Efficacy/Safety of the Use of Glucocorticoids in Oral and Maxillofacial Surgery

**Background:** Glucocorticoids are widely used in oral and maxillofacial surgery for their anti-inflammatory and immunosuppressive properties, but concerns about adverse effects (e.g., adrenal suppression, Cushing's syndrome, hyperglycemia) limit their use. This systematic review aimed to evaluate the efficacy and safety of glucocorticoids in patients aged 16–65 undergoing oral and maxillofacial surgery without other pathologies, focusing on appropriate doses, routes, and clinical applications.

**Methods:** A systematic review was conducted following PRISMA guidelines (registration CRD42023445218). Searches were performed in PubMed, Nature Portfolio, Cochrane, Medline, and Google Scholar from April 7 to June 2, 2023, using terms including corticosteroids, anti-inflammatory postoperative oral surgery, dexamethasone, and dentistry. Inclusion criteria: articles published in the last 10–15 years, open access, full text, in English/Spanish/Portuguese, studying populations aged 10–65, with PEDro scale >7. Exclusion criteria: not related to objectives, full text unavailable, low scientific evidence. From 742 PubMed results (filtered to 51), 20 were selected; from 1929 Nature Portfolio results (filtered to 9), 3 were selected; from 52 Cochrane and 69 Medline results, 1 each was selected; from 4080 Google Scholar results (filtered to 37), 27 were used. Quality assessment used the Cochrane risk of bias tool.

**Key Results:** The review included 5 key studies (Bhandage 2018, De la Cruz Carranza 2013, Manriquez-Guzman 2013, Chavez-Rimache 2020, Nunez-Dias 2019). - Bhandage et al. (2018): 20 patients (25–65 years) received intraoperative hydrocortisone and postoperative dexamethasone. Pain reduction was 70% on day 2 and 97% on day 4; edema reduced by 12 mm over 4 days. No adverse drug reactions were reported. - De la Cruz Carranza et al. (2013): 66 patients (18–30 years) compared oral dexamethasone 8 mg vs. 4 mg for third molar edema. The 8 mg dose was more effective. - Manriquez-Guzman et al. (2013): 116 patients (21–45 years) received dexamethasone 8 mg IM 1 hour before surgery vs. no premedication. In the no-premedication group, 92% had acute pain, 82% edema, and 80% trismus in the first 48 hours; in the premedication group, only 12%, 4%, and 2% had these symptoms, respectively. - Chavez-Rimache et al. (2020): 54 patients (18–25 years) received dexamethasone 4 mg IM with or without B vitamins (B1, B6, B12). The combination group had significantly lower pain at 24 hours and lower total analgesic consumption; swelling was similar between groups. - Nunez-Dias et al. (2019): 60 patients (16–35 years) received dexamethasone 4 mg IM pre- or post-surgery. Pre-surgical administration reduced facial edema more at 60 minutes; pain peaked at 6 hours in both groups with no significant difference.

ADDITIONAL FINDINGS

For cervicofacial infections, high-dose short-course corticosteroids (hydrocortisone 200–1050 mg/day, dexamethasone 8–10 mg/7 days, methylprednisolone 1–3 mg/kg/5–7 days IV) are recommended as adjuvants to antibiotics. Common glucocorticoid applications include temporomandibular joint disorders (intra-articular methylprednisolone 10 mg/day, limit 4 times/year), oral lichen planus (topical triamcinolone 0.1% or clobetasol 0.05%), Bell's palsy (oral prednisolone 1 mg/kg/day for 7–10 days), recurrent aphthous stomatitis (topical hydrocortisone 2.5 mg or dexamethasone 0.5 mg), and pemphigus (prednisone 0.5–1.5 mg/kg/day). Adverse effects with prolonged use (>60 days) occur in up to 90% of patients and include Cushing's syndrome, adrenal suppression, hyperglycemia, osteoporosis, and increased infection risk.

**Clinical Implications:** Glucocorticoids, especially dexamethasone 4–8 mg intramuscularly, are effective and safe for managing postoperative pain, edema, and trismus in oral and maxillofacial surgery patients without comorbidities. Preoperative administration is superior to postoperative use. Combining dexamethasone with B vitamins enhances analgesia. For cervicofacial infections, high-dose short-course corticosteroids with antibiotics may reduce airway edema and trismus. Clinicians must weigh benefits against risks of adrenal suppression and other adverse effects, particularly with prolonged use. Gradual withdrawal is essential to prevent adrenal insufficiency. The review notes a lack of studies in patients aged 10–16 years and calls for updated research on emerging therapies like KLF15 gene modulation.