Intramasseteric versus pterygomandibular space dexamethasone injection for oedema and trismus after mandibular third molar surgery: a randomised split-mouth clinical trial.

چکیده اصلی

BACKGROUND: This study compared intramasseteric versus pterygomandibular space dexamethasone injection for postoperative oedema and trismus after mandibular third molar surgery. METHODS: This prospective, randomised, participant- and outcome assessor-blinded, active-comparator split-mouth clinical trial with sequential interventions was conducted at Afyonkarahisar Health Sciences University between April 28, 2023 and April 27, 2024. Twenty adults aged 18-25 years, classified as American Society of Anesthesiologists Physical Status I and requiring bilateral surgical extraction of comparable mandibular third molars, were enrolled. The two interventions were performed in randomised order at a three-week interval. RESULTS: All 20 participants completed both interventions. Operative time did not differ between injection sites (18.1 ± 2.8 vs. 18.1 ± 2.9 min; p = 1.000). Change in oedema was lower in the intramasseteric group on days 2 (4 [1-8] vs. 6 [4-12]; p < 0.001; difference between site-specific medians favouring intramasseteric injection, 2.0 mm) and 7 (0.5 [0-1] vs. 1 [0-3]; p = 0.006; difference between medians, 0.5 mm). Trismus was less severe on days 2 (10.4 ± 2.7 vs. 13.1 ± 3.2 mm; p = 0.006; mean difference, 2.7 mm; 95% CI, 0.9 to 4.5) and 7 (0.7 ± 0.8 vs. 1.2 ± 1.2 mm; p = 0.006; mean difference, 0.5 mm; 95% CI, 0.2 to 0.8). Between-group pain, salivary cortisol level, Oral Health Impact Profile-14 score, and analgesic consumption differences were nonsignificant. CONCLUSIONS: Intramasseteric injection was associated with lower oedema and trismus severity. Patient-reported recovery outcomes did not differ significantly between the injection sites. The clinical relevance of these differences remains uncertain. TRIAL REGISTRATION: ClinicalTrials.gov NCT06604286; first submitted 17 September 2024 and first posted 19 September 2024 (retrospectively registered).

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