The Use of Perioperative Corticosteroids in Craniomaxillofacial Surgery

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Abstract
Learning Objectives: After studying this article, the participant should be able to: 1. Report the approximate prevalence of use of perioperative corticosteroids by surgeons performing craniomaxillofacial or facial aesthetic surgery. 2. Restate the most common reasons cited by craniomaxillofacial surgeons for using or not using perioperative corticosteroids. 3. Cite the most frequently used perioperative corticosteroid regimens in craniomaxillofacial surgery and their potential to cause clinically significant adrenal insufficiency after discontinuation. 4. Describe the potential side effects associated with the use of perioperative corticosteroids as well as predisposing conditions to the development of these side effects. A literature search could not identify a study on the prevalence of the use of perioperative corticosteroids by surgeons performing craniomaxillofacial surgery. To gather this information, we conducted a survey of North American members of the American Society of Maxillofacial Surgeons classified as “active” in the society's roster. The first 90 members in forward and reverse alphabetical order who were capable of receiving a fax transmission were faxed our survey. Sixty surgeons responded, for a response rate of 66.7 percent. Twenty-eight (46.7 percent) reported using short-term, high-dose, perioperative corticosteroids to control postsurgical inflammation. Surgeons performing facial aesthetic surgery alone or in addition to craniomaxillofacial surgery were more likely to be using steroids (Fisher's exact test, p = 0.038). A variety of steroid drugs and regimens were cited by steroid users. The most common reason for using steroids was to decrease edema. Thirty-two (53.3 percent) responders reported that they were not using steroids. The most common reason for not using them was a lack of literature to support their effectiveness. All responders were asked to report any complications encountered with the use of steroids. The majority (78.3 percent) reported no complications. The most common complication encountered was euphoria (13.3 percent). No one reported the occurrence of avascular necrosis of the hip or humerus with the use of steroids. Based on a literature review, an analysis of the steroid regimens and complications reported revealed that steroid use was generally safe. Nevertheless, in addition to the traditional steroid contraindications, consideration should be given to withholding steroids in patients with any of the known risk factors for avascular necrosis, in patients who are or recently have been on nonsteroidal anti-inflammatory drugs, and in aspirin-sensitive asthmatics. These patients may be at increased risk for serious adverse effects with the use of steroids. More research is required to objectively measure the effect of steroids on edema and, if beneficial, to determine the optimal drug regimen. (Plast. Reconstr. Surg. 103: 313, 1999.)

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