The clinical evaluation of dexamethasone in oral surgery

Role of Serratiopeptidase and Dexamethasone in the Control of Postoperative Swelling

Aim:

The present study is designed to evaluate and compare the ability of serratiopeptidase and dexamethasone to control edema following the surgical removal of mandibular third molar.

Materials and Methods:

Two drugs, dexamethasone and serratiopeptidase, were compared for its efficacy in reducing the postoperative swelling. A total of 100 patients requiring the surgical removal of impacted mandibular third molar were randomly divided into two groups, consisting of 50 patients each. One group was administered 1 mg dexamethasone, one-half h preoperatively and every 8^th hourly for 3 days postoperatively. The other group was given 10 mg serratiopeptidase every 8^th hourly for 3 days postoperatively. The swelling was measured on 1^st, 2^nd, 5^th, and 7^th postoperative days. The results of this study showed that serratiopeptidase was effective in reducing swelling from 2^nd to 5^th postoperative day, and dexamethasone was effective in reducing swelling from 1^st to 2^nd postoperative day, further, it also reduced the swelling from 2^nd to 5^th postoperative day.

Results:

There was highly significant difference in the facial measurement between serratiopeptidase and dexamethasone group on postoperative day 2 (the mean difference was 62.5 with P < 0.001) and statistically significant difference on postoperative day 1, day 5, and day 7 (P < 0.01).

Conclusion:

It can be concluded that serratiopeptidase, a proteolytic enzyme and dexamethasone, a long-acting corticosteroid was effective in reducing the swelling, but dexamethasone was more effective than serratiopeptidase in reducing the swelling.

A comparative study of the effect of two dosages of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective randomized study

INTRODUCTION

The aim of this clinical study was to evaluate and compare the relative efficacy of two different dosages of dexamethasone, i.e., 4 and 8 mg injected submucosally to reduce postoperative discomfort after mandibular third molar surgery.

METHODOLOGY

A prospective randomized study was conducted on 45 patients requiring surgical removal of an impacted third molar. Selected patients were divided randomly into three groups of 15 patients each: group I patients received one regimen single dose of 4 mg dexamethasone submucosally, group II received one regimen single dose of 8 mg dexamethasone submucosally, and group III (control group), no dexamethasone was given but only received injection of normal saline submucosally after establishing local anesthesia. The postoperative sequelae were assessed on the second and seventh postoperative day.

RESULT

As compared to group III, groups I and II showed statistically significant reduction in pain and swelling whereas no statistically significant difference was found between the test groups.

CONCLUSION

It can be concluded that corticosteroids are effective in curtailing the postoperative edema of lower third molar surgery but have negligible analgesic effect. As no statistically significant difference is found between both the regimes of dexamethasone, i.e., 4 and 8 mg so within the confines of our study, it may be concluded that 4 mg dexamethasone can be given safely to reduce the postoperative edema after the third molar surgery.

Do Corticosteroids Still Have a Role in the Management of Third Molar Surgery?

INTRODUCTION

The use of corticosteroids to reduce the post-operative sequelae of lower third molar surgery, namely pain, swelling and trismus, has been well studied by many researchers over the past 6 decades. This study reviewed the reported outcome of corticosteroids used in controlling the above sequalae after third molar surgery.

MATERIALS AND METHODS

A PubMed, Medline, EMBASE and Google search was undertaken of all controlled clinical trials on the effects of corticosteroids on pain, swelling and trismus after lower third molar surgery. The review was limited to studies published over the last 10 years (2006-2015).

RESULTS

Of the 46 initially retrieved articles, 34 were finally included. Eleven studies compared the effect of 2 similar (but different dose) or different group of corticosteroids. Thirty-one studies reported the effects of corticosteroids on all sequale, 2 reported the outcome on swelling and trismus and another 1 on swelling and pain only. In 16 of the studies, corticosteroid use resulted in significant reductions in pain after third molar removal. Twenty-two out of 29 studies reported reduced swelling against negative control while 18 out of 25 studies reported improved mouth opening. Fourteen studies reported the benefit of corticosteroids on all 3 sequelae, with 71.4% resulted from the use of methylprednisolone.

