Efficacy of submucosal injection of hyaluronidase after mandibular third molar surgery: a randomized controlled trial

Abstract

Objectives: This study aimed to investigate the efficacy of postoperative submucosal injection of hyaluronidase (HUD) for reducing sequelae and quality of life (QOL) after mandibular third molar (M3M) surgery. Materials and Methods: Participants with bilateral impacted M3M underwent surgical extraction with a split-mouth randomized controlled study design. M3M were removed by the same surgeon in 2 sessions, one a control and the other experimental. Submucosal injection of HUD was performed in the experimental session and submucosal injection of saline in the control session. Mouth opening, facial swelling, and pain intensity were measured before surgery, and then 2 and 7 days after surgery. The QOL of participants following surgery was evaluated by means of a patient-centered outcome questionnaire (PCOQ). Results: A total of 36 patients was included in the final data analysis. There was a significant reduction in the maximal mouth opening and postoperative pain in the experimental side at the 2 and 7 days after surgery (P<0.05), and a remarkable difference in facial swelling was reported on the experimental side 7 days after surgery (P<0.05). The PCOQ demonstrated that participants reported less pain and swelling on the experimental side. Conclusion:The present study provides clinical evidence that submucosal administration of HUD immediately after M3M surgery reduced postoperative discomfort and improved patients' QOL.

Comparative evaluation of efficacy of 2% lidocaine containing adrenaline with and without hyaluronidase in inferior alveolar nerve blocks for patients requiring bilateral mandibular extractions

“…[22][23][24] Hyaluronidase may be a useful preventive strategy for third molar surgical patients. 5 In some studies, they have said that because of its potential tissue-damaging effects, adding hyaluronidase to a buffered lidocaine solution with epinephrine did not significantly enhance the incidence of pulpal anaesthesia in IAN blocks. 2 Hyaluronidase obvious drawbacks include its added cost although not very high and potential side effects.…”

“…Hyaluronidase inhibits cellular recruitment and the production of pro‐inflammatory mediators resulting in less tissue infiltration and leukocyte adhesion to blood vessels 22–24 . Hyaluronidase may be a useful preventive strategy for third molar surgical patients 5 …”

“…The hyaluronidase enzyme momentarily liquefies the interstitial barrier by rupturing tissue planes, which facilitates the dispersion of local anaesthetic 4 . Hyaluronidase is used in various fields in reducing post‐operative edema, accelerate wound healing and is effective in penetration of nerve block anaesthesia, it eases patient discomfort following surgical procedure, and may also be effective when conventional anti‐inflammatory agents are restricted in case of surgical extraction 3,5,6 . The addition of hyaluronidase to lignocaine with adrenaline has been demonstrated to promote akinesia during inferior alveolar nerve block.…”

“…4 Hyaluronidase is used in various fields in reducing post-operative edema, accelerate wound healing and is effective in penetration of nerve block anaesthesia, it eases patient discomfort following surgical procedure, and may also be effective when conventional anti-inflammatory agents are restricted in case of surgical extraction. 3,5,6 The addition of hyaluronidase to lignocaine with adrenaline has been demonstrated to promote akinesia during inferior alveolar nerve block. Hyaluronidase has been shown to decrease the induction time of inferior alveolar nerve block as well as to improve the quality of the block.…”