Postoperative Facial Swelling Research Articles

Efficacy of Submucosal versus Pterygomandibular Dexamethasone Injection in Surgical Extraction of the Impacted Lower Third Molar

Objectives: This study aimed to evaluate the efficacy and postoperative complications of preoperative submucosal dexamethasone injection compared to preoperative dexamethasone injection into the pterygomandibular space for surgical extraction of the impacted lower third molar. Study design and setting: This was a quasi-experimental, cross-sectional study conducted at the Department of Oral and Maxillofacial Surgery, Dow International Dental College, Dow University of Health Sciences, Karachi, from April to July 2021. Methodology: The study sample consisted of 72 patients who reported surgical extraction of their lower wisdom teeth and consented to participate in this study. The patients were randomly divided into the submucosal injection group (SM) and the pterygomandibular space (PM) group. The injection time was recorded on the second and seventh postoperative days. Results: No significant differences in the duration of the intervention were observed between the two groups (23.08 min in PM, 23.07 min in SM). The postoperative facial swelling was significantly reduced transversely (ear lobe to the angle of the mouth) in both groups compared to their respective baselines on the first postoperative day. On the secondpostoperative day, significant changes were observed in the submucosal group in postoperative swelling. Conclusions: Using intraoral dexamethasone injections in third molar surgery significantly reduces conventional complications of surgery while avoiding the systemic side effects of steroids. Dexamethasone should be used regardless of the administration site when warranted, with less apprehension than is common in dentistry

Comparison Between the Effects of Alvogyl Paste and 0.2% Chlorhexidine Gel on Postoperative Swelling Following Mandibular Third Molar Surgery

Facial swelling, pain, and trismus are typical side sequelae of mandibular third molar surgery. These symptoms are all caused by tissue inflammation followed by trauma from surgery and the quality of life of these patients has been significantly impacted by these symptoms in the immediate post-operative period. Both Alvogyl and chlorhexidine bio-adhesive gel are routinely used in dental practice to reduce post-operative sequelae due to their antimicrobial and anti-inflammatory properties. The study was set up as a randomized controlled clinical study and conducted from February 2022 to September 2022. The study involved patients 18-39 years old who sought extraction of an impacted lower third molar attending the Oral Surgery Clinic in the College of Dentistry in Baghdad. The sample was divided into three groups, the first group received Alvogyl paste following third molar surgery while the second group received periokin chlorhexidine bio-adhesive gel and the last control group didn’t receive any medication. Results of a study with 51 patients, equally assigned into two study groups and a control group, indicate that in the study groups, there was a reduction in post-operative facial swelling in comparison with the control group and the reduction was statistically significant (P =0.001), and the Alvogyl paste was superior to chlorhexidine in swelling reduction but statistically not significant.

Efficacy of Dexamethasone Injection at Different Sites on Postoperative Sequelae After Extracting Mandibular Impacted Third Molars: A Randomized Controlled Trial

BackgroundDexamethasone, an efficacious anti-inflammatory agent, is widely used after tooth extraction. However, its optimal injection site has yet to be investigated. PurposeWe compare the efficacy of dexamethasone injection at different sites on postoperative sequelae after extracting mandibular impacted third molars (MITMs). Study design, setting, and sampleA prospective randomized controlled trial was conducted. Healthy adults with fully MITMs scheduled for extraction were included. Exclusion criteria were 1) Patients with the systemic alteration that prevented the surgical procedure; 2) pregnancy, breastfeeding, premenstrual period; 3) hypersensitivity to the drug under test; and 4) those who did not return for postoperative follow-up at one, three, and seven days. Exposure variableThe subjects were randomized to three groups. An online randomization plan generator assigned each subject to a single treatment by randomly permuting blocks. Different sites for postoperative dexamethasone injections included the buccal side of the adjacent second molar and extraction sockets. Dexamethasone injection (4 mg) on the buccal side of the adjacent second molar (group 1), an injection on the buccal side of extraction sockets (group 2), an injection of physiological saline (0.8 mL) on the buccal side of the adjacent second molar (control). Outcome variablesThe outcome variables were postoperative facial swelling, limitation of the mouth opening, postoperative pain, and postoperative quality of life evaluation. The pain was assessed using a visual analog scale (VAS) at one, three and seven days, postoperatively. The quality of life was recorded throughout the Posse scale at seven days. CovariatesThe covariates are age, sex, length of operation, and type of impacted teeth and surgery. AnalysesThe statistical analysis was performed using ANOVA, repeated measures ANOVA, Chi-square, or Fisher’s exact tests with P-values < 0.05 considered statistically significant. ResultsOur study included 58 participants with a mean age of 19.48 ± 3.31 years; group 1 (n = 24), group 2 (n = 20), and control group (n = 14). On day three postoperative, the swelling and trismus were significantly less in group one than in the other two groups (P < 0.05), and group one had an overall postoperative quality of life compared to other groups (P < 0.05). Unaffected speech function was present in 73.7% of patients in group 1, while 50% of patients in group 2 had affected speech function three days after the operation (p < 0.05). The "unable to open mouth" of the “Eating subscale” and “felt tingling” had statistical significance (p < 0.05). ConclusionsDexamethasone injections on the buccal side of the adjacent second molar can be a viable option for treating facial swelling and limitation of mouth opening after total MITMs extraction.