CONCLUSION

Although there are some conflicting effects, the results of this analysis shows in general the benefits derived from short-term use of corticosteroids in relation to pain, swelling and trismus following third molar surgical extraction, with no side effects observed.

FUNDING

This work was supported by the University of Malaya's High Impact Research grant UM.C/625/1/HIR/MOHE/05.

A randomized clinical trial to compare the efficacy of submucosal aprotinin injection and intravenous dexamethasone in reducing pain and swelling after third molar surgery: a prospective study

OBJECTIVE

The purpose of this study was to compare two different groups of drugs, aprotinin and dexamethasone for its efficacy in reducing post operative swelling and pain after third molar surgery.

METHODS

Fifty consecutive patients requiring surgical removal of single mandibular third molar (class II position B) under local anesthesia were randomly divided into two groups, each group consisting of 25 patients. One group was administered 8 mg dexamethasone through intravenous route pre-operatively. The other group received 1 ml of Aprotinin through submucosal route in operating area after the onset of local anesthesia. Swelling was assessed by measuring facial contours at baseline and at 1st, 3rd and 7th post-operative days. Pain was measured on the 1st, 3rd and 7th post-operative days using visual analog scale. Based on statistical analysis (paired t test and Wilcoxon's signed ranking test), the results showed statistically significant difference in post operative swelling and pain on 3rd postoperative day in dexamethasone group as compared to aprotinin group.

RESULTS

The results of present study showed a similar reduction in the severity of pain and swelling at the aprotinin and dexamethasone sites on 1st and 7th postoperative day. It was also noticed that the aprotinin promoted a greater reduction of swelling and pain on 3rd postoperative day.

CONCLUSION

It appeared that, benefits of aprotinin against the risks of dexamethasone and its efficacy in controlling pain and swelling after third molar surgery makes aprotinin to be a valuable alternative to dexamethasone.

What strategies are helpful in the operative management of third molars?

PURPOSE

The purpose of this review was to investigate and report strategies that might improve patient recovery after third molar (M3) surgery.

MATERIALS AND METHODS

This was a literature review on various topics to identify the methods of improving outcomes after M3 removal. Numerous topics were reviewed, including patient age, flap design, effect of smoking, use of antibacterial rinses, pre-emptive analgesia, and the role of antibiotics and corticosteroids in recovery.

RESULTS

Increased patient age appears to be a factor in a higher complication rate, but the literature is sparse. The results of studies on flap design are contradictory, but there is no difference in long-term periodontal health. Systematic reviews clearly show that longer periods of smoking cessation decrease surgical complications, but few studies have addressed M3 surgery. Likewise, the role of pre-emptive analgesia, although beneficial in a general surgical setting, has not been studied thoroughly with regard to M3 surgery. The use of chlorhexidine rinses to prevent alveolar osteitis and surgical site infection has been studied extensively, but meta-analyses have not convincingly proved this effect. The evidence is convincing that antibiotics decrease alveolar osteitis and surgical site infection. Similarly, it is clear that corticosteroids decrease postoperative trismus and edema; however, the role of steroids in decreasing pain is not proved.

CONCLUSION

This review found various factors associated with improving recovery and minimizing complications in M3 surgery.

Povidone-iodine: an anti-oedematous agent?

Polyvinylpyrrolidone-iodine (PVP-I) is a well-known antiseptic, widely used in various preparations and concentrations in all surgical fields. It is also used as an irrigant for open wounds and in some centres for irrigating sockets after tooth extraction. One of the authors (GA) incidentally discovered an anti-oedematous effect of PVP-I after using it in low concentration as an irrigant/coolant during the surgical removal of lower third molars. A prospective randomized clinical trial was subsequently performed on 50 patients (25 control, 25 treatment group) undergoing removal of impacted lower third molars. In the treatment group a 0.5% PVP-I solution at a concentration of 0.5mg/ml (we call it as "Arakeri's iodine solution") resulted in a significant reduction in postoperative swelling compared with the control group (P<0.01). This effect of PVP-I was suspected due to its inhibitory effect on leukotriene B4 and leukocyte extravasation (chemotaxis). Further evaluation of the effects of PVP-I as an irrigant in oral and maxillofacial surgery is needed.

