Elevation of c- reactive protein levels in patients undergoing oral and maxillofacial surgery

ABSTRACT

Twenty patients [twelve males and eight females]aged 7 to 52 years who had presented to the Oral Surgery Department, Faculty of Dentistry, Cairo University for treatment of various soft-tissue and intra-bony lesions of the maxillofacial region were enrolled in this study. The patients were divided equally into two groups according to the type of surgical procedure. Group I consisted of ten patients [age range 7-52, mean age 30.6] undergoing soft-tissue surgery of short duration and was considered to be small surgical tissue damage, such as cystectomy or extirpation of small benign tumour. Group II consisted of ten patients (age range 23-42, mean age 32.6) undergoing a surgical extirpation of a lesion that involves bone manipulation and of duration exceeding 3 hours and was considered to be of middle to great surgical tissue damage such as extirpation of mandibular cyst, intrabony benign tumours or locally malignant tumours. Blood samples for measuring CRP levels were obtained by venepuncture immediately before induction of anesthesia, immediately after surgical incision [time 0], 2, 6, 24, 48 , 72 hours and one week after the incision. The elevation and time course of plasma CRP levels in patients undergoing oral and maxillofacial surgery were analyzed. The results indicated that elevated plasma CRP levels could be detected starting from 2 hours after incision and reached a peak within 24 hours for surgeries involving only the soft tissues, whilst the peak was attained at 48 hours in surgeries involving the manipulation of bone. The elevation of CRP levels was highest and most significant for more aggressive surgery involving the bone, and more especially with the segmental excisional procedure followed for the locally malignant ameloblastoma. The results of this study suggest that CRP would be released by surgical injury and is associated with magnitude of tissue damage in oral and maxillofacial surgery. CRP has been thought to also be a mediator in various host responses other than the acute phase response. However, it is unclear how the elevation of plasma CRP affects physiologic, immunologic, or metabolic status during and after surgery. Therefore, further studies for exploring the role of CRP in host responses to surgical injury will be required.