title: The efficacy of corticosteroids in postparotidectomy facial nerve paresis.
abstract: OBJECTIVE
  To determine whether the administration of perioperative corticosteroids is effective in ameliorating facial nerve paresis after parotidectomy.
  
  
  METHODS
  Prospective, randomized, double-blinded, placebo-controlled clinical trial at a university medical center.
  
  
  METHODS
  Patients scheduled for parotidectomy and who met inclusion criteria were invited to enroll in the protocol. They were stratified according to the anticipated surgery (superficial or total parotidectomy) and then received one of two doses of dexamethasone (0.51 or 1.41 mg/kg divided into three doses) or placebo solution immediately preoperatively and then every 8 hours for 16 hours postoperatively. The facial nerve was graded for proportion (percentage) of function at each of the four major regions (frontal, orbital, midface and upper lip, and lower lip). The early postoperative function and rate of return of function were compared among the treatment groups.
  
  
  RESULTS
  Forty-nine patients were enrolled and evaluated (18 in the control group, 16 receiving low-dose dexamethasone, and 15 receiving high-dose dexamethasone). No therapeutic advantage of dexamethasone treatment could be appreciated with respect to the degree of early postoperative nerve function (81.3% for control patients vs. 69.5% for dexamethasone-treated patients [ =.239]). Similarly, the median time to recovery of complete facial nerve function was 60 days in the control group and was 150 days in the dexamethasone-treated patients.
  
  
  CONCLUSIONS
  Dexamethasone administration in patients undergoing parotidectomy is not justified. Despite the relatively modest risk profile of dexamethasone, we were unable to demonstrate any benefit in patients who were treated with either low-dose or high-dose steroids compared with placebo-treated patients in a randomized, controlled trial.
authors.affiliation: Division of Otolaryngology-Head and Neck Surgery, Stanford University Medical Center, California, USA.
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: Lee
authors.forename: Willard E
authors.initials: WE
authors.lastname: Fee
authors.forename: David J
authors.initials: DJ
authors.lastname: Terris
mesh_terms: D000328:Adult; D003907:Dexamethasone / Q000627:therapeutic use*; D004311:Double-Blind Method; D005158:Facial Paralysis / Q000188:drug therapy* / Q000209:etiology* / Q000503:physiopathology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010305:Parotid Diseases / Q000601:surgery*; D011446:Prospective Studies; D018709:Statistics, Nonparametric
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone