Thomas B Dodson1. 1. Department of Oral and Maxillofacial Surgery, Harvard School of Dental Medicine, Massachusetts General Hospital, Boston, USA.
Abstract
DATA SOURCES: Medline and Cochrane Library. STUDY SELECTION: Clinical trials of oral and orthognathic surgery involving CS administration. DATA EXTRACTION AND SYNTHESIS: The administered doses of CS in the selected articles were recalculated to equivalent anti-inflammatory doses of methylprednisolone, to facilitate comparison; doses of orally administered dexamethasone were decreased by 20% to adjust the dose according to the bioavailability difference between oral and intravenous administration and local injection. Where possible meta-analysis was performed using an inverse variance method, and results summarised using forest plots and relative risks, estimated based on fixed and random effects models. Heterogeneity was quantified. RESULTS: In oral surgery most clinical trials showed a significant decrease in oedema (p= <0.0001) after CS, and local injection of methylprednisolone ≥25 mg was expected to result in a significant decrease in oedema. Regarding the analgesic effect, several clinical trials showed a decrease in pain after CS (P <0.0001). Furthermore, CS administration resulted in a slightly higher risk of infection (relative risk 1.0041 [95%CI 0.9451, 1.0669]), but with a p value of 0.89. In orthognathic surgery methylprednisolone ≥85 mg administered intravenously seemed sufficient to produce a significant decrease in oedema, 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. CONCLUSIONS: These findings suggest that the administration of CS in oral surgery decreases oedema and pain significantly, with no higher risk of infection and with a minimum risk of other side effects.
DATA SOURCES: Medline and Cochrane Library. STUDY SELECTION: Clinical trials of oral and orthognathic surgery involving CS administration. DATA EXTRACTION AND SYNTHESIS: The administered doses of CS in the selected articles were recalculated to equivalent anti-inflammatory doses of methylprednisolone, to facilitate comparison; doses of orally administered dexamethasone were decreased by 20% to adjust the dose according to the bioavailability difference between oral and intravenous administration and local injection. Where possible meta-analysis was performed using an inverse variance method, and results summarised using forest plots and relative risks, estimated based on fixed and random effects models. Heterogeneity was quantified. RESULTS: In oral surgery most clinical trials showed a significant decrease in oedema (p= <0.0001) after CS, and local injection of methylprednisolone ≥25 mg was expected to result in a significant decrease in oedema. Regarding the analgesic effect, several clinical trials showed a decrease in pain after CS (P <0.0001). Furthermore, CS administration resulted in a slightly higher risk of infection (relative risk 1.0041 [95%CI 0.9451, 1.0669]), but with a p value of 0.89. In orthognathic surgery methylprednisolone ≥85 mg administered intravenously seemed sufficient to produce a significant decrease in oedema, 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. CONCLUSIONS: These findings suggest that the administration of CS in oral surgery decreases oedema and pain significantly, with no higher risk of infection and with a minimum risk of other side effects.