Three-Dimensional Quantitative Evaluation of the Effect of Local Administration of Dexamethasone on Facial Swelling after Impacted Mandibular Third Molar Extraction

Research Article

J Dent & Oral Disord. 2016; 2(7): 1036.

Three-Dimensional Quantitative Evaluation of the Effect of Local Administration of Dexamethasone on Facial Swelling after Impacted Mandibular Third Molar Extraction

Matsuda M¹*, Kondo S¹, Seto M¹, Kita R¹, Mori H², Moriyama S² and Kikuta T¹

¹Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Fukuoka University, Japan

²Department of Mechanical Engineering, Faculty of Engineering, Fukuoka University, Japan

*Corresponding author: Matsuda M, Department of Oral and Maxillofacial Surgery, Faculty of Medicine, Fukuoka University, Japan

Received: September 07, 2016; Accepted: September 23, 2016; Published: September 26, 2016


The most common dental surgery, the removal of impacted mandibular third molars, is associated with complications including postoperative facial swelling, pain and limited mouth opening. The beneficial effects of local administration of adrenal steroids (dexamethasone) to the cheek muscle after impacted mandibular third molar extraction are evaluated using a non-contact three- Dimensional (3D) scanner and conventional anthropometric measurements. In this prospective randomized controlled study, results revealed that administration of dexamethasone significantly suppressed postoperative swelling as compared with physiological saline on postoperative day 1 (dexamethasone group [n = 41], 3.29 cm3; physiological saline group [n = 40], 8.46 cm3, p<0.05) and on postoperative day 3 (dexamethasone group, 6.56 cm3; physiological saline group, 10.34 cm3, p<0.001). Patients in the dexamethasone group were able to open their mouths considerably wider than the physiological saline group for all comparisons (day 1: dexamethasone group, 38.0 mm; physiological saline group, 30.2 mm p<0.05, day 3: dexamethasone group, 40.4 mm; physiological saline group, 32.9 mm p<0.001, day 7: dexamethasone group, 43.6 mm; physiological saline group, 38.8 mm p<0.05). Postoperative pain was only suppressed significantly more in the dexamethasone group than in the physiological saline group on postoperative day 1 (p<0.05). In conclusion, local administration of dexamethasone significantly reduces the postoperative complications and 3D measurement is a simple and precise method for evaluating volumetric changes after the removal of impacted mandibular third molars.

Keywords: Impacted mandibular third molar extraction; Dexamethasone, Postoperative facial swelling; Three-dimensional measurement


Impacted mandibular third molar extraction is a common surgery in the field of oral surgery and is accompanied by a high incidence of postoperative complications including facial swelling, pain and limited mouth opening (trismus) [1]. Reports on devising pharmacotherapies and improving surgical procedures have been published in pursuit of mitigating these complications [2,3]. The number of studies of evaluation methods and measures to prevent postoperative facial swelling is particularly large [3-16].

The most commonly reported method for evaluating postoperative facial swelling is measuring the distance between two points on the face [3, 4, 6-15]. However, this method has a major drawback in term of objective and quantitative evaluations in that points on the face are displaced as a result of swelling of the reference points themselves and deformation of the facial skin due to contact with and pressure on the swollen area by the measuring instrument. Other reported methods include the face-bow method [4], the ultrasound method [5], and the laser scanner method [16]. These methods, however, have complicated approaches. The method using computed tomography [5] has the problem of radiation exposure, making it difficult to perform multiple scans and achieve objective, day-to-day quantification of swelling. We therefore decided to measure facial morphology using a simple, non-contact 3-Dimensional (3D) scanner.

Administration of adrenal steroids has been reported as a means of preventing swelling since the 1960s [17]. Due to the excellent anti-inflammatory action of adrenal steroids, these drugs have been used on a daily basis to reduce postoperative swelling in many cases. Numerous reports have stated that administration of corticosteroids suppresses facial swelling after extraction of impacted mandibular third molars [4-14]. Furthermore, systemic intravenous administration of corticosteroids for the purpose of preventing laryngeal swelling during tracheal extubation in the field of anesthesiology [18] has also been used to reduce recurrent nerve paralysis and prevent speech disturbance resulting from swelling of the vocal cords after thyroidectomy in the field of otolaryngology [19,20]. These reports show how corticosteroids are used in multiple fields to prevent perioperative swelling.

In the present study, we locally injected dexamethasone, a J Dent & Oral Disord 2(7): id1036 (2016) - Page - 02 Matsuda M Austin Publishing Group Submit your Manuscript | corticosteroid, into the nearby cheek muscle after extraction of impacted mandibular third molars, and quantitatively evaluated changes in facial volume (cm3) using a 3D scanner. We also evaluated postoperative mouth opening and pain by quantifying these parameters.

Subjects and Methods

Patient characteristics and group allocation method

Subjects comprised patients ≥18 years old and <45 years old requiring mucosal resection and bone milling in extraction of impacted mandibular third molars. Subjects were rated Class I or II and Position A or B according to winter’s classification of the difficulty of surgery for impacted mandibular third molars, and the target sample size was set at 100. Of these 100 samples distribution of the classification was as: 78 horizontal, 22 mezioangular. Subjects were randomly allocated by lottery to a group that received a subcutaneous injection of 4 mg of dexamethasone (1 mL) to the cheek muscle at the base of the gingival mucosal incision immediately after tooth extraction (Dexamethasone [DEX] group; n = 50) and the other group that received subcutaneous injection of 1 mL of physiological saline to the same site immediately after tooth extraction (physiological Saline [SAL] group; n = 50). Patients who were pregnant, prohibited from using corticosteroids, suffering from a serious systemic disease (American Society of Anesthesiologists Physical Status III or IV), had a history of allergic reactions to drugs, or suffering from diabetes were excluded in advance. The two groups did not differ significantly in terms of sex, age, surgical duration, height, weight, or body mass index (Table 1). This study was conducted with the approval of the institutional review board of Fukuoka University Hospital (approval no.: 13-9-04) and all subjects provided informed consent to participate after receiving explanations of the purpose of this study and the tooth extraction procedure. After excluding patients with inadequate 3D scanner data for measurements of facial swelling and patients who failed to turn up on the day of scanning, the final number of patients was 40 in the DEX group and 41 in the SAL group.