GP4c - Comparative Evaluation of Preoperative Local and Systemic Intramuscular Administration of Dexamethasone Injection in Mandibular Third Molar Impaction Surgery

Abstract: Statement of the problem: The study aimed to evaluate the effect of systemic and local intramuscular administration of dexamethasone on pain and mouth opening and postoperative swelling following mandibular third molar impaction surgery and to verify its effect on functional outcome.
Materials and methods: The study comprised of 36 cases graded as moderately difficult according to the Pederson difficulty index, further subdivided equally into 2 groups. In Group I, 2ml of 8mg dexamethasone was injected intramuscularly in the masseter muscle 2 hours prior to surgery. In Group 2, a 2ml injection of 8mg dexamethasone was injected in the deltoid muscle 2 hours prior to surgery (Figure 1). All the patients were evaluated for pain, mouth opening, and postoperative swelling at first, third, and seventh postoperative day, and intergroup comparisons were made for both groups.
Methods of data analysis: Statistical analysis was performed using SPSS software (IBM Corp, Armonk, NY). Data were presented as mean and appropriate. Statistical tests were applied.

Results: Both groups showed improvement in mouth opening with the resolution of pain and postoperative swelling in the last follow-up. However, Group I showed a considerable reduction in swelling and pain with less trismus when compared with Group II at all intervals (Table 1).
Outcomes data: For Group I, the mean changes in mouth opening were noted to be 26.94±1.06 mm, 31.05±1.03mm, 36.87±0.72, respectively at first, third, and seventh postoperative day from the initial mean mouth opening of 37.67±1.89mm (Figure 2). Mean changes in mouth opening for patients in Group II were noted to be 23.06±0.99mm, 27.88±0.99, and 35.05±0.63, respectively at first, third, and seventh postoperative day (Figure 4). The highest pain score was seen at first postoperative day after surgery (7.15±1.08 in Group I; 8.5±1.44 in Group II). The mean score for pain obtained was 5.11±1.01; 1.01±0.82, and 5.38±1.37; 2.069±1.12 for Group I and Group II at the end of postoperative third and seventh day, respectively. The average postoperative swelling for Group I was 5.83±1.18mm, 4.73±0.83mm, and 4.47±0.58mm, respectively, at first, third, and seventh postoperative day. Similarly, the average postoperative swelling was 6.93±1.72mm, 6.05±0.94mm, and 4.64±0.81mm at first, third, and seventh postoperative day in Group II.

Conclusion: Local intramuscular injection of dexamethasone through intra-buccal approach can be a simple, useful adjunct in the surgical treatment of impacted third molars for minimizing swelling, trismus, and pain following surgical extraction.

References: 1. Baxendale BR, Vater M, Lavery KM: Dexamethasone reduces pain and swelling following extraction of third molar teeth. Anesthesia 48(11):961-4, 1993
2. Messer EJ, Keller JJ: The use of intraoral dexamethasone after extraction of mandibular third molars. Oral Surg Oral Med Oral Pathol 40(5):594-8, 1975