Postoperative dexamethasone injected into masseter muscle and pterygomandibular space after mandibular third molar surgery; comparison of effects on pain, edema and trismus

Aim: The aim of this study is to comparatively evaluate the effects of dexamethasone injected into the masseter muscle and pterygomandibular space after mandibular third molar surgery on postoperative pain, edema, trismus and quality of life. Materials and Methods: This clinic study includes 20 patients between the ages of 18-25 who underwent extraction of bilaterally impacted mandibular third molars in 2 consecutive sessions. The patients' symmetrical, bilateral, bone-retained (mesioangular) third molars in the mandible were randomly divided into two groups; Group 1 (n = 20) received 8 mg IM dexamethasone injection into the masseter muscle after the surgical procedure, and Group 2 (n = 20) received 8 mg IM dexamethasone injection into the pterygomandibular cavity after the surgical procedure. Postoperative pain was recorded using the VAS scale at the 6th hour, 12th hour, 24th hour, 2nd and 7th days postoperatively. Edema; Tragus-lateral canthus, tragus-commissura loborum, tragus-soft tissue pogonion, tragus-gonion and gonion-lateral canthus lengths were used, and trismus was determined by measuring the distance between the mesial corners of the lower and upper right central incisors at maximum mouth opening. Salivary cortisol; Saliva samples were taken from the patients just before the surgical procedures and on the 2nd and 7th postoperative days and were evaluated by measurements using ELISA kits. Evaluation of oral health-related quality of life and patient satisfaction after the surgical procedure was made using the OHIP-14 form immediately before the operation and on the 2nd and 7th postoperative days. Results: Application of dexamethasone to the masseter muscle gave better results than application to the pterygomandibular space at the differences between 0.-2. day* and 0.-7. day# of edema and all day# of trismus. This difference was found to be statistically significant (p<0.001*, p=0.006#). Conclusion: Compared to 8 mg dexamethasone applied to the masseter muscle after impacted lower third molar surgery and applied to the pterygomandibular space; Although it has similar cortisol levels systemically, it has been observed that it is more effective in reducing edema and trismus due to its different local effects. Key Words: Dexamethasone, third molar surgery, mandibula, edema, trismus, application routes.