Corticosteroid administration in oral and orthognathic surgery: a systematic review of the literature and meta-analysis

PURPOSE

This study evaluated the effect of corticosteroid (CS) administration on edema, analgesia, and neuroregeneration in conjunction with surgical dental extraction, orthognathic surgery, and the risk of developing side effects.

MATERIALS AND METHODS

A systematic search of the literature was made. The primary predictor variable was CS administration and the outcome variables were edema, pain, and infection. A meta-analysis was performed. The risk of other side effects was evaluated through a simple review.

RESULTS

In oral surgery, most clinical trials showed a significant decrease in edema (P < .0001) after CS, and local injection of methylprednisolone > or =25 mg was expected to result in a significant decrease in edema. Regarding the analgesic effect, several clinical trials showed a decrease in pain after CS (P < .0001). Further, CS administration resulted in a slightly higher risk of infection (relative risk, 1.0041), but with a P value of .89. CS could be administered with no increased risk of infection. In orthognathic surgery, methylprednisolone > or =85 mg administered intravenously seemed sufficient to produce a significant decrease in edema, and several trials pointed toward a neuroregeneration effect, but no statistical analysis could be performed. Regarding the risk of other side effects, in oral surgery, a minimal risk of chronic adrenal suppression was seen; in orthognathic surgery, an elevated risk of avascular osteonecrosis, steroid-induced psychosis, and adrenal suppression was seen. There were no reports of decreased healing.

CONCLUSION

These findings suggest that the administration of CS in oral surgery decreases edema and pain significantly, with no higher risk of infection and with a minimum risk of other side effects.

Comparison of corticosteroids and rubber drain for reduction of sequelae after third molar surgery

INTRODUCTION

For reducing edema, trismus, and pain after impacted tooth surgery, some protocols are proposed but their relative effectiveness is controversial.

PURPOSE

The goal of this study was to evaluate and compare the effects of corticosteroids and rubber drain on the postoperative complications of impacted molar surgery.

PATIENTS AND METHODS

This study was carried out on 22 patients with bilateral symmetrical mandibular impacted third molars. For surgical removal of impacted teeth on one side of these patients, either rubber drain (11 cases) or perioperative corticosteroids (11 cases) were used (study group). The contralateral impacted teeth were removed routinely without using any drug or drain (control group). Facial edema, trismus, and pain perception of the study and control groups were recorded on the second and seventh postoperative days.

RESULTS AND DISCUSSION

This study showed that perioperative steroids reduce the trismus, facial swelling, and the severity of pain after third molar surgery. This study also revealed that the use of the drain reduces facial pain and trismus but has no effect on the facial swelling after impacted tooth surgery. Comparing the steroid and drain groups, we found that perioperative corticosteroids are more effective than the surgical drain in reducing postoperative pain and edema, but their effects on trismus are similar.

Efficacy of methylprednisolone injected into the masseter muscle following the surgical extraction of impacted lower third molars

The aim of this study was to demonstrate the efficacy of methylprednisolone, as a single 40-mg dose, injected into the masseter muscle upon completion of extraction of impacted lower third molars. A prospective, randomized cross-over study was made of 35 healthy patients. The difficulty of extraction was similar in all cases. The study group received 40 mg of methylprednisolone injected into the masseter muscle via the intrabuccal approach, immediately after suturing of the surgical wound. The control group received no intramuscular corticoid. Evaluations were made of postoperative pain, trismus and swelling. Oral aperture was measured, along with the following distances for the assessment of swelling: tragus-lip commissure, gonion-lip commissure and gonion-external canthus of the eye, before and 2 and 7 days after surgery. The patients administered methylprednisolone 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<0.05). The results obtained show that 40 mg of methylprednisolone injected into the masseter muscle in the immediate postoperative period reduces swelling, trismus and pain.

Determination of the anti-inflammatory effects of methylprednisolone on the sequelae of third molar surgery

PURPOSE

The anti-inflammatory effect and adrenal suppressive side effect of methylprednisolone sodium succinate (MP) on the postoperative sequelae of third molar surgery were evaluated using objective methods in a double-blind, crossover study.

