الفهرس 
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Abstract
This study aimed to evaluate the effects of submucosal dexamethasone on postoperative edema , trismus and pain following surgical removal of impacted lower third molar through a comparative study with traditional intravenous Dexamethasone injection .
This study carried on twenty healthy patients classified as ASA type I* required surgical removal of impacted lower third molar. The patients were selected from the outpatient clinic of Oral and Maxillofacial Surgery Departement , Faculty of Dentistry , Suez Canal University. Their age was ranged from 17 to 32 years , fifteen of whom were females and five were males. The patients were divided into two groups , each consisted of ten patients , group (I) received 4 mg submucosal Dexamethasone at the surgical site and buccal vestibule (local ), group (II) received the same drug and dose intravenously (systemic) . The group received the injection ten minutes before surgery.
The surgical operations were performed under local anasethesia . All patients received two gram (AUGMENTIN™ ) as a prophylactic dose preoperatively and one gram every twelve hours postoperatively for four days . Oral paracetamol 500 mg tablets was prescribed to all patients for pain relief , they were informed not to exceed the dose of six tablets per day.
Edema was measured by marked three points on the ear lobule , angle of the mandible and corner of the mouth , then the distance between the points measured and the surface area of the drew triangle was calculated .Edema was measured by calculating the percentage of increase in area measurement taking the preoperative measurement as a baseline
Trismus assessed by the differences of the interincisal distances pre- and postoperative , while pain was evaluated by counting the number of analgesics tablets by the patients .
Pain was recorded by counting the number of analgesic tablets taken by the patients daily among the postoperative week .
All the patients were instructed to return for evaluation at the second and seventh days postoperative.
The statistical analysis revealed that there was no significant difference between the two groups in the duration of operation. The statistical analysis of Edema revealed that there was a statically significant decrease in edema in the submucosal group on comparing with the intravenous group at the second days postoperative where P value was 0.013 .But , at the seventh day postoperative there was no significant difference between the two groups.
Regarding trismus, no significant differences between the measurement of interincisal distances between the two groups throughout the whole postoperative period were found.full recovery of trismus had not taken place after one week.
Statistical analysis of pain revealed that there was insignificant decrease in the mean number of analgesic used by the submucosal group on the surgery day and the first , third , fifth and sixth days followed surgery , as the P value were 0.439 , 0.256 , 0.059 , 0.120 and 0.151 respectively . But , There was a highly statistically significant decrease in the mean number of analgesic tablets in the submucosal group on the second day after surgery as P value was 0.005. Also There was a statistically significant decrease in the mean number of analgesic on The fourth day after surgery in the submucosal group as the P value was 0.048.