Corticosteroid administration in oral and orthognathic surgery

Abstract

Medline and Cochrane Library. Clinical trials of oral and orthognathic surgery involving CS administration. 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. 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. 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.