoperatively. The quality of life was recorded throughout the Posse scale at 7 days.

COVARIATES

The covariates are age, sex, length of operation, and type of impacted teeth and surgery.

ANALYSES

The statistical analysis was performed using analysis of variance, repeated measures analysis of variance, χ2 test, or Fisher's exact tests with P values < .05 considered statistically significant.

RESULTS

Our study included 58 participants with a mean age of 19.48 ± 3.31 years; group 1 (n = 24), group 2 (n = 20), and control group (n = 14). On day 3 postoperative, the swelling and trismus were significantly less in group 1 than in the other 2 groups (P < .05), and group 1 had an overall postoperative quality of life compared to other groups (P < .05). Unaffected speech function was present in 73.7% of patients in group 1, while 50% of patients in group 2 had affected speech function 3 days after the operation (P < .05). The "unable to open mouth" of the "Eating subscale" and "felt tingling" had statistical significance (P < .05).

CONCLUSION AND RELEVANCE

Dexamethasone injections on the buccal side of the adjacent second molar can be a viable option for treating facial swelling and limitation of mouth opening after total MITMs extraction.

Does Betamethasone Injection Into the Pterygomandibular Space Affect the Postoperative Outcomes of Impacted Lower Third Molar Surgery?

BACKGROUND

Pain, swelling, and trismus are common outcomes following impacted lower third molar surgery.

PURPOSE

The purpose of the study was to evaluate the effect of betamethasone injection into the pterygomandibular space on the aforementioned sequelae of third molar surgery.

STUDY DESIGN, SETTING, AND SAMPLE

A split-mouth, double-blind, randomized clinical trial was conducted on 40 patients with symmetrical bilateral impacted lower third molars. The surgeries were performed at an outpatient clinic under local anesthesia.

PREDICTOR/EXPOSURE/INDEPENDENT VARIABLE

The predictor variable is the steroid treatment. The experimental group received a 1 mL (6 mg) betamethasone injection into the pterygomandibular space, while the control group received a normal saline.

MAIN OUTCOME VARIABLE(S)

The primary outcome variable was postoperative pain assessed using a visual analog scale. The secondary outcome variables were the number of analgesic tablets consumed, facial swelling, and trismus.

COVARIATES

The age and sex of the patients, the direction of impaction, and the duration of surgery were recorded.

ANALYSES

Comparisons between the groups were carried out using an unpaired t test. An analysis of variance test was used to assess intragroup differences. The significance was considered at P ≤ .05.

RESULTS

Of the 265 patients initially screened for study enrollment, the final sample included 40 subjects, with a mean age of 28.3 years (±7.4), 28 (70%) were mal and 12 (30%) were female. There was no significant difference between the two groups concerning postoperative pain or the number of consumed analgesic tablets. However, the betamethasone group exhibited significantly reduced facial swelling and increased mouth opening. On the first postoperative day, the visual analog scale pain score did not significantly differ between the betamethasone group (6.0 ± 1.7) and the control group (6.8 ± 1.4), with a P value of 0.112. On the first postoperative day, facial swelling measured 4.2 ± 1.3 mm in the betamethasone group compared to 6.0 ± 0.9 mm in the control group (P < .001). Mouth opening in the betamethasone group was 30.8 ± 6.7 mm, while in the control group, it measured 21.9 ± 5.5 mm (P < .001).

CONCLUSION AND RELEVANCE

Local betamethasone has no effect on pain after third molar surgery, but facial swelling and trismus are significantly reduced.

The Influence of Bolus of Methylprednisolone on Postorthognathic Surgery Symptoms: A Controlled Clinical Trial

OBJECTIVE

Despite improvements in maxillary and mandibular osteotomy, complications still result in around 20%. Post and intraoperative standard therapies, based on the use of betamethasone and tranexamic acid, could help to minimize the onset of side effects. The aim of the study was to compare the role of a supplementary bolus of methylprednisolone rather than the standard therapy in the onset of postoperative symptoms.

METHODS

The authors enrolled 10 patients, affected by class 2 and 3 Dentoskeletal, submitted to the institution for maxillomandibular repositioning osteotomy between October 2020 and April 2021. Patients were divided into 2 groups as follows: 5 patients (group A ) received standard therapy consisting of the administration of 4 mg of betamethasone, intraoperatively, and 1 g of tranexamic acid in 2 administrations. The remaining 5 patients (group B ) received a supplementary bolus of 20 mg methylprednisolone before the end of the surgery.All patients received, in the postoperative period, 4 mg of betamethasone every 12 hours, for 3 days. Postoperative outcomes were evaluated with a questionnaire evaluating speaking discomfort, pain when swallowing, feeding discomfort, drinking discomfort, swelling, and ache. Each parameter was associated with a numeric rating scale ranging from 0 to 5.

RESULTS

The authors observed that patients treated with a supplementary bolus of methylprednisolone (group B ) had a statistically significant reduction of all postoperative symptoms as compared with patients of group A (* P < 0.05, ** P <0.01 Fig. 1 ).

CONCLUSION

The study highlighted that the additional bolus of methylprednisolone improved all of the 6 parameters investigated by the questionnaire submitted to patients, resulting in a faster recovery and improvement of the patient's compliance with surgery. Further studies with a larger population are needed to confirm preliminary results.

Review of dexamethasone administration for management of complications in postoperative third molar surgery

Dexamethasone has been used in oral and maxillofacial surgery for postoperative pain, swelling, and trismus following third molar surgeries. It is a potent and powerful drug that can alleviate the aforementioned postoperative sequelae. Dexamethasone is responsible for inhibiting the release of inflammatory mediators in the inflammation process to improve patient quality of life after surgical intervention. There are several available routes of administering dexamethasone. This article will help determine the suggested routes of administration, dosage, parameters, and dexamethasone timing for third molar surgeries.