Dexamethasone in Orthognathic Surgery: A Narrative Review of Pharmacological Rationale, Clinical Efficacy, Dosing Strategies, and Safety

Dexamethasone is the corticosteroid most often given to patients undergoing orthognathic surgery, yet the dose, timing, and route that produce the best results are still debated.This narrative review brings together the pharmacological rationale for dexamethasone, the clinical evidence for its effects on facial edema, pain, postoperative nausea and vomiting (PONV), and neurosensory disturbance after orthognathic surgery, and the available data on dosing, timing, route of administration, and safety.Clinical trials in orthognathic patients were considered alongside systematic reviews and meta-analyses from orthognathic, oral and maxillofacial, facial plastic, and general surgery; trials confined to third molar and other minor dentoalveolar surgery were not included, and the evidence was synthesized narratively without statistical pooling.Perioperative corticosteroids consistently reduce early facial edema, with the clearest effect in the first 24 to 48 hours; most swelling resolves within weeks whether or not a steroid is given.Doses from 5 mg to 40 mg have been tested, and higher doses have not produced greater benefit.Lower pain scores, reduced opioid consumption, and a lower incidence of PONV are supported mainly by large meta-analyses in general surgical populations, with modest effect sizes.Systemic dexamethasone has not been shown to hasten recovery of inferior alveolar nerve function, and topical application to the exposed nerve has given conflicting results.A single preoperative intravenous dose is the best-supported regimen.Continuing dexamethasone after surgery has rarely been tested on its own, and the one orthognathic trial with a separate postoperative arm found no added benefit.Short perioperative courses appear safe, the main measurable effect being a transient rise in blood glucose.A single moderate preoperative dose of dexamethasone is therefore a reasonable standard, and routine postoperative dosing cannot be recommended until trials that isolate its contribution become available.