Effect of Preoperative Single Dose Dexamethasone Injection in Masseter Muscle on Postoperative Sequelae Following Lower Impacted Third Molar Surgery

Document Type : مقاله‌های پژوهشی

Authors

1 Dentistry Graduate Student, School of Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran

2 Assistant Professor, Department of Oral & Maxillofacial Surgery, School of Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran.

3 Associate Professor, Community Health Research Center, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran

4 Postgraduate Student, Department of Oral & Maxillofacial Surgery, School of Dentistry, Isfahan (Khorasgan) Branch, Islamic Azad University, Isfahan, Iran

Abstract

Introduction: The surgical removal of impacted lower third molars involves trauma to soft and bony tissue and can result in pain, swelling and trismus. The purpose of this study was to evaluate the efficacy of dexamethasone, as a single 4 mg dose injected into the masseter muscle prior to extraction of impacted lower third molars on theses postoperative sequelae.
Materials and Methods: This prospective, randomized clinical research consisted of 43 healthy patients. The study group received 4 mg dexamethasone into the masseter muscle via intrabuccal approach immediately before starting the procedure while the control group received no corticoid. 7 days after surgery. Data were analyzed using t-test (α = 0.05).
Results: The patients administered dexamethasone showed superior results after surgery in terms of oral aperture, pain and all the facial swelling parameters, with statistically significant differences versus the controls (p value < 0.001). Also there was statistically significant difference in terms of patients trismus between case and control groups (p value < 0.001).
Conclusion: The results obtained showed that 4 mg of dexamethasone injected into the masseter muscle in the immediately before starting the procedure significantly reduces swelling, trismus and pain.
Key words: Dexamethasone, Masseter muscle, Surgery, Oral, Molar, Third. 

1. Shepherd JP, Brickley M. Surgical removal of third molars. BMJ 1994; 309(6955): 620-1.
2. Fragiskos D. Oral surgery. 1st ed. Heidelberg, Germany: Springer-Verlag Berlin Heidelberg; 2007. p. 121-4.
3. Grossi GB, Maiorana C, Garramone RA, Borgonovo A, Creminelli L, Santoro F. Assessing postoperative discomfort after third molar surgery: A prospective study. J Oral Maxillofac Surg 2007; 65(5): 901-17.
4. Neupert EA, III, Lee JW, Philput CB, Gordon JR. Evaluation of dexamethasone for reduction of postsurgical sequelae of third molar removal. J Oral Maxillofac Surg 1992; 50(11): 1177-82.
5. Trevor A, Katzung B, Knuidering-Hall M. Katzung & Trevor's pharmacology examination and board review. 11th ed. New York, NY: McGraw-Hill Education; 2015. p. 270-4.
6. Malamed SF. Medical emergencies in the dental office. 7th ed. Philadelphia, PA: Mosby; 2014.
7. Gersema L, Baker K. Use of corticosteroids in oral surgery. J Oral Maxillofac Surg 1992; 50(3): 270-7.
8. Kirmeier R, Truschnegg A, Payer M, Acham S, Schulz K, Jakse N. Evaluation of a muscle relaxant on sequelae of third molar surgery: a pilot study. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2007; 104(3): e8-14.
9. Warraich R, Faisal M, Rana M, Shaheen A, Gellrich NC, Rana M. Evaluation of postoperative discomfort following third molar surgery using submucosal dexamethasone - a randomized observer blind prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116(1): 16-22.
10. Hirschmann JV. Some principles of systemic glucocorticoid therapy. Clin Exp Dermatol 1986; 11(1): 27-33.
11. Bamgbose BO, Akinwande JA, Adeyemo WL, Ladeinde AL, Arotiba GT, Ogunlewe MO. Effects of co-administered dexamethasone and diclofenac potassium on pain, swelling and trismus following third molar surgery. Head Face Med 2005; 1: 11.
12. Alexander RE, Throndson RR. A review of perioperative corticosteroid use in dentoalveolar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 90(4): 406-15.
13. Chandwani B, Ceneviz C, Mehta N, Scrivani S. Incidence of bruxism in TMD population. N Y State Dent J 2011; 77(5): 54-7.
14. Hasanzadeh M, Shirani M, Movahedian Attar B. Effects of different routs of dexamethasone administration on the complications after surgical removal of impacted mandibular third molar. J Isfahan Dent Sch 2017; 13(2): 132-9. [In Persian].
15. Dereci O, Tuzuner-Oncul AM, Kocer G, Yuce E, Askar M, Ozturk A. Efficacy of immediate postoperative intramasseteric dexamethasone injection on postoperative swelling after mandibular impacted third molar surgery: A preliminary split-mouth study. J Pak Med Assoc 2016; 66(3): 320-3.
16. Grossi GB, Maiorana C, Garramone RA, Borgonovo A, Beretta M, Farronato D, et al. Effect of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective study. J Oral Maxillofac Surg 2007; 65(11): 2218-26.
17. Hupp JR, Tucker MR, Ellis E. Contemporary oral and maxillofacial surgery. 7th ed. Philadelphia, PA: Mosby; 2018.
18. Falci SGM, Lima TC, Martins CC, Santos CRRD, Pinheiro MLP. Preemptive effect of dexamethasone in third-molar surgery: A meta-analysis. Anesth Prog 2017; 64(3): 136-43.
19. Latt MM, Kiattavorncharoen S, Boonsiriseth K, Pairuchvej V, Wongsirichat N. The efficacy of dexamethasone injection on postoperative pain in lower third molar surgery. J Dent Anesth Pain Med 2016; 16(2): 95-102.
20. von Arx DP, Simpson MT. The effect of dexamethasone on neurapraxia following third molar surgery. Br J Oral Maxillofac Surg 1989; 27(6): 477-80.
21. Rocha-Neto AM, Nogueira EF, Borba PM, Laureano-Filho JR, Vasconcelos BC. Application of dexamethasone in the masseter muscle during the surgical removal of lower third molars. J Craniofac Surg 2017; 28(1): e43-e47.