A Prospective, Double-blind, Randomized Study of the Effects of Perioperative Steroids on Palatoplasty Patients

The effect of steroid injection of the tongue base on reducing postoperative airway obstruction in cleft palate repair

“…Other studies revealed that peri-operative IV steroid effectively lowered the risk of postoperative airway distress and may play a role in reducing health care costs. 12,13 Despite the published data on the role of IV steroids in UAO after palatoplasty, there are no data on the role of steroids in reducing lingual oedema if injected locally in the tongue base prior to palatal repair. One case report described the great and prompt effect of steroid injected locally into the base of the tongue of a 20-year-old patient in reducing traumatic macroglossia after failure of other conventional measures.…”

Does Perioperative Steroid Use Improve Clinical Outcomes in Open Repair of Craniosynostosis?

“…As an important indicator of quality care, the association between steroid use with shortened hospital LOS has also been corroborated in outcome studies of steroid use in tonsillectomies and a double-blind study of palatoplasties. 3,18,19 Initiatives to optimize early recovery further maintain importance given that fear or anxiety in parents/ caretakers dealing with protracted facial swelling can necessitate prolonged hospital stay. As we move toward a more cost-conscious environment in the health care industry, the focus on care processes to improve health care quality and reduction of hospital costs is increasingly noteworthy.…”

“…28 As steroid toxicity is proportionate to the dosage and duration of its therapy, there lacks a parallel from what these studies offer to compare with the more austere and short-duration regimens in our identified studies. Acartürk and colleagues 3,29 used an administration of high-dose steroids (IV methylprednisolone 30 mg/kg over 15 minutes) followed by a 48-hour infusion of 5.4 mg/kg and a rapid oral taper to treat traumatic superior orbital fissure and found no steroid-associated complications in a range of 6-month to 3-year follow-up period. Senders et al 3,29 found no steroid-associated fistula formation at 2 and 12 months' followup when IV dexamethasone (0.25 mg/kg; once before surgery, every 8 hours for 2 doses after surgery) was given to patients undergoing primary palatoplasty.…”

“…Acartürk and colleagues 3,29 used an administration of high-dose steroids (IV methylprednisolone 30 mg/kg over 15 minutes) followed by a 48-hour infusion of 5.4 mg/kg and a rapid oral taper to treat traumatic superior orbital fissure and found no steroid-associated complications in a range of 6-month to 3-year follow-up period. Senders et al 3,29 found no steroid-associated fistula formation at 2 and 12 months' followup when IV dexamethasone (0.25 mg/kg; once before surgery, every 8 hours for 2 doses after surgery) was given to patients undergoing primary palatoplasty. 3,29 Although no complications attributable to steroid use were reported in our included studies, the omission in documentation of follow-up period in 2 studies offers little comfort on the sound monitoring for its adverse events and emphasizes future reporting.…”

“…A wide array of randomized and nonrandomized trials conducted for facial soft tissue procedures, orthognathic procedures, and cleft lip and palate procedures have demonstrated efficacy of steroids in accelerating resolution of postprocedure facial edema. [3][4][5][6][7] Secondary beneficial outcome end points such as reduction of postoperative pain, faster resolution of postsurgical ecchymosis, decreased airway obstruction in cleft surgeries, improved control of postoperative nausea and vomiting, and faster time to ambulation have been reported. [3][4][5][6][7][8] Although perioperative steroid use appears to be well recognized and adopted, its safety and efficacy in craniosynostosis surgery remain understudied.…”