Corticosteroid Use in Orthognathic Surgery Practices: A Review of Literature

Abstract

Background: Corticosteroids are widely used in maxillofacial and orthognathic surgery owing to their potent anti-inflammatory, immunomodulatory, and antiemetic properties. Although concerns persist regarding their potential adverse effects on wound healing, infection risk, and glucose metabolism, recent evidence supports their safety and efficacy when used as short-term perioperative therapy. Objective: This review aims to summarize current evidence on the clinical efficacy, optimal dosage, timing, and safety profile of corticosteroid administration—particularly dexamethasone—in orthognathic surgery. Methods: A comprehensive review of randomized controlled trials, systematic reviews, and meta-analyses published between 1974 and 2025 was conducted. Studies evaluating perioperative corticosteroid use in orthognathic and related maxillofacial procedures were analyzed with respect to postoperative outcomes, including edema, trismus, pain, nausea and vomiting (PONV), wound healing, infection risk, and systemic adverse effects. Results: Evidence consistently demonstrates that a single intravenous dose of 8–16 mg dexamethasone significantly reduces postoperative edema, trismus, pain, and PONV without increasing the risk of impaired wound healing or infection. Incorporation of corticosteroids into Enhanced Recovery After Surgery (ERAS) protocols enhances patient comfort, decreases opioid consumption, and promotes earlier discharge. Short-term administration (<48 hours) does not cause clinically significant hypothalamic–pituitary–adrenal (HPA) axis suppression but may lead to transient hyperglycemia, particularly in diabetic patients. Conclusion: Single-dose perioperative dexamethasone represents a safe and effective adjunct in orthognathic surgery. Its inclusion in ERAS-based perioperative management reduces postoperative morbidity, accelerates recovery, and improves patient outcomes.

Keywords

• corticosteroids
• dexamethasone
• orthognathic surgery

Ortognatik Cerrahi Uygulamalarında Kortikosteroid Kullanımı: Literatür derlemesi

Abstract

Arka Plan: Kortikosteroidler, güçlü antiinflamatuar, immünmodülatör ve antiemetik etkileri nedeniyle maksillofasiyal ve ortognatik cerrahide yaygın olarak kullanılmaktadır. Yara iyileşmesi, enfeksiyon riski ve glukoz metabolizması üzerindeki olası olumsuz etkilerine ilişkin endişeler devam etse de, güncel kanıtlar kısa süreli perioperatif kullanımda kortikosteroidlerin güvenli ve etkili olduğunu göstermektedir. Amaç: Bu derlemenin amacı, ortognatik cerrahide kortikosteroid—özellikle deksametazon—uygulamasının klinik etkinliği, optimal dozu, uygulama zamanı ve güvenlilik profiline ilişkin güncel kanıtları özetlemektir. Yöntemler: 1974–2025 yılları arasında yayımlanan randomize kontrollü çalışmalar, sistematik derlemeler ve meta-analizleri kapsayan kapsamlı bir literatür taraması yapılmıştır. Ortognatik ve ilişkili maksillofasiyal cerrahi girişimlerde perioperatif kortikosteroid kullanımını değerlendiren çalışmalar; postoperatif ödem, trismus, ağrı, bulantı ve kusma (PONV), yara iyileşmesi, enfeksiyon riski ve sistemik advers etkiler açısından analiz edilmiştir. Bulgular: Kanıtlar, tek doz intravenöz 8–16 mg deksametazon uygulamasının postoperatif ödem, trismus, ağrı ve PONV’yi anlamlı şekilde azalttığını; buna karşın yara iyileşmesinde bozulma veya enfeksiyon riskinde artışa yol açmadığını tutarlı biçimde göstermektedir. Kortikosteroidlerin Enhanced Recovery After Surgery (ERAS) protokollerine dâhil edilmesi, hasta konforunu artırmakta, opioid tüketimini azaltmakta ve daha erken taburculuğu desteklemektedir. Kısa süreli uygulamanın (<48 saat) klinik olarak anlamlı hipotalamo–hipofizer–adrenal (HPA) aks baskılanmasına neden olmadığı, ancak özellikle diyabetik hastalarda geçici hiperglisemiye yol açabileceği bildirilmiştir. Sonuç: Tek doz perioperatif deksametazon, ortognatik cerrahide güvenli ve etkili bir adjuvan tedavi seçeneğidir. ERAS temelli perioperatif yönetim stratejilerine dâhil edilmesi, postoperatif morbiditeyi azaltmakta, iyileşme sürecini hızlandırmakta ve hasta sonuçlarını iyileştirmektedir.