A reliable and reproducible method for repositioning 3D images to calculate changes in facial volume after orthognathic surgery

PurposeAn accurate, reproducible method to calculate post-operative facial swelling in patients who have undergone orthognathic surgery is important to evaluate the effects of different therapies and surgical techniques on edema. The purpose of this study was to describe such a method and assess its reliability. Materials and methodsA prospective study of patients undergoing orthognathic surgery was conducted. 3D facial photographs were taken on these patients immediately postoperatively, and again at least 21 days later using the 3DMD face system (3DMD LLC., Atlanta, GA, USA). These were cropped using specific anatomic points and the difference in facial volume between the photographs was calculated. Intra-rater reliability and inter-rater reliability were assessed using the Intraclass Correlation Coefficient (ICC). Results30 patients were included in the study for analysis. When the difference in facial swelling was calculated twice by the same rater, the mean difference between the two measurements was 4.0 ± 4.2 mL. When calculated by two separate raters, the mean difference was found to be 5.0 ± 3.8 mL. The ICCs for intra-rater and inter-rater reliability were excellent at 0.979 and 0.981 respectively. ConclusionThis method allows for reproducible calculation of post-operative facial swelling and could be useful to evaluate the effects of different therapies used to limit swelling and to track the resolution of swelling. It can also potentially be used as a visual aid for patient counseling during the pre-surgical visits.

Comparative Evaluation of Postoperative Facial Swelling and Occlusion in Orthognathic Treatment with Clear Aligners versus Fixed Orthodontic Appliances: A Systematic Review

The purpose of this systematic review was to assess the postoperative facial swelling (FS) and occlusion attained with clear aligner therapy (CAT) and fixed orthodontic therapy (OT) after orthognathic surgery (OS). The focused question was “Is there a difference in postoperative FS and occlusion attained with CAT and fixed OT after OS?” Indexed databases were searched up to and including October 2023 using different keywords. Original clinical studies that compared postoperative FS and occlusion attained with CAT and fixed OT after OS were included. Risk of bias (RoB) and quality of evidence were also assessed. Four retrospective studies were included. One study reported no difference in postoperative FS among patients that underwent CAT or fixed OT after OS. In one study, patients treated with CAT demonstrated less FS in the first post-surgical week than individuals that underwent fixed OT. In one study, postoperative occlusion was comparable among patients that underwent CAT or fixed OT, whereas in another, postoperative occlusion was better in patients that underwent fixed OT than CAT. All studies had a moderate RoB and none of the investigations were based on power-adjusted data. Based upon the sparsity and questionable quality of available evidence, there is a need to render a firm conclusion. However, it seems that CAT and fixed OT are comparable in relation to postoperative occlusion and FS after OS.

