Abstract
BackgroundOrthognathic surgery is associated with considerable swelling and neurosensory disturbances. Serious swelling can lead to great physical and psychological strain. A randomized, prospective, controlled clinical trial was realized in order to evaluate the effect of a preoperative intravenous dexamethasone injection of 40 mg on postoperative swelling and neurosensory disturbances after orthognathic surgery.MethodsThirty-eight patients (27 male and 11 female) patients, all with the indication for an orthognathic surgery, were enrolled in this study (mean age: 27.63 years, range: 16–61 years) and randomly divided into two groups (study group/ control group). Both groups underwent either maxillary and/or mandibular osteotomies, resulting in three subgroups according to surgical technique (A: LeFort I osteotomy, B: bilateral sagittal split osteotomy (BSSO), C: bimaxillary osteotomy). The study group received a single preoperative intravenous injection of 40 mg dexamethasone. Facial edema was measured by 3D surface scans on the 1st, 2nd, 5th, 14th and 90th postoperative day. Furthermore, neurosensory disturbances on the 2nd, 5th, 14th and 90th postoperative day were investigated by thermal stimulation.ResultsFacial edema after LeFort I osteotomy, BSSO and bimaxillary osteotomy showed a significant decrease in the study group compared to the control group (P = 0.048, P = 0.045, P < 0.001). The influence of dexamethasone on neurosensory disturbances was not significant for the inferior alveolar nerve (P = 0.746) or the infraorbital nerve (P = 0.465).ConclusionsPatients undergoing orthognathic surgery should receive a preoperative injection of dexamethasone in order to control and reduce edema. However, there was no influence of dexamethasone on reduction of neurosensory disturbances.Trial registrationDRKS00009033.
Highlights
Orthognathic surgery is associated with considerable swelling and neurosensory disturbances
Two-dimensional measurements cannot reflect the extension of facial swelling adequately
Postoperative swelling The degree of swelling was measured by matching a three-dimensional mask in swollen condition (D1-D14)
Summary
Orthognathic surgery is associated with considerable swelling and neurosensory disturbances. A randomized, prospective, controlled clinical trial was realized in order to evaluate the effect of a preoperative intravenous dexamethasone injection of 40 mg on postoperative swelling and neurosensory disturbances after orthognathic surgery. Several trials in oral and maxillofacial surgery have evaluated the use of glucocorticoids to reduce and control the postoperative side effects [5, 8,9,10,11,12,13,14]. All these clinical trials were not able to measure the swelling three-dimensionally due to a lack of technical capabilities, such as 3D scanning facilities. The threedimensional volume of swelling in its complete extension should be quantified in the present study. 3D surface
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