Perioperative corticosteroid administration has long been advocated for the reduction of postoperative facial swelling in orthognathic surgery. There is good evidence to support its use in reducing facial edema1. Other studied benefits of steroid use in facial surgery include decreased post-operative pain, nausea, and decreased length of hospital stay. Reported complications of steroid use include compromised healing, infection, and sleep disturbances among others. The ideal steroid regimen remains a contentious topic among surgeons, largely due the heterogeneity of current literature and conflicting evidence in various studies2.
The purpose of our study is to prospectively investigate the postoperative effects of 2 different perioperative methylprednisolone (MP) dosages in orthognathic surgery.
To address our research objectives, we have designed a prospective, double-blinded randomized control trial. Patients undergoing any combination of Le Fort 1 osteotomy (LF1), bilateral sagittal split osteotomy (BSSO), and/or functional genioplasty (FG) in our department were included. Patients with pertinent medical history precluding the use of high-dose steroids were excluded. Patients were randomly assigned (1:1) to receive either 1000mg (Group 1) or 125mg (Group 2) of MP perioperatively. Three-dimensional facial photographs were taken of patients using a 3DMD facial scanner on postoperative day 2 (T1) and at least 4 weeks after surgery (T2). Postoperative edema was determined by measuring the volumetric change (in cm3) in 3D facial shells from T1 to T2 using the 3DMD Vultus software. Visual analog scales evaluating pain, perceived swelling, nausea, and sleep quality were also completed on postoperative day 2 by the patients. The postoperative length of stay in hospital and the rate of postoperative infections were documented. A 1-way ANOVA was used to compare independent variables between the 2 groups. The t-test was used to analyze dependent variables. A P value < .05 was considered statistically significant.
A total of 180 patients enrolled in our study. Group 1 included 91 patients and Group 2 included 89 patients. The average swelling for all patients was 39.9 cm3 (Gr 1 = 44.1 cm3, Gr 2 = 34.8 cm3). No significant difference in postoperative edema was shown between groups (p = 0.058). There was no statistically significant difference facial swelling with respect to procedure types, average duration of surgery, sex, and average age (all p > 0.05). These data are summarized in Table 1. No significant difference in pain, perceived swelling, nausea, sleep quality, length of stay in hospital, and postoperative infection was shown between groups (all P > .05).
Our results are indicating that a perioperative dose of 125mg is as efficacious as a 1000mg dose of methylprednisolone for the reduction of postoperative facial swelling in orthognathic surgery. There are no added benefits or increased risks of using the higher dose of steroid.
1. Dan A, Thygesen T, Pinbolt E. Corticosteroid administration in oral and orthognathic surgery: a systemic review of the literature and meta-analysis. J Oral Maxillofac 68:2207-2220, 2015
2. Chegini S, Dhariwal D: Review of evidence for the use of steroids in orthognathic surgery. British Journal of Oral and Maxillofacial Surgery 50: 97-101, 2012.