Efikasnost submukozne, oralne i intramuskularne primene deksametazona u redukciji trizmusa, otoka i bola nakon hirurgije donjih trećih molara

  • Filip Djordjević University of Priština/Kosovska Mitrovica, Faculty of Medical Sciences, Department of Oral Surgery, Kosovska Mitrovica, Serbia
  • Marija Bubalo Military Medical Academy, Dentistry Clinic, Belgrade, Serbia
  • Dejan Perić University of Priština/Kosovska Mitrovica, Faculty of Medical Sciences, Department of Oral Surgery, Kosovska Mitrovica, Serbia
  • Djordje Mihailović University of Priština/Kosovska Mitrovica, Faculty of Medical Sciences, Department of Oral Surgery, Kosovska Mitrovica, Serbia
  • Zoran Bukumirić University of Belgrade, Faculty of Medicine, Belgrade, Serbia
  • Dejan Dubovina University of Priština/Kosovska Mitrovica, Faculty of Medical Sciences, Department of Oral Surgery, Kosovska Mitrovica, Serbia
DOI: https://doi.org/10.2298/VSP220331062D
Ključne reči: deksametazon, lekovi, putevi primene, molar, treći, hirurgija, oralna, procedure, trizmus

Sažetak


Uvod/Cilj. Hirurška ekstrakcija impaktiranih donjih trećih molara je, u izvesnom stepenu, neizbežno praćena postoperativnom pojavom trizmusa, otoka i osećaja bola. Kortikosteroidi (naročito deksametazon) su lekovi koji se najčešće koriste u prevenciji tih komplikacija. Cilj rada bio je da se utvrdi efikasnost deksametazona u prevenciji postoperativnih komplikacija, edema, trizmusa i bola, nakon hirurške ekstrakcije impaktiranih donjih trećih molara, u zavisnosti od načina njegove administracije. Metode. Prospektivnom studijom obuhvaćeno je 30 zdravih pacijenata, starijih od 18 godina, oba pola, sa potpuno impaktiranim donjim trećim molarom – klase I ili II i pozicije B ili C, prema klasifikaciji Pell-a i Gregory-ja, i vertikalne pozicije prema klasifikaciji Winter-a. Svi pacijenti su nasumično podeljeni u tri grupe u zavisnosti od načina primene deksametazona: oralno – deksametazon primenjen u obliku oralnih tableta, u dozi od 4 mg, sat vremena pre operacije; submukozno – rastvor deksametazona primenjen submukozno, u dozi od 4 mg, u predelu bukalnog sulkusa, nakon sprovodne anestezije za donji alveolarni nerv i dodatne anestezije za bukalni nerv; intramuskularno – rastvor deksametazona primenjen intramuskularno, u dozi od 4 mg, u predelu deltoidnog mišića, neposredno pre intervencije. Preoperativno i pri svakoj kontrolnoj poseti (prvog, drugog i sedmog dana postoperativno) određivani su interincizalno rastojanje, stepen edema i stepen bola primenom vizuelno analogne skale (VAS). Sedmog postoperativnog dana evidentiran je ukupan broj analgetika koje su pacijenti uzimali. Rezultati. U postoperativnom periodu nije bilo statistički značajne razlike između ispitivanih grupa u pogledu efikasnosti u smanjenju otoka, trizmusa i bola (p ˃ 0,05). Zaključak. Nema značajne razlike u efikasnosti deksametazona u odnosu na način primene – oralno, intramuskularno ili lokalno submukozno, u redukciji postoperativnog trizmusa, otoka i bola nakon hirurškog lečenja impaktiranog donjeg trećeg molara.

Reference

1.      Messer EJ, Keller JJ. The use of intraoral dexamethasone after extraction of mandibular third molars. Oral Surg Oral Med Oral Pathol 1975; 40(5): 594‒8.

2.      Beirne OR, Hollander B. The effect of methylprednisolone on pain, trismus, and swelling after removal of third molars. Oral Surg Oral Med Oral Pathol 1986; 61(2): 134‒8.

3.      McGrath C, Comfort MB, Lo EC, Luo Y. Changes in life quality following third molar surgery – the immediate postoperative period. Br Dent J 2003; 194(5): 265‒8; discussion 261.

4.      Alexander RE, Throndson RR. A review of perioperative corticosteroid use in dentoalveolar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 90(4): 406‒15.

5.      Markiewicz MR, Brady MF, Ding EL, Dodson TB. Corticosteroids reduce postoperative morbidity after third molar surgery: a systematic review and meta-analysis. J Oral Maxillofac Surg 2008; 66(9): 1881‒94.

6.      Kim K, Brar P, Jakubowski J, Kaltman S, Lopez E. The use of corticosteroids and nonsteroidal antiinflammatory medication for the management of pain and inflammation after third molar surgery: a review of the literature. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2009; 107(5): 630‒40.

7.      Shaikh S, Verma H, Yadav N, Jauhari M, Bullangowda J. Applications of steroid in clinical practice: a review. ISRN Anesthesiology 2012; 2012: 1‒11.

8.      Darwade DA, Kumar S, Mehta R, Sharma AR, Reddy GS. In search of a better option: dexamethasone versus methylprednisolone in third molar impaction surgery. J Int Oral Health 2014; 6(6): 14–7.