PATIENTS AND METHODS

Twenty patients who were to undergo surgical removal of bilateral, symmetrically placed lower third molars were studied. Each patient was given 125 mg MP intravenously before surgery on one side, and a placebo before surgery on the opposite side on a random basis. Ultrasonographic and computed tomographic examinations were performed to determine the amount of facial edema. Trismus was evaluated by measuring maximal interincisal opening, and pain was evaluated by recording the number of standard analgesic tablets used on the day of surgery and the first postoperative day. Hypothalamic-pituitary-adrenal (HPA) axis function was tested by measuring basal plasma cortisol (hydrocortisone) levels preoperatively and postoperatively. The adrenocorticotropic hormone (ACTH) stimulation test also was performed before and after administration of MP, to evaluate adrenal function.

RESULTS

Statistical analysis of the data indicated a significant decrease in edema, trismus, and pain in the MP group. Plasma cortisol levels showed a nonsignificant decrease in both the MP- and placebo-treated groups. The ACTH stimulation test indicated normal HPA axis function before and after MP administration. No clinically apparent infection, disturbance of wound healing, or other corticosteroid-related complications were noted. Eighteen patients (90%) indicated a preference for the overall postoperative course when MP was used.

CONCLUSION

In the absence of contraindications for corticosteroid administration, preoperative use of MP appears to be a safe and effective method of reducing postoperative complications in third molar surgery.

Reduction of postoperative facial swelling by low-dose methylprednisolone: an experimental study

The effectiveness of a low-dose, preoperative regimen of methylprednisolone for the reduction of postoperative facial edema after impacted third molar surgery was evaluated using the facial plethysmograph. Eleven patients were given 16 mg methylprednisolone orally the evening before surgery, combined with 20 mg methylprednisolone intravenously immediately preoperatively, in a double blind, randomized, crossover study. Facial contour was measured preoperatively, and then on days 1, 2, 3, 4, and 7 postoperatively. The low dose of methylprednisolone reduced swelling by 42% at 24 hours and 34% at 48 hours postoperatively. By the third day the difference was only 19%, suggesting the need for either a sustained release formulation or a multiday course. Trismus or the need for analgesic medication were not affected by this dose of methylprednisolone.

Prevention of postoperative swelling and pain by dexamethasone after operative removal of impacted third molar teeth

In a placebo-controlled double-blind study, we examined the effect of perioperative oral administration of 6 mg dexamethasone, given once 12 h before and once 12 h after osteotomy of two impacted molar teeth, on postoperative edema, limitation of jaw opening, and intensity of postoperative pain. On the first day after surgery the difference in the increase in cheek swelling was 54.3% (P < 0.001) as measured with a tape, 46% (P < 0.001) measured with a gauge in the first molar area and 29% (P < or = 0.056) by sonographic measurement of the cheek diameter in the molar area. The limitation in the jaw opening was reduced by 17.7% (P < 0.002) after dexamethasone. Pain assessed by visual analog scale was reduced by dexamethasone by 50% (P < 0.01). The amount of analgesics required postoperatively (codeine phosphate) was reduced by 37% (P = 0.02) following dexamethasone administration. Seventy-six percent of our patients preferred perioperative medication of dexamethasone.

Evaluation of dexamethasone for reduction of postsurgical sequelae of third molar removal

Sixty patients with bilaterally symmetrical impacted third molars participated in this double-blind, within-subject study to quantify the effects of 4 mg of dexamethasone on reducing postsurgical sequelae. Each patient's surgery was staged by mouth side and completed in two appointments 5 to 6 weeks apart. A preoperative dose of dexamethasone given intravenously was randomized to mouth side and surgical appointment; sterile water served as a control. Major areas assessed in this study were facial swelling, pain, and trismus. No difference in swelling and daily pain was noted. However, trismus and global pain were significantly affected by the steroid. Patients had a daily postsurgical increase in incisal opening of 4 to 6 mm over the control side during the examination period. Patients evaluated pain by choosing the least painful side. By a greater than 4:1 margin, patients chose the steroid side as the least painful side. No increase in the rate or type of complications was detected between control and steroid sides.