Risk factors for postoperative facial swelling at 1 week after bimaxillary orthognathic surgery in Class III patients

ObjectiveTo quantify facial swelling at 1 week after Le Fort I osteotomy and bilateral sagittal splitting ramus osteotomy in Class III patients and to identify factors contributing to the swelling based on clinical, morphologic, and surgical variables. Study DesignData from 63 patients were examined in this single-center, retrospective study. Facial swelling was quantitatively measured by superimposing computed tomography data taken in the supine position at 1 week and 1 year postoperatively and extracting the area of maximum intersurface distance. Age, sex, body mass index, thickness of subcutaneous tissue, and of masseter muscle, maxillary length (A-VRP), mandibular length (B-VRP), and posterior maxillary height (U6-HRP), surgical movement (ΔA-VRP, ΔB-VRP, ΔU6-HRP), drainage method, and usage of facial bandages were examined. Multiple regression analysis was performed using the above factors. ResultsThe median swelling at 1 week postoperatively was 8.35 IQR (5.99–11.47) mm. Multiple regression analysis revealed three factors that were significantly associated with facial swelling: Use of postoperative facial bandages (P=0.03), masseter muscle thickness (P=0.03), and ΔB-VRP (P=0.04). ConclusionAbsence of a facial bandage, thin masseter muscle, and large horizontal mandibular movement are risk factors for facial swelling at 1 week postoperatively.

Efficacy and safety of modified Hartel approach in the treatment of primary trigeminal neuralgia with radiofrequency thermocoagulation

Objective: To assess the efficacy and safety of modified Hartel approach in the treatment of primary trigeminal neuralgia with radiofrequency thermocoagulation. Methods: A total of 89 patients with primary trigeminal neuralgia in Nanjing Drum Tower Clinical College of Xuzhou Medical University from July 2021 to July 2022 were prospectively included, and were divided into experimental group (n=45, modified Hartel approach: selecting 2.0 cm lateral to and 1.0 cm below angulus oris as insertion point) and control group (n=44, traditional Hartel approach: selecting 2.5 cm lateral to the angulus oris as insertion point) according to the random number table method. There were 19 males and 26 females in the experimental group, and aged (67.6±8.8) years. Meanwhile, there were 19 males and 25 females in the control group, and aged (64.8±11.7) years. All the patients were treated by CT-guided radiofrequency thermocoagulation. The success rate of one-time puncture, number of punctures, the time of puncture, operation time, numerical rating scale (NRS) scores and complications were recorded and compared between the two groups. Results: The success rate of one-time puncture in experimental group was 64.4% (29/45), which was higher than that in control group 31.8% (14/44) (P<0.05). The number of punctures [M (Q1, Q3)], the time of puncture [M (Q1, Q3)] and operation time in the experimental group were 1 (1, 2), 218 (206, 378) s, (19.9±2.7) min, which were less than those of control group [2 (1, 3), 390 (231, 598) s, (27.0±3.9) min] (all P<0.05). The NRS scores [M (Q1, Q3)] of 1 day, 1 month and 3 months after surgery in the experimental group were 1 (1, 2), 1 (0, 2) and 1(0, 1), respectively, which were lower than the baseline level [6 (6, 7)] (all P<0.05). The NRS scores [M (Q1, Q3)] of 1 day, 1 month and 3 months after surgery in the control group were 1 (1, 2), 1 (0, 2) and 1 (0, 2), respectively, which were lower than the baseline level [6 (6, 7)] (all P<0.05). There was no statistically significant difference in the incidence of nausea and vomiting, facial numbness, and decreased masticatory muscle strength between the two groups (all P>0.05) In the experimental group, two patients had puncture needles into the oral cavity, with timely detection and replacement of puncture needles, and no infection occurred. There was no cerebrospinal fluid leakage and decreased corneal reflex in both groups. Conclusion: The modified Hartel approach can significantly improve the success rate of one-time puncture via foramen ovale, reduce the operation time and the incidence of postoperative facial swelling, which is a safe and effective puncture method.

Reliability of 3D Stereophotogrammetry for Measuring Postoperative Facial Swelling.

