Role of Dexamethasone at the Surgical Site in The Control of Pain and Oedema in Management of Bilateral Mandibular Fractures Osteosynthesis Using the Split-Mouth Technique: Dexamethasone and Oedema in Bilateral Mandibular Fractures Osteosynthesis

Banish Pervaiz; Rutaba Ashraf; Noor Ul Ain; Mor Khan Shar; Haseeb Uddin; Muhammad Umar Farooq

doi:10.54393/pjhs.v6i4.2807

Authors

Banish Pervaiz Department of Oral and Maxillofacial Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
Rutaba Ashraf Department of Oral and Maxillofacial Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
Noor Ul Ain Department of Oral and Maxillofacial Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
Mor Khan Shar Department of Oral and Maxillofacial Surgery, School of Dentistry, Shaheed Zulfiqar Ali Bhutto Medical University, Islamabad, Pakistan
Haseeb Uddin Department of Oral and Maxillofacial Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
Muhammad Umar Farooq Department of Oral and Maxillofacial Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan

DOI:

https://doi.org/10.54393/pjhs.v6i4.2807

Keywords:

Dexamethasone, Edema, Mandibular Fracture, Osteosynthesis

Abstract

Osteosynthesis is a widely used technique for the treatment of fractures, ensuring stability in the healing process. This might cause postoperative pain, edema, trismus, infection, and reduced jaw mobility. Objectives: To assess the effectiveness of Dexamethasone in alleviating pain and oedema at the surgical site in patients undergoing bilateral mandibular fracture osteosynthesis using the split-mouth technique. Methods: A quasi-experimental study was conducted at the Pakistan Institute of Medical Sciences from 11th October 2023 to 10th August 2024, enrolling 30 participants with bilateral mandibular fractures. They were divided into two groups using the split-mouth technique, with 30 surgical sites in each group. Using a table of random numbers, surgical sites were assigned to Group A (study group), in which submucosal dexamethasone was administered after closure of the incision site, and Group B (control group), which did not receive submucosal dexamethasone. Postoperative pain and edema were evaluated at 24 hours, 72 hours, and one week postoperatively. Results: The mean age of the participants was 25.77 ± 8.274, with 73.3% being male. Group A experienced slightly reduced pain than group B (p s 0.005). After 24 hours and 1 week postoperatively, there were statistically significant differences in postoperative oedema among the two groups (p≤0.05), but not at 72 hours (p>0.05). Conclusions: It was concluded that dexamethasone can be used as an adjunct to improve postoperative outcomes in patients with mandibular fractures by decreasing pain and oedema.

References

Ramadan N. Efficacy of Various Routes of Dexamethasone Administration on Post-Operative Complications Following Impacted Mandibular Third Molar Surgeries, Comparative Clinical Study. Egyptian Dental Journal. 2021 Jan; 67(1-January (Oral Surgery)): 267-75. doi: 10.21608/edj.2020.52489.1395.

Dongol A, Jaisani MR, Pradhan L, Dulal S, Sagtani A. A Randomized Clinical Trial of the Effects of Submucosal Dexamethasone After Surgery for Mandibular Fractures. Journal of Oral and Maxillofacial Surgery. 2015 Jun; 73(6): 1124-32. doi: 10.1016/j.joms.2014.12.042.

Sheikh ZA, Alam J, Shah R, Salah S, Naseem S, Ahmed J. Influence of Perioperative Dexamethasone on the Delayed Union in Mandibular Fractures. Indus Journal of Bioscience Research. 2025 Mar; 3(3): 678-87. doi: 10.70749/ijbr.v3i3.895.

Selvido DI, Bhattarai BP, Niyomtham N, Riddhabhaya A, Vongsawan K, Pairuchvej V et al. Review of Dexamethasone Administration for Management of Complications in Postoperative Third Molar Surgery. Journal of the Korean Association of Oral and Maxillofacial Surgeons. 2021 Oct; 47(5): 341-50. doi: 10.5125/jkaoms.2021.47.5.341.

Sneha A, Pendem S, Krishnan M, Dhasarathan P, Aravindan V. Impacted Mandibular Fracture: A Report of a Rare Case. Cureus. 2023 May; 15(5). doi: 10.7759/cureus.38999.

Ingawale DK and Mandlik SK. New Insights into the Novel Anti-Inflammatory Mode of Action of Glucocorticoids. Immunopharmacology and Immunotoxicology. 2020 Mar; 42(2): 59-73. doi: 10.1080/08923973.2020.1728765.

Yao TC, Huang YW, Chang SM, Tsai SY, Wu AC, Tsai HJ. Association Between Oral Corticosteroid Bursts and Severe Adverse Events: A Nationwide Population-Based Cohort Study. Annals of Internal Medicine. 2020 Sep; 173(5): 325-30. doi: 10.7326/M20-0432.

Black R and Grodzinsky AJ. Dexamethasone: Chondroprotective Corticosteroid or Catabolic Killer? European Cells and Materials. 2019 Nov; 38: 246. doi: 10.22203/eCM.v038a17.

