Impacted mandibular third molar surgery; the role of dexamethasone in postoperative swelling and trismus

The objective of this study was to evaluate the therapeutic effect of dexamethasone in post-operative edema and trismus after impacted third molar surgery. It was a prospective randomized control study carried in Department of Oral and Maxillofacial surgery, BADC, Larkana from March 2012 to Feb 2013. Patients age between 20-45 years of either gender; unilateral mandibular impacted third molars [right or left] were included. Patients divided in two groups by using random allocation number. Patients in Group-A were given intramuscular 8 mg dexamethasone 1 hour before surgery and four tablets [2mg] dexamethasone orally immediate postoperatively and 24 hours after surgery. The facial swelling was checked before surgery, after 24 hours [1st day], after 48 hours [2nd day], after 72 hours [3rd day] and on 7th postoperative day Inter-incisor distance was checked on every follow up. Data was analyzed by SPSS version 17. Mean and standard deviation was calculated for age and gender. Mean and SD of facial swelling and mouth opening was calculated before extraction, on 1st, 2nd, 3rd and on 7th post-operative day in both groups. The dexamethasone group showed significant reduction in swellingcompared with control group at all intervals. Dexamethasone resulted in significantly less trismus than controls on day 2 postoperatively, but there was no significant difference among the groups at 7thday. Dexamethasone is effective in minimizing swelling and trismus after removal of impacted lower third molar and improves the social life of individual

The selective and non-selective cyclooxygenase inhibitors valdecoxib and piroxicam induce the same postoperative analgesia and control of trismus and swelling after lower third molar removal

We compared the clinical efficacy of orally administered valdecoxib and piroxicam for the prevention of pain, trismus and swelling after removal of horizontally and totally intrabony impacted lower third molars. Twenty-five patients were scheduled to undergo removal of symmetrically positioned lower third molars in two separate appointments. Valdecoxib (40 mg) or piroxicam (20 mg) was administered in a double-blind, randomized and crossed manner for 4 days after the surgical procedures. Objective and subjective parameters were recorded for comparison of postoperative courses. Both agents were effective for postoperative pain relief (N = 19). There was a similar mouth opening at suture removal compared with the preoperative values (86.14 ± 4.36 and 93.12 ± 3.70 percent of the initial measure for valdecoxib and piroxicam, respectively; ANOVA). There was no significant difference regarding the total amount of rescue medication taken by the patients treated with valdecoxib or piroxicam (173.08 ± 91.21 and 461.54 ± 199.85 mg, respectively; Wilcoxon test). There were no significant differences concerning the swelling observed on the second postoperative day compared to baseline measures (6.15 ± 1.84 and 8.46 ± 2.04 mm for valdecoxib and piroxicam, respectively; ANOVA) or on the seventh postoperative day (1.69 ± 1.61 and 2.23 ± 2.09 mm for valdecoxib and piroxicam, respectively; ANOVA). The cyclooxygenase-2 selective inhibitor valdecoxib is as effective as the non-selective cyclooxygenase inhibitor piroxicam for pain, trismus and swelling control after removal of horizontally and totally intrabony impacted lower third molars.

Estudo clínico comparativo entre duas drogas de açäo antiinflamatória (dexametasona e meloxicam) no controle do edema e trismo após exodontia de terceiros molares inferiores inclusos / Comparative clinical study of two anti-inflammatory drugs (dexametasone and meloxicam) as to their ability of controlling swelling and trismus after extraction of submerged mandibular third molars

Foram selecionados 16 pacientes adultos, com idade variando entre 15 e 27 anos (média de 18,5 anos), sem nenhum comprometimento local ou sistêmico, com indicaçäo de exodontia de terceiros molares inferiores inclusos, bilateralmente e em posiçöes similares. As drogas foram administradas, na primeira ou segunda cirurgia, aleatoriamente, de modo duplo-cego. Fez-se a avaliaçäo do edema, através da variaçäo de pontos de referências faciais, e do trismo, através da variaçäo da distância interincisal. De acordo com os resultados, conclui-se que näo houve diferença significativa na limitaçäo de abertura bucal quando se compararam os tratamentos com meloxicam ou dexametasona. Já em relaçäo ao edema, a dexametasona mostrou uma maior eficácia

Evaluation of dexamethasone and ibuprofen combination: the reduction of post surgical sequelae of mandibular third molar

To determine the efficacy of dexamethasone in combination with ibuprofen for reducing pain, swelling and trismus. Fifty patients having bilateral impacted mandibular third molar. Right side of the patient was put into study group and left side as control by giving l/M lnj of 8 mg dexamethasone and sterile H[2]O respectively followed by ibuprofen 400 mg 6 hourly for 5 days. The patients towards study side reported significantly less pain, swelling and trismus as compared to those in the control group

Botulinum toxin A for trismus in cephalic tetanus

O tétano cefálico é uma forma localizada de tétano. Da mesma maneira que nas formas generalizadas, o trismo é componente clínico, proeminente, leva a grande dificuldade na alimentaçäo, na deglutiçäo da saliva e para a higiene da boca. Essas dificuldades frequentemente precedem os problemas respiratórios e as pneumonias aspirativas, que se constituem em complicaçöes que ameaçam a vida dos pacientes. Drogas relaxantes musculares de outro tipo que as drogas curarizantes trazem pouco benefício para o trismo. A neurotoxina tetânica (tetanospasmin) e a toxina botulínica compartilham muitas semlhanças, como estrutura química símile, origem de microorganismos relacionados (clostridium tetani e Clostridium botulinum, respectivamente) e, presumivelmente, os mesmos mecanismos de açäo no neurônio. A diferença entre as duas reside na sua peculiar neuroespecificidade, atuando em diferentes neurônios. Injeçäo de doses reduzidas da toxina botulínica em músculos envolvidos em distonias focais ou outras desordens com espasticidade muscular localizada tem se mostrado eficaz em abolir as contraçöes. Descrevemos o uso da toxina botulínica A com sucesso no tratamento do trismo num paciente sofrendo de tétano cefálico. Acreditamos que esta forma de tratamento possa ser de valor no sentido de diminuir o risco de complicaçöes pulmonares nos pacientes com tétano