Corticosteroid administration in oral and orthognathic surgery: a systematic review of the literature and meta-analysis.
OBJECTIVE
This study evaluated the effect of corticosteroid (CS) administration on edema, analgesia, and neuroregeneration in conjunction with surgical dental extraction, orthognathic surgery, and the risk of developing side effects.


METHODS
A systematic search of the literature was made. The primary predictor variable was CS administration and the outcome variables were edema, pain, and infection. A meta-analysis was performed. The risk of other side effects was evaluated through a simple review.


RESULTS
In oral surgery, most clinical trials showed a significant decrease in edema (P < .0001) after CS, and local injection of methylprednisolone > or =25 mg was expected to result in a significant decrease in edema. Regarding the analgesic effect, several clinical trials showed a decrease in pain after CS (P < .0001). Further, CS administration resulted in a slightly higher risk of infection (relative risk, 1.0041), but with a P value of .89. CS could be administered with no increased risk of infection. In orthognathic surgery, methylprednisolone > or =85 mg administered intravenously seemed sufficient to produce a significant decrease in edema, 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.


CONCLUSIONS
These findings suggest that the administration of CS in oral surgery decreases edema and pain significantly, with no higher risk of infection and with a minimum risk of other side effects.
Dan
Anne E B
AE
Department of Oral and Maxillofacial Surgery, School of Dentistry, Faculty of Health Sciences, University of Copenhagen, Copenhagen, Denmark. dan_anne@hotmail.com
Thygesen
Torben H
TH
Pinholt
Else M
EM
D000305:Adrenal Cortex Hormones / Q000008:administration & dosage* / Q000009:adverse effects; D000309:Adrenal Insufficiency / Q000139:chemically induced; D000818:Animals; D004305:Dose-Response Relationship, Drug; D004487:Edema / Q000517:prevention & control; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D007273:Injections, Intramuscular; D007275:Injections, Intravenous; D009416:Nerve Regeneration / Q000187:drug effects; D056948:Orthognathic Surgical Procedures; D010020:Osteonecrosis / Q000139:chemically induced; D010149:Postoperative Pain / Q000517:prevention & control; D011605:Psychoses, Substance-Induced / Q000209:etiology; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors; D013530:Surgical Wound Infection / Q000209:etiology; D014081:Tooth Extraction
D000305:Adrenal Cortex Hormones; D005938:Glucocorticoids