Efficacy of Submucosal versus Pterygomandibular Dexamethasone Injection in Surgical Extraction of the Impacted Lower Third Molar
DOI:
https://doi.org/10.51985/JBUMDC2023251Keywords:
Pterygomandibular space; dexamethasone injection; submucosal dexamethasone; third molar surgery; randomized controlled trial.Abstract
Objectives: This study aimed to evaluate the efficacy and postoperative complications of preoperative submucosal dexamethasone injection compared to preoperative dexamethasone injection into the pterygomandibular space for surgical extraction of the impacted lower third molar.
Study design and setting: This was a quasi-experimental, cross-sectional study conducted at the Department of Oral and Maxillofacial Surgery, Dow International Dental College, Dow University of Health Sciences, Karachi, from April to July 2021.
Methodology: The study sample consisted of 72 patients who reported surgical extraction of their lower wisdom teeth and consented to participate in this study. The patients were randomly divided into the submucosal injection group (SM) and the pterygomandibular space (PM) group. The injection time was recorded on the second and seventh postoperative days. Results: No significant differences in the duration of the intervention were observed between the two groups (23.08 min in PM, 23.07 min in SM). The postoperative facial swelling was significantly reduced transversely (ear lobe to the angle
of the mouth) in both groups compared to their respective baselines on the first postoperative day. On the secondpostoperative day, significant changes were observed in the submucosal group in postoperative swelling.
Conclusions: Using intraoral dexamethasone injections in third molar surgery significantly reduces conventional complications of surgery while avoiding the systemic side effects of steroids. Dexamethasone should be used regardless of the administration site when warranted, with less apprehension than is common in dentistry
References
Friedman, J. W. The prophylactic extraction of third molars:
a public health hazard. American journal of public health
, 97 (9), 1554-1559. DOI: 10.2105/ajph.2006.100271
From NLM.
Bruce, D.; Dudding, T.; Gormley, M.; Richmond, R. C.;
Haworth, S. An observational analysis of risk factors associated
with symptomatic third molar teeth. Wellcome Open Res
, 7, 71. DOI: 10.12688/wellcomeopenres.17673.2
Aznar-Arasa, L.; Harutunian, K.; Figueiredo, R.; ValmasedaCastellón, E.; Gay-Escoda, C. Effect of preoperative ibuprofen
on pain and swelling after lower third molar removal: a
randomized controlled trial. International journal of oral and
maxillofacial surgery 2012, 41 (8), 1005-1009. https://doi.org/
1016/j.ijom.2011.12.028.
Cho, H.; Lynham, A.; Hsu, E. Postoperative interventions to
reduce inflammatory complications after third molar surgery:
review of the current evidence. Australian dental journal 2017,
(4), 412-419.
Montgomery, M. T.; Hogg, J. P.; Roberts, D. L.; Redding, S.
W. The use of glucocorticosteroids to lessen the inflammatory
sequelae following third molar surgery. Journal of oral and
maxillofacial surgery 1990, 48 (2), 179-187. https://doi.org/
1111/adj.12526.
Tiigimae-Saar, J.; Leibur, E.; Tamme, T. The effect of
prednisolone on reduction of complaints after impacted third
molar removal. Stomatologija 2010, 12 (1), 17-22.
Neupert III, E. A.; Lee, J. W.; Philput, C. B.; Gordon, J. R.
Evaluation of dexamethasone for reduction of postsurgical
sequelae of third molar removal. Journal of oral and
maxillofacial surgery 1992, 50 (11), 1177-1182. https://doi.org/
1016/0278-2391(92)90149-T.
Kalkwarf, K. L.; Hinrichs, J. E.; Shaw, D. H. Management
of the dental patient receiving corticosteroid medications.
Oral Surgery, Oral Medicine, Oral Pathology 1982, 54 (4),
-400. https://doi.org/10.1016/0030-4220(82)90385-1.
Satyanarayana Killampalli, D. Y. V.; Yuwanati, M.; Krishnan,
M.; Kumar, S. P.; George, M.; Lakshmanan, S. Preemptive
Analgesic Efficacy of Dexamethasone and Diclofenac in
Mitigating Post-surgical Complications After Mandibular
Third-Molar Surgery: A Systematic Review. Cureus 2023, 15
(7), e42709. DOI: 10.7759/cureus.42709.
Majid, O. W. Submucosal dexamethasone injection improves
quality of life measures after third molar surgery: a comparative
study. Journal of Oral and Maxillofacial Surgery 2011, 69
(9), 2289-2297. https://doi.org/10.1016/j.joms.2011.01.037.
Canellas, J. V. D. S.; Ritto, F. G.; Tiwana, P. Comparative
efficacy and safety of different corticosteroids to reduce
inflammatory complications after mandibular third molar
surgery: a systematic review and network meta-analysis. Br
J Oral Maxillofac Surg 2022, 60 (8), 1035-1043. DOI:
1016/j.bjoms.2022.05.003.
