Aims: A randomized controlled trial (RCT) was conducted to determine the efficacy of high dose intravenous betamethasone on neurosensory disturbances, facial oedema and pain in bilateral sagittal split osteotomy (BSSO). Materials and methods: Thirty-eight patients (mean age 23.5 years, range 17–62 years) with mandibular prognathism or retrognathism were consecutively enrolled in the study. The patients were randomly divided into three groups: (A) control ( n = 12), (B) 16 mg betamethasone (perioperative) ( n = 11) and (C) 4 + 8 + 4 mg betamethasone (pre-, peri- and postoperatively) ( n = 15). Measurement of pain (visual analog scale), sensitivity in lower lip (visual analog scale) and oedema were performed preoperatively and postoperatively (1 day, 7 days, 2 months and 6 months). The intake of non-steroidal anti-inflammatory medication and paracetamol was individually assessed. Furthermore, we recorded gender, age, operating time, bleeding, nerve exposure, advancement versus setback and length for hospital stay. Results: There was a significant difference ( p = 0.013) between the two test groups and the control group (1 day) with regard to facial oedema. No differences were found between the test and the control groups for any of the parameters after 6 months. Less bleeding perioperative gave significant reduction in pain ( p = 0.021). Higher doses of NSAID and paracetamol were associated with a significantly delayed recovery ( p < 0.001) of the nerve at 6 months postoperatively.
Conclusion: Betamethasone gave significant reduction of facial oedema in short term. Betamethasone did not reduce neurosensory disturbances. Lesser bleeding decreases postoperative pain. High consumption of NSAID and Paracetamol were associated with delayed healing of the nerve.
Key words: steroids; neurosensory disturbances; bilateral sagittal split osteotomy; orthognathic