Use of corticosteroids in oral surgery

Perioperative use of corticosteroids has been advocated for reduction of pain, edema, and trismus following oral surgical procedures. Clinical trials involving the use of corticosteroids in oral surgery are reviewed with emphasis on the following points: 1) the type of procedure; 2) the specific regimen and its relative potency; and 3) the methods used to determine results. The potential for complications induced by perioperative corticosteroid use, such as adrenal suppression and delayed wound healing, are also discussed. Initial trials subjectively demonstrated that corticosteroids reduced the amount of inflammation associated with oral surgery, especially edema. Subsequent objective evaluation of corticosteroid use has shown consistent reductions in edema. Corticosteroid doses ranged from 80 to 625 mg hydrocortisone equivalent anti-inflammatory dosage. No significant adverse reactions were noted. Based on these studies, the use of perioperative corticosteroids appears to be a safe and rational method of reducing postoperative complications following the removal of impacted third molars. Conclusions about corticosteroid use in other oral surgical procedures cannot be reached until more research is conducted.

Risks and benefits of removal of impacted third molars. A critical review of the literature

A critical review of the literature about risks and benefits of the removal of impacted 3rd molar teeth is presented in 4 categories: risk of non-intervention, risk of intervention, benefit of non-intervention and benefit of intervention. There are well-defined criteria for removal of impacted 3rd molar teeth. Absolute indications and contra-indications for the removal of asymptomatic 3rd molar teeth cannot be established because no long-term studies exist which validate the benefit to the patient either of early removal or of deliberate retention of these teeth. The prudent course of action for the clinician to follow is based on rational clinical decision-making using traditional methods of evaluation to effect the optimal outcome, keeping the interests of the individual patient above all else.

Dexamethasone as an adjunct in oropharyngeal obstruction in a patient with leukemia

Incipient airway obstruction due to fulminating bacterial infection of pharyngeal tissues requires prompt and definitive intervention. A case is presented in which dexamethasone was a key adjunct to antibiotic therapy in averting this problem in a severely neutropenic patient with acute leukemia.

The use of glucocorticosteroids to lessen the inflammatory sequelae following third molar surgery

Acceptance of the use of glucocorticosteroids in density to control postsurgical inflammation has been impaired by concerns over side effects, adrenal suppression, and efficacy. The pattern of administration generally used is characterized as short-term, high-dose or pulse therapy, which has not been associated with significant side effects or adrenal suppression beyond 10 days. The selection of an appropriate glucocorticosteroid with minimal mineralocorticoid activity and extended biological activity is desirable. Oral and parenteral dosing are possible, and the latter can be administered as acetates (repository) or esters. The efficacy of glucocorticosteroids in reducing pain, swelling, and trismus after third molar surgery is difficult to ascertain because of methodological inconsistencies between investigations. In general, studies that used low dosing schedules have failed to produce dramatic and prolonged results. High-dosing intravenous (IV) studies have demonstrated significant short-term improvements, but the effects were not sustained. Combining IV administration with multiple oral dosing or a single intramuscular (IM) dose may be required to extend short-term improvement. High-dosing IM studies have shown significant and sustained anti-inflammatory effects with a single dose administered either pre- or post-operatively.

Postoperative changes after bilateral mandibular osteotomies: a computed tomography study

Twelve patients undergoing bilateral osteotomy of the ramus of the mandible were examined with CT preoperatively and postoperatively. The maximum area of the cheek and oropharynx was measured together with the thickness of the masseter muscle and the overlying subcutaneous tissue. The preoperative CT examinations showed wide anatomic variations. The postoperative examinations showed a diminished oropharynx lumen of approximately 43%. Swelling of the cheek averaged 61% and was associated with the well-vascularized masseter muscle. The TMJs were measured and a slight widening of the joint space was found postoperatively.