Keywords

• kortikosteroidler
• deksametazon
• ortognatik cerrahi

References

1. 1. Ramamoorthy S., Cidlowski J.A. Corticosteroids. Rheum Dis Clin North Am 2016; 42(1):15–31.
2. 2. Stahn C., Löwenberg M., Hommes D.W., Buttgereit F. Molecular mechanisms of glucocorticoid action and selective glucocorticoid receptor agonists. Mol Cell Endocrinol 2007; 275(1–2):71–78.
3. 3. Tsigos C., Chrousos G.P. Hypothalamic–pituitary–adrenal axis, neuroendocrine factors and stress. J Psychosom Res 2002; 53(4):865–871.
4. 4. Charmandari E., Tsigos C., Chrousos G. Endocrinology of the stress response. Annu Rev Physiol 2005; 67:259–284.
5. 5. Buttgereit F., Straub R.H., Wehling M., Burmester G.R. Glucocorticoids in the treatment of rheumatic diseases: an update on the mechanisms of action. Arthritis Rheum 2004;50(11):3408–3417.
6. 6. Gersema L., Baker K. Use of corticosteroids in oral surgery. J Oral Maxillofac Surg 1992; 50(3):270–277.
7. 7. Melmed S., Conn P.M. Endocrinology: basic and clinical principles. Totowa, NJ: Humana Press; 2005.
8. 8. Rhen T., Cidlowski J.A. Antiinflammatory action of glucocorticoids—new mechanisms for old drugs. N Engl J Med 2005; 353(16):1711–1723.

