Does Injection of Dexamethasone Into the Pterygopalatine Fossa Reduce the Side Effects of Third Molar Surgery?

Sequelae of third molar impaction (TMI) surgery, including pain, limited jaw movement, and edema, may be mitigated by dexamethasone injected into the pterygopalatine fossa (PPF).

This study's purpose was to measure and compare pain, maximum interincisal distance (MID), and edema between dexamethasone and saline injected into the PPF.

A split-mouth, randomized, triple-blinded study was carried out at our institution from 2023 to 2024. Patients with 4-quadrant TMI of the same classification were included. Subjects were excluded for drug allergies, recent medication use, inability to complete the protocol, or medical contraindications. Split-mouth procedures were performed with a minimum interval of 4 weeks.

The sides of the mouth were assigned randomly to study and control groups. The study group was injected with 8 mg dexamethasone and the control group with normal saline solution.

Therapeutic response was assessed using 3 facial swelling indices, MID, and pain scores on postoperative days 1 (D-1), 3 (D-3), 5 (D-5), and 7 (D-7).

The covariates were operative duration and TMI classifications.

Wilcoxon signed-rank test, χ² and paired t-test analyses were used to compare the 2 groups at P < .05 with the SPSS statistic program.

Nineteen subjects (mean age 21.38 ± 3.11 years; 47.36% male) completed the study. The dexamethasone group showed significantly lower facial swelling indices than controls on D-3 and D-7. On D-3, all 3 facial measurements (Ex-Go, Tr-Ch, and Tr-Pg ratios) were lower in the study group (P = .001, P = .001, and P = .002, respectively). On D-7, Ex-Go and Tr-Pg ratios remained significantly lower (P = .001 and P = .002). Swelling reduction was consistent across all measurements. MID and pain scores also showed significant reductions. The MID difference was 5.53 ± 2.16 mm on D-3 (P = .001), and the D-1 pain score was 4.21 ± 2.55 in the study group versus 6.68 ± 2.19 in controls (P = .001).

This study demonstrated a novel, clinician-friendly technique which PPF-administered dexamethasone significantly reduces post-TMI facial swelling and pain compared to placebo.