The anti-inflammatory effect of organo-heparinoid cream after bilateral mandibular osteotomies

The aim of the present study was to compare the effect on swelling after bilateral osteotomies of the mandible of treatment with organo-heparinoid (Hirudoid) cream and that of a placebo cream. 12 patients (7 female, 5 male), median age of 29.5 years, were included in the study. 5 patients received bilateral sagittal-split procedures for symmetrical mandibular advancement, and 7 patients received bilateral mandibular osteotomies for symmetrical mandibular set-back. Each of the 2 operated sides were randomized for treatment with active medication or placebo; 1.5 g of the active- or placebo cream were carefully rubbed into the skin above the masseteric muscle 4 times a day for 4 days. Periodic identical CT-scans were performed to evaluate swelling; patients were CT-scanned preoperatively and once or twice postoperatively. 3 variables were used to assess the swelling: (1) thickness of the subcutis; (2) maximum thickness of the masseteric muscle; (3) cross-sectional area of the soft tissues facial to the ramus of the mandible. No significant differences in postoperative swelling could be demonstrated between the 2 treatments. There were no detectable systemic effects of the treatment with organo-heparinoid.

Management of posttreatment endodontic pain with oral dexamethasone: a double-blind study

In a double-blind study, twenty-five subjects who received oral dexamethasone and twenty-five placebo subjects rated their postoperative pain 8 and 24 hours following initial endodontic treatment. The subjects who received dexamethasone reported statistically significantly less postoperative pain than the subjects who received the placebos. The question is raised as to whether oral corticosteroids are appropriate for routine management of posttreatment endodontic pain.

Evaluation of methylprednisolone and flurbiprofen for inhibition of the postoperative inflammatory response

The ideal anti-inflammatory agent for use in third molar surgery should control pain, reduce swelling and trismus, and have no unwanted side effects. This investigation evaluated and compared the efficacy of corticosteroids, nonsteroidal anti-inflammatory agents, and placebo for reduction of the acute postoperative inflammatory response and its undesirable sequelae in patients undergoing the surgical removal of impacted third molars. Corticosteroids appeared to have maximal effect in controlling edema but had minimal analgesic effects. Nonsteroidal anti-inflammatory agents appear to be effective analgesics. A combination of these agents may be necessary to control the sequelae of oral surgical procedures most effectively.

Decadronphosphate in the relief of complaints after third molar surgery. A double-blind, controlled trial with bilateral oral surgery

The purpose of the present double-blind study was to investigate the preventive effect of 4 mg dexamethasone (1 ml Decadronphosphate) on swelling, trismus and pain after removal of impacted mandibular third molars. The population comprised 30 healthy individuals (17 female, 13 male) who needed removal of 2 identical, impacted mandibular third molars. Each patient served as his own control as the teeth were removed in 2 sittings with either steroid or placebo injected into the masseter muscle just before starting the operation. Control visits took place 48 h and 7 days after the operations. The results showed that steroid administration led to about 50% reduction of postoperative swelling and trismus and to about 30% reduction of postoperative pain. No general or local complaints/complications occurred due to the steroid injection. It is concluded that prophylactic steroid treatment is effective in reducing postoperative complaints and that the administration is safe in the absence of contraindications for such administration. Prophylactic steroid treatment is therefore recommended in third molar surgery when pronounced postoperative reaction can be expected.

Interrelation of complaints after removal of impacted mandibular third molars

Swelling, pain and trismus were evaluated quantitatively after the removal of impacted mandibular third molars on 30 healthy individuals. Evaluation took place 48 h and 7 days after surgery. The mutual correlation between the complaints was determined as well as the correlation between the length of the operation and the degree of postoperative complaints. It is concluded from the study that the longer the operation takes, the more postoperative pain can be expected. However, neither swelling nor trismus is correlated with the length of time of the operation. The size of the swelling was not related to the degree of trismus or postoperative pain. A strong interrelation between postoperative pain and trismus indicates pain as the main reason for reduced mouth opening after removal of impacted mandibular third molars.

The facial plethysmograph: a new instrument to measure facial swelling volumetrically

A critical review of methods used to evaluate postoperative facial swelling is presented. A new, noninvasive method using a feeler arm to trace and measure facial contours is described. The overall accuracy and reproducibility of this method was tested by measuring acrylic "mock swellings." The results suggest that the method was accurate to within 5% in measuring swellings of known volume. The reproducibility of replicate measures also showed a low level of error (3.3%). This device may provide a unique method for the systematic study of treatments designed to minimize postoperative facial swelling.