This study aimed to determine the reliability of three-dimensional (3D) stereophotogrammetry as a measurement instrument for evaluating soft tissue changes in the head and neck area. Twelve patients received a bilateral sagittal split osteotomy (BSSO). Test and retest 3D photographs were captured within the first three postoperative weeks, and a reference 3D photograph was capture at three months postoperatively. Distance measurements, mean and root mean square of the distance map, and volume differences were obtained. Reliability of these parameters was assessed by intraclass correlation coefficients (ICCs), standard error of measurement (SEM), and smallest detectable change (SDC). All distance measurements had an ICC > 0.91, and the distance map parameters and volume differences showed ICCs > 0.89. The neck region presented the largest SEMs (5.09 mL) and SDC (14.1 mL) for the volume difference. In conclusion, 3D stereophotogrammetry is reliable for distance and volume measurements of soft tissues in patients after a BSSO advancement.

Effect of pre-operative 40 mg oral methylprednisolone on post- odontectomy facial swelling, intraoral redness, pain and level of TNF-α

Odontectomy is the surgical removal of teeth by making a mucoperiosteal flap and reducing the jawbone. This procedure is likely to cause injury and damage to soft and hard tissues, stimulate inflammatory responses, and generate release of proinflammatory cytokines, one of which is TNF- ɑ, resulting in the facial swelling, intraoral redness, and pain. This study was aimed at observing effects of 40 mg methylprednisolone, administered 1 hour before odontectomy on facial swelling, intraoral redness, and pain and level of TNF-ɑ after odontectomy. The randomized placebo-control trial study involved 24 subjects who underwent odontectomy at the Oral Surgery and Maxillofacial clinic of Prof. Soedomo Dental Hospital, Universitas Gadjah Mada. To comply with the inclusion criteria, the subjects were divided into placebo group (12 patients) and methylprednisolone group (12 patients). The observation of facial swelling, intraoral redness, pain (VAS) and level of TNF-ɑ (ELISA) was done before odontectormy, H+1 (24 hours after odontectomy) and H+3 (72 hours after odontectomy). The data gathered were analyzed using Repeated Measures ANOVA and post-hoc Bonferroni (p &lt; 0.05). The results showed that those administered with methylprednisolone an hour before odontectomy experienced less postoperative facial swelling (p = 0.000), a lower score of intraoral redness (p = 0.000), a lower score of pain (p = 0.000) and a lower level of TNF-ɑ (p = 0.000) compared to the placebo. The changes in TNF-α showed the strongest correlation with the changes in postoperative pain and intraoral redness compared with facial swelling. Oral administration of 40 mg methylprednisolone an hour before odontectomy is more effective in reducing facial swelling, intraoral redness, pain and level of TNF-ɑ following odontectomy of mandibular third molar compared with the placebo.

Transeptal Approach to the Maxillary Sinus and Pterygopalatine Fossa.

Transeptal Approach to the Maxillary Sinus and Pterygopalatine Fossa.

A Randomized Case-controlled Clinical Trial of the Effect of Preemptive Etoricoxib, Prednisolone and a Control Group on of Postoperative Sequelae after Surgical Removal of Impacted Mandibular Third Molars

Background: The aim of this study was to compare the anti-inflammatory effects of prednisolone andetoricoxib after third molar extraction.Method: A prospective, controlled study was conducted on 39 volunteers were allocated in three differentgroups, to receive either 120 mg etoricoxib or 10mg prednisolone 30 minutes prior to the procedure, and alsoa controlled group who didn’t receive any medication pre-operatively.Baseline measurements were obtainedpreoperatively, and subsequent assessments were made on immediate postoperative, at 48 hours and 7 daysafter surgery to measure postoperative facial swelling by use of linear measurements, interincisal mouthopening width and visual analog scale score for pain. The amount of analgesics consumed was recorded.Descriptive statistics were used to compare the two groups at P &lt; 0.05.Conclusion: Considering the results that were obtained upon the efficacy of different pre-emptive medication,Etoricoxib showed statistically significant values in terms of pain reduction and restriction in mouth opening,in the other hand prednisolone showed significance results in terms of edema reduction.

Comparative efficiency of the preoperative pterygomandibular space injection of two doses of dexamethasone in mandibular third molar surgery.