9.      Majid OW, Mahmood WK. Use of dexamethasone to minimise post-operative sequelae after third molar surgery: comparison of five different routes of administration. Oral Surg 2013; 6(4): 200–8.

10.   Chaudhary PD, Rastogi S, Gupta P, Niranjanaprasad Indra B, Thomas R, Choudhury R. Pre-emptive effect of dexamethasone injection and consumption on post-operative swelling, pain, and trismus after third molar surgery. A prospective, double blind and randomized study. J Oral Biol Craniofac Res 2015; 5(1): 21‒7.

11.   Nehme W, Fares Y, Abou-Abbas L. Piezo-surgery technique and intramuscular dexamethasone injection to reduce postoperative pain after impacted mandibular third molar surgery: a randomized clinical trial. BMC Oral Health 2021; 21(1): 393.

12.   Falci SGM, Lima TC, Martins CC, Santos CRRD, Pinheiro MLP. Preemptive Effect of Dexamethasone in Third-Molar Surgery: A Meta-Analysis. Anesth Prog 2017; 64(3): 136‒43.

13.   Alcântara CE, Falci SG, Oliveira-Ferreira F, Santos CR, Pinheiro ML. Pre-emptive effect of dexamethasone and methylprednisolone on pain, swelling, and trismus after third molar surgery: a split-mouth randomized triple-blind clinical trial. Int J Oral Maxillofac Surg 2014; 43(1): 93‒8.

14.   Zerener T, Aydintug YS, Sencimen M, Bayar GR, Yazici M, Altug HA, et al. Clinical comparison of submucosal injection of dexamethasone and triamcinolone acetonide on postoperative discomfort after third molar surgery. Quintessence Int 2015; 46(4): 317‒26.

15.   Ngeow WC, Lim D. Do Corticosteroids Still Have a Role in the Management of Third Molar Surgery? Adv Ther 2016; 33(7): 1105‒39.

16.   Graziani F, D'Aiuto F, Arduino PG, Tonelli M, Gabriele M. Perioperative dexamethasone reduces post-surgical sequelae of wisdom tooth removal. A split-mouth randomized double-masked clinical trial. Int J Oral Maxillofac Surg 2006; 35(3): 241‒6.

17.   Grossi GB, Maiorana C, Garramone RA, Borgonovo A, Beretta M, Farronato D, et al. Effect of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective study. J Oral Maxillofac Surg 2007; 65(11): 2218‒26.

18.   Pell GJ, Gregory GT. Impacted mandibular third molar: Classification and modified technique for removal. Dent Dig 1933; 39(9): 330–8.

19.   Winter GB. Impacted mandibular third molar. St. Louis: American Medical Book; 1926.

20.   Schultze-Mosgau S, Schmelzeisen R, Frölich JC, Schmele H. Use of ibuprofen and methylprednisolone for the prevention of pain and swelling after removal of impacted third molars. J Oral Maxillofac Surg 1995; 53(1): 2‒7; discussion 7‒8. 

21.   Noboa MM, Ramacciato JK, Teixeira RG, Viccentini CB, Groppo CG, Motta RH. Evaluation of effects of two dexamethasone formulations in impacted third molar surgeries. Rev Dor São Paulo 2014; 15(3): 163‒8.

22.   Majid OW, Mahmood WK. Effect of submucosal and intramuscular dexamethasone on postoperative sequelae after third molar surgery: comparative study. Br J Oral Maxillofac Surg 2011; 49(8): 647‒52.

23.   Gopalakrishnan V, Darekar HS, Sahoo NK. Effectiveness of submucosal v/s intramuscular dexamethasone in mandibular third molar surgeries. Int J Med Sci Clin Inven 2015; 2(1): 648–55.

24.   Nair RB, Rahman NM, Ummar M, Hafiz KA, Issac JK, Sameer KM. Effect of submucosal injection of dexamethasone on postoperative discomfort after third molar surgery: a prospective study. J Contemp Dent Pract 2013; 14(3): 401‒4.

25.   Ehsan A, Ali Bukhari SG, Ashar, Manzoor A, Junaid M. Effects of pre-operative submucosal dexamethasone injection on the postoperative swelling and trismus following surgical extraction of mandibular third molar. J Coll Physicians Surg Pak 2014; 24(7): 489‒92.

26.   Warraich R, Faisal M, Rana M, Shaheen A, Gellrich NC, Rana M. Evaluation of postoperative discomfort following third molar surgery using submucosal dexamethasone - a randomized observer blind prospective study. Oral Surg Oral Med Oral Pathol Oral Radiol 2013; 116(1): 16‒22. 

27.   Antunes AA, Avelar RL, Martins Neto EC, Frota R, Dias E. Effect of two routes of administration of dexamethasone on pain, edema, and trismus in impacted lower third molar surgery. Oral Maxillofac Surg 2011; 15(4): 217‒23.

28.   Boonsiriseth K, Klongnoi B, Sirintawat N, Saengsirinavin C, Wongsirichat N. Comparative study of the effect of dexamethasone injection and consumption in lower third molar surgery. Int J Oral Maxillofac Surg 2012; 41(2): 244‒7.

Objavljeno
2023/05/03
Broj časopisa
Vol. 80 Br. 04 (2023): Vojnosanitetski pregled
Rubrika
Originalni članak