Effect of methylprednisolone on swelling after orthognathic surgery

The effectiveness of methylprednisolone for the reduction of postoperative facial edema was evaluated by the computed tomographic examination of 39 patients who underwent either a Lefort I osteotomy or a transoral vertical osteotomy. Results of the CT scans, which were performed preoperatively and at 24 and 72 hours postoperatively, showed that in the LeFort I osteotomy patients methylprednisolone reduced the degree of facial edema by 61% at 24 hours postoperatively and by 10% at 72 hours. In the transoral vertical osteotomy patients methylprednisolone reduced the degree of facial edema by 38% at 24 hours postoperatively and by 45% at 72 hours. It was concluded that methylprednisolone is effective for the control and management of postoperative facial edema following orthognathic surgery.

Prophylactic use of indomethacin for prevention of postsurgical complications after removal of impacted third molars

Indomethacin (100 mg. per day for 3 days) was tested for its prophylactic effects on the postsurgical complications of pain, swelling, and trismus after removal of impacted teeth. The drug resulted in a significant reduction of the swelling and an analgesic effect which was equal to that of acetaminophen and codeine. Only two minor side effects were encountered.

Effect of indomethacin on postsurgical edema in rats

The effectiveness of intramuscular indomethacin was compared with that of hydrocortisone succinate for the control of edema resulting from experimentally induced surgical trauma in rats. Both drugs produced a significant reduction in tissue water, but no difference could be detected between the effects of the two drugs. These findings indicate the advisability of clinical trials of indomethacin in the control of postsurgical swelling and pain.

Quantitation of experimental postsurgical edema

Many oral surgical procedures are followed by varying degrees of edema. Although numerous methods of minimizing swelling have been advocated, no technique has gained complete acceptance. A major problem has been the inability to document the efficacy of suggested treatments convincingly. The present study quantitates edema by measuring differences in percentage of water content between operated and unoperated tissues over a period of one week. Percentage difference in water content peaked by 48 to 72 hours and was followed by gradual resolution. By use of this model system, a steroid-induced, dose-dependent suppression of postsurgical swelling was confirmed.

The use of intraoral dexamethasone after extraction of mandibular third molars

All oral surgeions have encountered problems associated with edema, trismus, and pain after intraoral procedures. In third-molar surgery, pain and trismus are often directly proportional to edema. Therefore, in the patient with minimal edema, pain and trismus should be proportionally reduced. Parenteral use of the corticosteroid dexamethasone, given as a transoral injection at the time of operation, appears to be effective in the prevention of postoperative edema.

Bilateral surgical removal of impacted lower third molar teeth as a model for drug evaluation: a test with ibuprofen

It was considered that double-blind crossover studies of therapeutic efficacy after acute injury could well be done in patients who required surgical removal of impacted wisdom teeth from both sides of the lower jaw. In the present trial 24 healthy patients received either placebo or ibuprofen (Brufen: 400 mg three times daily), a non-steroidal anti-inflammatory agent, for 5 days commencing the day before surgery. Treatments were given on the two occasions when impacted wisdom teeth were to be removed from one side or other of the lower jaw. A number of objective and subjective parameters were recorded for paired comparison of the post-operative courses, including swelling, trismus and pain. A mechanical device which allows simple and accurate measurement of cheek swelling is described. On the 1st, 3rd and 5th post-operative days in the ibuprofen group the measured swelling averaged 93, 89 and 82%, respectively, of that in the placebo group; the corresponding alpha-values were 0.35, 0.06 and 0.07. Patients with less swelling after ibuprofen were not always those with a high serum concentration of the drug. Ibuprofen significantly reduced pain on the day of the operation. This may at least partly account for less trismus and the preference of the patients for their post-operative courses with ibuprofen. Examination of various haematological parameters did not reveal any significant difference between the two operations. Subjective scores indicated that neither wound-healing nor bleeding was affected by ibuprofen, nor were any side effects detected.