BackgroundImpacted mandibular third molar removal is one of the most commonly performed oral surgical procedures. This procedure can lead to several postoperative complications, such as trismus, facial swelling, and pain, which occur as a result of the inflammatory responses to surgery. This study compared the efficiency of preoperative injections of 4 mg versus 8 mg dexamethasone into the pterygomandibular space to reduce postoperative sequelae.MethodsThis was a randomized, prospective, split-mouth, controlled study, including 52 mandibular third molar surgeries in 26 patients. Each patient was randomized to either the 4 mg or 8 mg dexamethasone injection group. Dexamethasone was injected into the pterygomandibular space after numbness from local anesthesia. Data were collected for trismus, facial swelling, visual analog scale (VAS) pain score, and the number of analgesics taken during the evaluation period. The level of significance was set at P < 0.05.ResultsStatistically significant differences in postoperative facial swelling (P = 0.031, diff = 1.4 mm) and pain (P = 0.012, diff = 0.020) were found between the 8 mg and 4 mg dexamethasone groups. However, there were no significant differences between the groups for trismus and the total number of analgesics consumed (P > 0.05).ConclusionCompared to the 4 mg preoperative dexamethasone injection, the 8 mg preoperative dexamethasone injection into the pterygomandibular space was more effective in reducing postoperative swelling and pain following the surgical removal of the impacted mandibular third molar. However, the difference in trismus could not be evaluated clinically. Therefore, the recommendation of administering the 4 mg dexamethasone preoperative injection is optimal in the third molar surgical procedure.

Hyperbaric CO2 Cryotherapy for Managing Swelling After Mandibular Angle Ostectomy.

Postoperative facial swelling after mandibular angle ostectomy is a concern for patients as it affects their quality of life. This study aimed to evaluate the effect of hyperbaric CO2 cryotherapy in relieving postoperative swelling. Thirty-seven patients (mean age: 22.95 ± 3.49 years) who underwent bilateral mandibular angle ostectomy from April to October 2019, were included in this study. A split-mouth design was adopted and through a random sequence, either side of the face was designated as the experimental side. Both received routine nursing care, while the experimental side underwent an additional hyperbaric CO2 cryotherapy treatment. The facial structure was recorded by a 3-dimensional laser scanner pre- and postoperatively. Geomagic Studio was used for alignment, visualization, and quantification of the swelling. The largest deviation value on each side was adopted to assess the overall swelling. Parameters were compared using the paired t-test, and P<0.05 was considered statistically significant. No necrosis of the skin and adjacent structures or other complications occurred in these patients. After the first day of cryotherapy, the deviation in the experimental and the control groups was (8.40 ± 1.95) mm and (10.42 ± 2.03) mm, respectively. The next day, after cryotherapy, the value further reduced to (5.42 ± 1.36) mm and (8.24 ± 2.22) mm for the experimental and control groups, respectively. And the effect remained till the seventh day. No difference was observed in terms of volume of drainage. Hyperbaric CO2 cryotherapy is safe and effective in relieving postoperative swelling and seems to be more effective than the traditional cold-pack treatment after mandibular angle ostectomy.

The effect of manual lymphatic drainage on patient recovery after orthognathic surgery—A qualitative and 3-dimensional facial analysis

The aim of this study was to investigate the effect of manual lymphatic drainage (MLD) on postoperative facial swelling and pain. A randomized, single-center, prospective, 2-arm clinical trial with blinded endpoint assessment was set up. Patients were enrolled from the Maxillofacial Department of the Ghent University Hospital (Belgium) between January 2015 and March 2018. Both the intervention group (n=13) and the control group (n=13) received the same postoperative care; in addition, the intervention group underwent 6 sessions of MLD after orthognathic surgery. Three-dimensional facial scans were performed and questionnaires administered on postoperative days 3, 7, 14, 30, 90, and 180. A linear mixed model was performed, and statistical significance was assumed at the 5% level. In total, 26 patients (mean age 29 years; range 16-57 years) were included for statistical analysis. A faster decrease in swelling in the intervention group was observed on 3-dimensional scans. Furthermore, patients receiving MLD reported reduction in swelling and pain within the first month after surgery. However, no statistically significant difference could be detected in these observations (P > .05). Within the limitations of this study, no statistically significant difference could be found between patients treated with or without MLD after orthognathic surgery with regard to swelling and pain.

