Perioperative therapies to reduce edema after orthognathic surgery: a systematic review and meta- analysis

Objective To systematically review the literature and assess the effectiveness of perioperative systemic and nonsystemic therapies in reducing edema after orthognathic surgery. Study Design Four databases (PubMed, Web of Science, Bireme, and Scopus) were searched. Only randomized clinical trials were included and assessed using the RoB 2.0 software (Cochrane Collaboration, London, UK). Studies were grouped into time of assessment and systemic/nonsystemic therapy. Results Eighteen studies were included in this review (8 in the meta-analysis, n = 349). The qualitative assessment of systemic (enzyme therapy, dexamethasone, betamethasone, and Venoplant) and nonsystemic therapies (thermotherapy and K-Taping) appear to reduce edema. Manual lymphatic drainage (MLD) after 72 hours (CI:-1.03 to 2.31; P = .45), and 30 days (CI:-1.53 to 0.49; P = .49), and laser after 24 hours (CI:-1.36 to 1.48; P = .93), 72 hours (CI:-4.81 to 2.92; P = .63), 30 days (CI:-3.44 to 0.99; P = .28), and 90 days (CI:-1.83 to 0.96; P = .54) showed no significance. Thermotherapy reduced edema after 48 hours (CI:-48.47 to-13.31; P = .0006) and 30 days (CI:-14.73 to-1.98; P = .01). Conclusion The Grading of Recommendations, Assessment, Development and Evaluations tool showed moderate evidence for thermotherapy (significant reduction of edema), whereas the MLD and laser results were rated as high certainty of evidence (no reduction of edema). (Oral Surg Oral Med Oral Pathol Oral Radiol 2023;135:211-235)