Administration of corticosteroids in mandibular fractures- A double edged sword

Abstract

Aim: To compare the effectiveness of five day versus one day perioperative dose of corticosteroids in mandibular fractures operated via an intraoral approach. Materials and method: This is a prospective, randomized, controlled, double blind clinical study involving 144 subjects from (2011-2015) who underwent Open reduction and internal fixation (ORIF) via intraoral approach for simple, non-comminuted, fractures of mandible. The subjects were randomly assigned into 2 groups of 72 each by lottery method. Patients in Group A (control group) were administered a tapering dose of Dexamethasone 8mg IV over 5days while patients in Group B (test group) received one preoperative and one postoperative dose of intravenous (IV) Dexamethasone. Both groups were administered 1 st dose of 8mg Dexamethasone simultaneously. Both the groups were followed up on the 1 st day, 3 rd day, 1 st week post operatively and were evaluated for pain (VAS on 10cm scale), swelling, paraesthesia, nausea and vomiting and any other adverse effects. Results: Postoperatively swelling at 48hours was higher in test group by 7.5% which was statistically significant (p = 0.001). Paraesthesia was also 10% higher in test group but wound dehiscence was higher in control group by 7.5%. The test group also recorded lower incidence of infection clinically as well as radiographically. Conclusion: 5 day steroid regimen and 1 day regimen were equally effective in increasing patients comfort by reducing swelling. However, 1 day regimen was significantly satisfactory with regard to healing and long term outcomes while being cost effective at the same time.