The Effect of Submucous Dexamethasone Injection on the Post-Operative Sequelae After Impacted Third Molar Surgery

Background: Different method were attempted by many researchers to reduce postoperative inflammatory response following surgical extraction of lower wisdom teeth because this is a very common procedure and is usually associated with pain, difficulty in mouth opening and swelling. Aims: To assess the effect of sub mucosal injection of 4mg/1ml dexamethasone on reduction of postoperative pain, facial swelling and trismus following the surgical extraction of impacted lower wisdom teeth. Materials and Method: forty patients were selected to be included in this randomized clinical study with a total number of 42 impacted mandibular third molars, they divided randomly into two groups, control and study group of twenty patients for each, patients in the study group received 4mg/1 ml submucos injection of dexamethas one, while patients in the control group received placebo (normal saline) five minutes after local anesthesia administration, and surgical removal of impacted teeth was done after further five minutes. evaluation of mouth opening and swelling was done as a baseline and on the second and seventh post-operative days after surgery, while pain was scored daily until the 7 th postoperative day by the patient according to numerical rating scale. Assessment of trismus was done by measuring the maximum interincisal distance swelling was evaluated by measuring the distance between five selected points. Every one of these factors in addition to the time of surgery were compared between the two groups. Results: Study group showed less limitation in mouth opening than control group but there was no statistically significant difference between them however study group showed a significant reduction in pain scores on the first and the second post-operative days and a significant improvement of swelling compared with the control group at the 48 hour follow up. Conclusion: Submucosal injection of dexamethasone was effective in minimizing facial swelling, Pain and trismus after surgical extraction of mandibular third molar.

Clinical effects of platelet rich fibrin in prevention of bleeding and swelling after mandibular angle reduction

Objective To observe the clinical effect of platelet- rich fibrin (PRF) on prevention of postoperative hemorrhage and facial traumatic swelling in patients with mandibular angle osteotomy. Methods Twenty-five patients with mandibular angle hypertrophy were included in this study from January 2014 to November 2015. Split face comparative study was carried out to use the left and right sides as the experimental side and the control side, respectively. The PRF in the experimental side was placed in the mandibular osteotomy, while the control side was placed in platelet- poor plasma (PPP). After operation, the drainage volume and facial swelling degree were measured. Results The drainage volume of the experimental group (PRF group) was (20.35±7.40) ml, the control group (PPP group) was (43.23±11.96) ml, and the difference was statistically significant (P<0.05). There was no such case without swelling in postoperative third day. The facial swelling score on the experimental side was (1.19±0.40), the control side was (2.62±0.64), and two groups of postoperative facial swelling scores were significantly different (P<0.05). Conclusions The PRF can reduce postoperative bleeding and facial swelling after mandibular angle osteotomy. Key words: Mandibular angle reduction; Platelet- rich fibrin; Postoperative hemorrhage; Facial traumatic swelling

Therapeutic efficacy of cryotherapy on facial swelling, pain, trismus and quality of life after surgical removal of mandibular third molars: A systematic review.

The objective was to test the hypothesis of no difference in facial swelling, pain, trismus and immediate quality of life after surgical removal of mandibular third molars, with or without post-operative cryotherapy. A MEDLINE (PubMed), EMBASE database and Cochrane library search in combination with a hand search of relevant journals were conducted by including human randomised controlled trials published in English until 17 July 2018. The search identified 37 titles. Six studies with low or unclear risk of bias fulfilled the inclusion criteria. Intermittent cryotherapy for 30minutes during the first post-operative days significantly diminished facial swelling, pain and trismus compared with no cryotherapy. Patient's satisfaction and perception of recovery were significantly increased with cryotherapy. Therapeutic efficacy of intermittent cryotherapy on post-operative facial swelling, pain and trismus seems to be improved compared with continuous cryotherapy. Considerable variations in study design, diversity of used evaluation methods, outcome measures and various methodological confounding factors posed serious restrictions to review the literature in a quantitative systematic manner. Thus, conclusions drawn from the results of this systematic review should be interpreted with caution. Further well-designed randomised controlled trials including standardised protocol, larger patient sample, blinded outcome assessors, patient-reported outcome measures and three-dimensional volumetric analysis of facial swelling are required before evidence-based recommendations can be provided.