9. 9. Xu J., Wang B., Ao H. Corticosterone effects induced by stress and immunity and inflammation: mechanisms of communication. Front Endocrinol (Lausanne) 2025; 16:1448750.
10. 10. Longui C.A. Glucocorticoid therapy: minimizing side effects. J Pediatr (Rio J) 2007; 83:S163–S171.
11. 11. Proffit W.R., Turvey T.A., Phillips C. The hierarchy of stability and predictability in orthognathic surgery with rigid fixation. Head Face Med 2007; 3:21.
12. 12. Friscia M., Sbordone C., Petrocelli M., Vaira L.A., Attanasi F., Cassandro F.M., et al. Complications after orthognathic surgery: our experience on 423 cases. Oral Maxillofac Surg 2017;21(2):171–177.
13. 13. Stahn C., Buttgereit F. Genomic and nongenomic effects of glucocorticoids. Nat Clin Pract Rheumatol 2008; 4(10):525–533.
14. 14. Semper-Hogg W., Fuessinger M.A., Dirlewanger T.W., Cornelius C.P., Metzger M.C. Influence of dexamethasone on postoperative swelling and neurosensory disturbances after orthognathic surgery. Head Face Med 2017; 13(1):19.
15. 15. Jean S., Dionne P.L., Bouchard C., Giasson L., Turgeon A.F. Perioperative systemic corticosteroids in orthognathic surgery. J Oral Maxillofac Surg 2017; 75(12):2638–2649.
16. 16. Lima C.A.A., Favarini V.T., Torres A.M., da Silva R.A., Sato F.R.L. Oral dexamethasone decreases postoperative pain, swelling, and trismus. Oral Maxillofac Surg 2017; 21(3):321–326.
17. 17. Bravo M., Bendersky Kohan J., Uribe Monasterio M. Effectiveness of glucocorticoids in orthognathic surgery. Br J Oral Maxillofac Surg 2022; 60(2):e231–e245.
18. 18. Henzi I., Walder B., Tramèr M.R. Dexamethasone for postoperative nausea and vomiting. Anesth Analg 2000; 90(1):186–194.
19. 19. De Oliveira G.S., Castro-Alves L.J.S., Ahmad S., Kendall M.C., McCarthy R.J. Dexamethasone to prevent postoperative nausea and vomiting. Anesth Analg 2013; 116(1):58–74.
20. 20. Kang Y., Koshika K., Takashima K., Nakakuki A., Hasunuma K., Hayashi M., et al. Dexamethasone and ondansetron combined decreases postoperative nausea and vomiting in orthognathic surgery. Anesth Prog 2025; 72(1):3–8.
21. 21. Fearon K.C.H., Ljungqvist O., Von Meyenfeldt M., Revhaug A., Dejong C.H.C., Lassen K., et al. Enhanced recovery after surgery. Clin Nutr 2005; 24(3):466–477.
22. 22. Ljungqvist O., Scott M., Fearon K.C. Enhanced recovery after surgery. JAMA Surg 2017; 152(3):292.
23. 23. Joachim M.V., Miloro M. Enhanced recovery after orthognathic surgery. J Oral Maxillofac Surg 2025; 83(9):1079–1092.
24. 24. Magraw C., Pham M., Neal T., Kendell B., Reside G., Phillips C., et al. Multimodal analgesic protocol after third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol 2018; 126(3):214–217.
25. 25. Becker D.E. Basic and clinical pharmacology of glucocorticosteroids. Anesth Prog 2013; 60(1):25–32.
26. 26. Graziani F., D’Aiuto F., Arduino P.G., Tonelli M., Gabriele M. Perioperative dexamethasone after wisdom tooth removal. Int J Oral Maxillofac Surg 2006; 35(3):241–246.
27. 27. Üstün Y., Erdoğan O., Esen E., Karsli E.D. Methylprednisolone after third molar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2003; 96(5):535–539.
28. 28. Czock D., Keller F., Rasche F.M., Häussler U. Pharmacokinetics and pharmacodynamics of glucocorticoids. Clin Pharmacokinet 2005; 44(1):61–98.
29. 29. Widar F., Kashani H., Alsén B., Dahlin C., Rasmusson L. Steroids after bilateral sagittal split osteotomy. Int J Oral Maxillofac Surg 2015; 44(2):252–258.
30. 30. Chegini S., Dhariwal D.K. Steroids in orthognathic surgery. Br J Oral Maxillofac Surg 2012; 50(2):97–101.
31. 31. Hooley J.R., Hohl T.H. Steroids after traumatic oral surgery. J Oral Surg 1974; 32(11):864–866.
32. 32. Gupta K., Waknis P.P. Postoperative steroid dosing in orthognathic surgery. J Oral Maxillofac Surg Med Pathol 2023; 35(4):305–307.
33. 33. Bär A.K., Werkmeister R., Dort J.C., Al-Nawas B. Perioperative care in orthognathic surgery. J Craniomaxillofac Surg 2024; 52(11):1244–1258.
34. 34. Dan A.E.B., Thygesen T.H., Pinholt E.M. Corticosteroid administration in oral and orthognathic surgery. J Oral Maxillofac Surg 2010; 68(9):2207–2220.
