デキサメタゾンによる第三大臼歯内反症外科的抜歯の術後症状軽減効果

Efficacy of Dexamethasone in Reducing Postoperative Symptoms of the Surgical Extraction of Impacted Third Molars.

抄録

はじめに:

抗炎症薬の中でもデキサメタゾンは半減期が長く、特に口腔外科処置において強い効果を示す。デキサメタゾンの投与は不快感や炎症を軽減し、術後合併症を最小限に抑えることで回復を促進する。本研究の目的は、第三大臼歯埋伏歯除去術後の術後疼痛および腫脹の軽減、開口緩和に対するデキサメタゾン術前・術後投与の有効性を評価することである。

INTRODUCTION: Among anti-inflammatory medications, dexamethasone has an extended half-life and strong effects, particularly in oral surgical procedures. Administering dexamethasone helps reduce discomfort and inflammation and enhances recovery by minimizing postoperative complications. This study aimed to assess the effectiveness of dexamethasone administered before and after surgery in reducing postoperative pain and swelling and relieving mouth opening following the surgical removal of impacted third molars.

材料と方法:

デキサメタゾンを術前・術後に投与済みの患者60名を対象に、非ランダム化2群に分けた観察的前向きコホート研究を実施した。第一群は、第三大臼歯内反症の外科的除去術の1時間前にデキサメタゾン8mgを筋肉内投与し、第二群は手術直後に同用量を投与した。観察者は、ベースライン時（術前）、および第三大臼歯埋伏歯抜歯後2日目と7日目に、両群の疼痛、腫脹、開口度を評価した。

MATERIAL AND METHODS: An observational, prospective cohort study was conducted on 60 patients who had already been administered with dexamethasone pre- and postoperatively and were divided into two non-randomized groups. The first group had received 8 mg of dexamethasone intramuscularly one hour before the surgical removal of impacted third molars, while the second group had received the same dose immediately after surgery. The observer evaluated pain, swelling, and mouth opening in both groups at baseline (preoperative) and on the second and seventh days after the surgical extraction of impacted third molars.

結果:

腫脹に関しては、術後2日目に両群間に有意差が認められた（p<0.05）。2群は1群（127.50±13.29mm）よりも顕著な腫脹（140.34±10.11mm）を示し、p値は0.006であった。2日目の疼痛評価では、2群は1群（3.33±0.98）よりも不快感が顕著に高く（3.60±0.99）、p値は0.0463であった。術前の開口度には有意差はなかったが（p=0.288）、術後2日目には顕著な差がみられた。第1群では、第2群（38.69±4.40mm）よりも有意に開口減少が少なかった（45.69±6.06mm）。

RESULTS: In terms of swelling, the second postoperative day showed a significant difference between the two groups (p<0.05). Group 2 exhibited more pronounced swelling (140.34±10.11 mm) than group 1 (127.50±13.29 mm), with a p-value of 0.006. Pain evaluation on the second day revealed that group 2 experienced notably higher levels of discomfort (3.60±0.99) than group 1 (3.33±0.98), with a p-value of 0.0463. While there was no significant variation in mouth opening before the operation (p=0.288), the second postoperative day showed a marked difference. Group 1 demonstrated a significantly less reduction in mouth opening (45.69±6.06 mm) than group 2 (38.69±4.40 mm), with a p-value of 0.001.

結論:

本研究により、術前にデキサメタゾンを投与することで、術後に投与する場合と比較して、術後の腫脹、疼痛、開口の管理が良好になることが示された。これらの結果は、第三大臼歯抜歯後の患者の転帰を改善するために、手術前に副腎皮質ステロイドを利用するという現在の臨床実践を支持するものであった。

CONCLUSION: The study has shown that administering dexamethasone before surgery led to better management of swelling, pain, and mouth opening after the procedure, compared to giving it postoperatively. These results supported the current clinical practice of utilizing corticosteroids prior to surgery to enhance patient outcomes following third molar extraction.