Effect of preemptive dexamethasone and etoricoxib on postoperative period following impacted third molar surgery - a randomized clinical trial.

Background The aim of this study was to compare the anti-inflammatory effects of dexamethasone and etoricoxib after third molar extraction. Material and Methods A prospective, randomized, controlled, split-mouth study was conducted. 19 volunteers were allocated randomly to receive 90mg etoricoxib 1 hour prior to the procedure or 4mg intramuscular dexamethasone immediately after anesthesia. Baseline measurements were obtained preoperatively, and subsequent assessments were made on immediate postoperative, at 72 hours and 7 days after surgery to measure postoperative facial swelling by use of linear measurements, interincisal mouth opening width and visual analog scale score for pain. The amount of analgesics consumed was recorded. Descriptive statistics and the independent-samples t-test were used to compare the two groups at P < 0.05. Results Dexamethasone was effective in the control roasted edema for measurements of the mandibular angle - wing of the nose and mandibular angle - labial commissure 72 hours after surgery. And for the measurement mandibular angle - mentum, in the time of 72 hours and 7 days. There was no statistically significant difference in relation to pain and trismus. Conclusions Considering significant results for some measures of the variable edema for the group that used intramuscular dexamethasone and the difference without statistical significance between groups for the other variables studied, we seem to reflect the intramuscular indication of the corticosteroid in a single dosage in relation to the use of etoricoxib as pre-emptive medication. Key words:Corticosteroids, COX-2 selective, third-molar surgery.

Effect of intranasal excision under open the nasal vestibular flap on nasal vestibular cyst under nasal endoscopy

Objective:Objective:To observe the clinical Effect of intranasal excision under open the nasal vestibular flap on nasal vestibular cyst under nasal endoscopy.Method:Forty-five patients with nasal vestibular cyst were randomly divided into two groups: nasal vestibule flap group (n=25) and labial gingival crevicular approach group (n=20).Comparison of two groups of patients with operation time, intraoperative blood loss, wound healing time, postoperative local numbness or pain, 1 week after eating the inconvenience, the degree of postoperative wound pain, postoperative facial swelling degree were compared between the two groups.Result:①The operation of the two groups was successful, and all patients were not relapse followed-up for 1-3 years and averaged 1.5 years. ②Compared with labial gingival crevicular groove approach group,the amount of bleeding, wound healing time, postoperative upper lip numbness in local incidence, one week after operation of eating or the incidence rate of eating inconvenience pain aggravate in nasal vestibular double flap group with were all statistically significant (P<0.05).The operation time of the two groups were not statistically significant(P>0.05).③The degree of pain and swelling of the face in the nasal vestibule flap group were significantly lighter than that of the labial gingival crevicular approach group(P<0.05).Conclusion:Endoscopic resection of nasal vestibular cyst through nasal vestibule flap approach has advantages in less intraoperative bleeding,shorter wound healing time,much less postoperative local reaction, less pain and lower postoperative recurrence rate, and does not increase operative time.

Predicting postoperative facial swelling following impacted mandibular third molars extraction by using artificial neural networks evaluation

Patients’ postoperative facial swelling following third molars extraction may have both biological impacts and social impacts. The purpose of this study was to evaluate the accuracy of artificial neural networks in the prediction of the postoperative facial swelling following the impacted mandibular third molars extraction. The improved conjugate grads BP algorithm combining with adaptive BP algorithm and conjugate gradient BP algorithm together was used. In this neural networks model, the functional projective relationship was established among patient’s personal factors, anatomy factors of third molars and factors of surgical procedure to facial swelling following impacted mandibular third molars extraction. This neural networks model was trained and tested based on the data from 400 patients, in which 300 patients were made as the training samples, and another100 patients were assigned as the test samples. The improved conjugate grads BP algorithm was able to not only avoid the problem of local minimum effectively, but also improve the networks training speed greatly. 5-fold cross-validation was used to get a better sense of the predictive accuracy of the neural network and early stopping was used to improve generalization. The accuracy of this model was 98.00% for the prediction of facial swelling following impacted mandibular third molars extraction. This artificial intelligence model is approved as an accurate method for prediction of the facial swelling following impacted mandibular third molars extraction.