González-Morelos, M.; Franco-de la Torre, L.; FrancoGonzález, D. L.; Gómez-Sánchez, E.; Alonso-Castro, Á.;
Molina-Frechero, N.; Anaya-Esparza, L. M.; Isiordia-Espinoza,
M. A. Efficacy of Methylprednisolone Compared to Other
Drugs for Pain, Swelling, and Trismus Control after Third
Molar Surgery: A Meta-Analysis. Healthcare (Basel) 2022,
(6). DOI: 10.3390/healthcare10061028.
Kaewkumnert, S.; Phithaksinsuk, K.; Changpoo, C.; Nochit,
N.; Muensaiyat, Y.; Wilaipornsawai, S.; Piriyaphokai, U.;
Powcharoen, W. Comparison of intraosseous and submucosal
dexamethasone injection in mandibular third molar surgery:
a split-mouth randomized clinical trial. International journal
of oral and maxillofacial surgery 2020, 49 (4), 529-535.
https://doi.org/10.1016/j.ijom.2019.10.006.
Moraschini, V.; Hidalgo, R. Effect of submucosal injection
of dexamethasone after third molar surgery: a meta-analysis
of randomized controlled trials. International journal of oral
and maxillofacial surgery 2016, 45 (2), 232-240. https://doi.org
/10.1016/j.ijom.2015.09.008.
Altaweel, A. A.; El-Hamid Gaber, A.; Alnaffar, M. Z.;
Almowallad, A. S.; Almech, M. H.; Almuwallad, A. S.;
Alharbi, R. K.; Arab, W. A. A novel therapeutic approach for
reducing postoperative inflammatory complications after
impacted mandibular third molar removal. Medicine
(Baltimore) 2022, 101 (37), e30436. DOI: 10.1097/MD.
Baxendale, B.; Vater, M.; Lavery, K. Dexamethasone reduces
pain and swelling following extraction of third molar teeth.
Anaesthesia 1993, 48 (11), 961-964. https://doi.org/10.1111/
j.1365-2044.1993.tb07474.x.
Tiwana, P. S.; Foy, S. P.; Shugars, D. A.; Marciani, R. D.;
Conrad, S. M.; Phillips, C.; White Jr, R. P. The impact of
intravenous corticosteroids with third molar surgery in patients
at high risk for delayed health-related quality of life and
clinical recovery. Journal of oral and maxillofacial surgery
, 63 (1), 55-62. https://doi.org/10.1016/j.joms.2004.01.029.
Maurette, P. E.; de Maurette, M. A.; Cotinho, M.; Fernandes,
C. Clinical comparative study of the effectiveness of two
dosages of Dexamethasone to control postoperative swelling,
trismus and pain after the surgical extraction of mandibular
impacted third molars. 2008.
Grossi, G. B.; Maiorana, C.; Garramone, R. A.; Borgonovo,
A.; Creminelli, L.; Santoro, F. Assessing postoperative
discomfort after third molar surgery: a prospective study.
Journal of oral and maxillofacial surgery 2007, 65 (5), 901-
https://doi.org/10.1016/j.joms.2005.12.046.
Laureano Filho, J. R.; Maurette, P. E.; Allais, M.; Cotinho,
M.; Fernandes, C. Clinical comparative study of the
effectiveness of two dosages of Dexamethasone to control
postoperative swelling, trismus and pain after the surgical
extraction of mandibular impacted third molars. Medicina
oral, patologia oral y cirugia bucal 2008, 13 (2), E129-132.
From NLM.
dos Santos Canellas, J. V.; Ritto, F. G.; Tiwana, P. Comparative
efficacy and safety of different corticosteroids to reduce
inflammatory complications after mandibular third molar
surgery: a systematic review and network meta-analysis.
British Journal of Oral and Maxillofacial Surgery 2022.
https://doi.org/10.1016/j.bjoms.2022.05.003.
Rocha-Neto, A. M.; Nogueira, E. F. d. C.; Borba, P. M.;
Laureano-Filho, J. R.; Vasconcelos, B. C. d. E. Application
of Dexamethasone in the Masseter Muscle During the Surgical
Removal of Lower Third Molars. Journal of Craniofacial
Surgery 2017, 28 (1), e43-e47. DOI: 10.1097/scs.
Zhang, S.; Song, M.; An, W.; Wang, Z. Effects of different
doses of dexamethasone as local anesthetic adjuvant on
brachial plexus block: A protocol for systematic review and
meta analysis. Medicine 2021, 100 (17). https://doi.org/
1097%2FMD.0000000000025651.
Knezevic, N. N.; Anantamongkol, U.; Candido, K. D.
Perineural dexamethasone added to local anesthesia for brachial
plexus block improves pain but delays block onset and motor
blockade recovery. Pain Physician 2015, 18 (1), 1.
Nair, R. B.; Rahman, N. M.; Ummar, M.; Hafiz, K. A.; Issac,
J. K.; Sameer, K. Effect of submucosal injection of
dexamethasone on postoperative discomfort after third molar
surgery: a prospective study. The journal of contemporary
dental practice 2013, 14 (3), 401. https://doi.org/ 10.1016/
j.joms.2006.11.036.
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