35. 35. de Lima V.N., Lemos C.A.A., Faverani L.P., Santiago Júnior J.F., Pellizzer E.P. Corticoids in orthognathic surgery. J Oral Maxillofac Surg 2017; 75(7):1528.e1–1528.e8.
36. 36. Joachim M.V., Miloro M. Multimodal pain management in orthognathic surgery. Int J Oral Maxillofac Surg 2025; 54(10):914–923.
37. 37. Nils H.J., Arce Recatala C., Castano A., Ribas D., Flores-Fraile J. Glucocorticoids in oral and maxillofacial surgery. Dent J (Basel) 2023; 11(10):239.
38. 38. Alexander R.E., Throndson R.R. Perioperative corticosteroids in dentoalveolar surgery. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2000; 90(4):406–415.
39. 39. Weber T.M. Jr., Taylor K.J., Squier B., Dammling C.W., Kinard B.E. Perioperative management in orthognathic surgery. J Oral Maxillofac Anesth 2024; 3:18.
40. 40. Abukawa H., Ogawa T., Kono M., Koizumi T., Kawase-Koga Y., Chikazu D. IV dexamethasone reduces postoperative edema. J Oral Maxillofac Surg 2017; 75(6):1257–1262.
41. 41. Dipalma G., Inchingolo A.M., Riccaldo L., Morolla R., Lauria P., Giorgio R.V., et al. Drug administration and postoperative pain. Clin Exp Dent Res 2025; 11(5).
42. 42. Fernández-Martín U., Lisbona-González M.J., Vallecillo-Rivas M., Mallo-Magariños M., Herrera-Briones F.J. Dexamethasone vs methylprednisolone in third molar surgery. J Clin Med 2024;13(16):4614.
43. 43. Lin H.H., Kim S.G., Kim H.Y., Niu L.S., Lo L.J. Higher dose dexamethasone after orthognathic surgery. Ann Plast Surg 2017; 78(3):S61–S69.
44. 44. Zhou W., Liu F., Fang J., Han L. Preventive dexamethasone in jaw cyst surgery. BMC Anesthesiol 2022;22(1):344.
45. 45. Misch C.E. Contemporary implant dentistry. St. Louis: Mosby Elsevier; 2008.
46. 46. Schaberg S.J., Stuller C.B., Edwards S.M. Methylprednisolone and swelling after orthognathic surgery. J Oral Maxillofac Surg 1984; 42(6):356–361.
47. 47. Liu D., Ahmet A., Ward L., Krishnamoorthy P., Mandelcorn E.D., Leigh R., et al. Complications of systemic corticosteroid therapy. Allergy Asthma Clin Immunol 2013; 9(1):30.
48. 48. Stanbury R.M., Graham E.M. Systemic corticosteroid therapy— side effects. Br J Ophthalmol 1998; 82(6):704–708.
49. 49. De Oliveira G.S., Almeida M.D., Benzon H.T., McCarthy R.J. Singledose dexamethasone for postoperative pain. Anesthesiology 2011; 115(3):575–588.
50. 50. Wang A.S., Armstrong E.J., Armstrong A.W. Corticosteroids and wound healing. Am J Surg 2013;206(3):410–417.
51. 51. Guo S., DiPietro L.A. Factors affecting wound healing. J Dent Res 2010; 89(3):219–229.
52. 52. Mantzoros I., Kanellos I., Demetriades H., Christoforidis E., Kanellos D., Pramateftakis M.G., et al. Steroids and colonic anastomosis healing. Tech Coloproctol 2004; 8(Suppl 1):S180–S183.
53. 53. Markiewicz M.R., Brady M.F., Ding E.L., Dodson T.B.Corticosteroids after third molar surgery. J Oral Maxillofac Surg 2008; 66(9):1881–1894.
54. 54. Vyas N., Agarwal S., Shah N., Patel D., Aapaliya P. Intramuscular methylprednisolone after third molar surgery. Kathmandu UnivMed J 2015; 12(1):4–8.
55. 55. Corcoran T.B., Myles P.S., Forbes A.B., Cheng A.C., Bach L.A., O’Loughlin E., et al. Dexamethasone and surgical-site infection. N Engl J Med 2021; 384(18):1731–1741.
56. 56. Feeley A.A., Feeley T.B., Feeley I.H., Sheehan E. Infection risk after perioperative corticosteroids. J Arthroplasty 2021;36(8):3042–3053.
57. 57. Katerenchuk V., Ribeiro E.M., Batista A.C. Intraoperative dexamethasone and blood glucose. Anesth Analg 2024; 139(3):490–508.
58. 58. Allen D.C., Jedrzynski N.A., Michelson J.D., Blankstein M., Nelms N.J. Dexamethasone and blood glucose in diabetes. J Arthroplasty 2020; 35(3):671–674.
59. 59. Low Y., White W.D., Habib A.S. Postoperative hyperglycemia after dexamethasone. J Clin Anesth 2015; 27(7):589–594.
60. 60. Yared J.P., Starr N.J., Torres F.K., Bashour C.A., Bourdakos G., Piedmonte M., et al. Single-dose dexamethasone after cardiac surgery. Ann Thorac Surg 2000; 69(5):1420–1424.
61. 61. Dubovsky A.N., Arvikar S., Stern T.A., Axelrod L. Neuropsychiatric complications of glucocorticoids. Psychosomatics 2012;53(2):103–115.
62. 62. Brown E.S., Chandler P.A. Mood and cognitive changes during corticosteroid therapy. Prim Care Companion CNS Disord 2001;3(1).