Dexamethasone Injection Into Pterygomandibular Space Versus Sublingual Space on Post-Operative Sequalae of Lower Third Molar Intervention

Abstract

Background The surgical removal of lower third molar is still the most common surgical procedure that is done in oral and maxillofacial surgery field and creates the predictable post-operative sequelae such as pain, swelling, stiffness and difficulty in mouth opening. The purpose of this study is to compare pre-operative dexamethasone injection into pterygomandibular space (PGS) and sublingual space (SLS) in lower third molar intervention of post-operative pain, swelling, and limited mouth opening. Methods This study is the split-mouth, randomized crossover clinical trial in 30 healthy patients (mean age 21 years). These patients had similar bilateral lower third molar impactions. The patients were randomly divided into two groups receiving either 8-mg dexamethasone injection into SLS or PGS with the 4-week washout period intervention. Clinical assessment of facial swelling and maximum mouth opening was performed before operation and on day 2 and day 7 after operation. The post-operative pain was also measured by patients’ response on pain visual analogue scale (VAS) on the first, second and third day after intervention. Results There is no significant difference between PGS group and SLS group in pain and swelling on the second and seventh day after operation. However, PGS group showed a greater degree of limited mouth opening than SLS group on the second day after operation. Conclusions This study showed that 8-mg dexamethasone injection into PGS or SLS was not different in reduction of pain, swelling, and limited mouth opening. This result suggests that dexamethasone injection into PGS or SLS is similarly effective.

Pain in Oral and Maxillofacial Surgery and Implant Dentistry: Types and Management

“…112 According to other literature, dexamethasone is applied via different routes in third molar surgeries, with the submucosal route showing superior effects. [113][114][115][116][117] Platelet rich fibrin (PRF) in third molar surgery was involved in a randomized clinical trial in 2015, resulting in no significant differences of pain in the intervention and the control areas. 118 However, a study by Al-Hamed et al in 2016 with PRF said that it decreased pain more than promoting soft tissue healing, 119 the mechanism of which includes the promotion of blood clots since this material is filled with growth factors and cytokines needed for recovery and pain reduction.…”

Efficacy and safety of ibuprofen gargle for postoperative pain after mandibular third molar extraction: A phase II, placebo‐controlled, double‐blind, randomized crossover trial

“…The split‐mouth randomized controlled trial is a popular study design in oral health (Ceccheti et al, 2014 ; Christoffoli et al, 2021 ; Moranon et al, 2019 ). However, owing to contamination and carryover effect, treatment effects cannot be evaluated in this study design (Hujoel & DeRouen, 1992 ; Lesaffre et al, 2009 ).…”

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

“…Validating the evidence presented by Latt et al 61 and Gozali et al 23 , a 2019 study by Moranon et al 62 found that injections of 8 mg dexamethasone into the pterygomandibular or sublingual space were effective similarly in easing postoperative sequelae after third molar surgeries.…”