Determination of the anti-inflammatory effects of methylprednisolone on the sequelae of third molar surgery

Purpose: The anti-inflammatory effect and adrenal suppressive side effect o f methylprednisolone sodium succinate (MP) on the postoperative sequelae of third molar surgery were evaluated using objective methods in a double-bli nd, crossover study. Patients and Methods: Twenty patients who were to undergo surgical removal of bilateral, symmetrically placed lower third molars were studied. Each pa tient was given 125 mg MP intravenously before surgery on one side, and a p lacebo before surgery on the opposite side on a random basis. Ultrasonograp hic and computed tomographic examinations were performed to determine the a mount of facial edema. Trismus was evaluated by measuring maximal interinci sal opening, and pain was evaluated by recording the number of standard ana lgesic tablets used on the day of surgery and the first postoperative day. Hypothalamic-pituitary-adrenal (HPA) axis function was tested by measuring; basal plasma cortisol (hydrocortisone) levels preoperatively and postoperat ively. The adrenocorticotropic hormone (ACTH) stimulation test also was per formed before and after administration of MP, to evaluate adrenal function. Results: Statistical analysis of the data indicated a significant decrease in edema, trismus, and pain in the MP group. Plasma cortisol levels showed a nonsignificant decrease in both the MP- and placebo-treated groups. The A CTH stimulation test indicated normal HPA axis function before and after MP administration. No clinically apparent infection, disturbance of wound hea ling, or other corticosteroid-related complications were noted. Eighteen pa tients (90%) indicated a preference for the overall postoperative course wh en MP was used. Conclusion: In the absence of contraindications for corticosteroid administ ration, preoperative use of MP appears to be a safe and effective method of reducing postoperative complications in third molar surgery.