Kishore K, Lone PA, Kouser T. Comparative Study of Effectiveness of Dexamethasone Injection After Orif in Mandible. International Journal of Science and Research. 2018 ;7(9): 15-6.

Delgado DA, Lambert BS, Boutris N, McCulloch PC, Robbins AB, Moreno MR et al. Validation of Digital Visual Analog Scale Pain Scoring with A Traditional Paper-Based Visual Analog Scale in Adults. Journal of the American Academy of Orthopedic Sciences Global Research and Reviews. 2018 Mar; 2(3): e088. doi: 10.5435/JAAOSGlobal-D-17-00088.

Crossley KM, Bennell KL, Cowan SM, Green S. Analysis of Outcome Measures for Persons with Patellofemoral Pain: Which Are Reliable and Valid?. Archives of Physical Medicine and Rehabilitation. 2004 May; 85(5): 815-22. doi: 10.1016/S0003-9993(03)00613-0.

McGrath PA, Seifert CE, Speechley KN, Booth JC, Stitt L, Gibson MC. A New Analogue Scale for Assessing Children's Pain: An Initial Validation Study. Pain. 1996 Mar; 64(3): 435-43. doi: 10.1016/0304-3959(95)00171-9.

Chotipanich A and Kongpit N. Precision and Reliability of Tape Measurements in the Assessment of Head and Neck Lymphedema. PLOS ONE. 2020 May; 15(5): e0233395. doi: 10.1371/journal.pone.0233395.

Herrera-Briones FJ, Sánchez EP, Botella CR, Capilla MV. Update on the Use of Corticosteroids in Third Molar Surgery: Systematic Review of the Literature. Oral surgery, Oral medicine, Oral pathology, and Oral radiology. 2013 Nov; 116(5): e342-51. doi: 10.1016/j.oooo.2012.02.027.

Rocha-Neto AM, de Carvalho Nogueira EF, Borba PM, Laureano-Filho JR, do Egito Vasconcelos BC. Application of Dexamethasone in the Masseter Muscle During the Surgical Removal of Lower Third Molars. Journal of Craniofacial Surgery. 2017 Jan; 28(1): e43-7. doi: 10.1097/SCS.0000000000003188.

Mubeen S, Farheen I, Saddique Aslam Khattak KN, Manzoor I. Importance of Dexamethasone for Control of Edema and Pain at Surgical Site in the Mandibular Fracture Osteosynthesis Treatment. Pakistan Journal of Medical and Health Sciences. 2023 Apr; 17(03): 395-. doi: 10.53350/pjmhs2023173395.

Wemambu J, Opaleye T, Yussuf A, Alonge M, Okoturo E. Comparison of Two Dexamethasone Intervention Time Points in Reducing Post-Operative Sequelae of Mandibular Fracture Osteosynthesis: Dexamethasone Intervention in Mandibular Fracture Osteosynthesis. Nigerian Journal of Dental Research. 2023 Jul; 8(2): 45-52. doi: 10.4314/njdr.v8i2.2.

Hashim MH, Shadab R, Kali B, Khan N, Tariq ZR, Ali S, Zahid S. Role of Dexamethasone at Surgical Site in the Control of Pain and Edema in the Management of Mandibular Fracture Osteosynthesis. Pakistan Oral and Dental Journal. 2020 Jul; 40(2): 72-5.

Oksa M, Haapanen A, Furuholm J, Thorén H, Snäll J. Effect of Perioperative Systemic Dexamethasone on Pain, Edema, and Trismus in Mandibular Fracture Surgery: A Randomized Trial. Journal of Craniofacial Surgery. 2021 Nov; 32(8): 2611-4. doi: 10.1097/SCS.0000000000007775.

Genc A, Cakarer S, Yalcin BK, Kilic BB, Isler SC, Keskin C. A Comparative Study of Surgical Drain Placement and the Use of Kinesiologic Tape to Reduce Postoperative Morbidity After Third Molar Surgery. Clinical Oral Investigations. 2019 Jan; 23: 345-50. doi: 10.1007/s00784-018-2442-x.

Rodrigues VP, Deboni MC, Cecchetti MM, Ocaña RP, Frare JG, de Araújo JG et al. Hydrocortisone Irrigation for Postoperative Control of Edema in Inferior Third Molar Removal–A Pilot Study. Journal of Oral and Maxillofacial Surgery, Medicine, and Pathology. 2020 Sep; 32(5): 351-5. doi: 10.1016/j.ajoms.2020.04.004.

Nair RB, Rahman NM, Ummar M, Hafiz KA, Issac JK, Sameer KM. Effect of Submucosal Injection of Dexamethasone on Postoperative Discomfort After Third Molar Surgery: A Prospective Study. The Journal of Contemporary Dental Practice. 2013 May; 14(3): 401. doi: 10.5005/jp-journals-10024-1335.