Efficacy of different dexamethasone routes and doses in reducing the postoperative sequelae of impacted mandibular third-molar extraction: A network meta-analysis of randomized clinical trials.

BACKGROUND: The aim of this network meta-analysis was to assess the comparative effects of different dexamethasone (DXM) routes and doses on reducing postoperative sequelae (pain, swelling, trismus) after surgical extraction of impacted mandibular third molars. METHODS: Five databases were searched on September 22, 2021, for randomized controlled trials. Risk of bias (ROB) was assessed using the Cochrane ROB 2 tool. Study heterogeneity, publication bias, and quality of evidence were investigated. Network meta-analyses were conducted (P < .05), and the P-score was used to rank comparisons of DXM doses and routes. RESULTS: Thirty-four eligible studies were included. Eight studies had low ROB, 21 had some concerns, and 5 had high ROB. The certainty of evidence evaluated by the Confidence in Network Meta-Analysis tool indicated low to very low certainty in most comparisons. The results showed that most DXM route and dose combinations were superior to a placebo in reducing the postoperative sequelae 1 day after surgical extraction. The results also showed that a 4-mg DXM submucosal injection substantially reduces pain 3 days after extraction compared with a 4-mg twin-mix or 8-mg intramuscular injection. Overall, it appears that 4 mg DXM submucosal injection or admixed with local anesthetic is effective in reducing postoperative sequelae after surgical extraction. CONCLUSIONS: Within the limitations of this study, the administration of DXM appears to be effective in reducing the postoperative sequelae, especially in the submucosal route. However, no noteworthy differences were found between the investigated DXM route and dose comparisons. PRACTICAL IMPLICATIONS: Submucosal DXM injection effectively reduce postoperative sequelae of third-molar extractions.

The diagnostic accuracy of intraoperative frozen section biopsy for diagnosis of sentinel lymph node metastasis in breast cancer patients: a meta-analysis.

Sentinel lymph node (SLN) sampling is important for evaluating the nodal stage of breast cancer when the axillary nodes are clinically free of metastasis. The intraoperative frozen section (IFS) of SLN is used for lymph node assessment. This meta-analysis aims to provide evidence about the diagnostic accuracy and the applicability of IFS of SLN in breast cancer patients. Data were collected by searching PubMed, Cochrane, Scopus, and Web of Science electronic databases for trials matching our eligibility criteria. The statistical analysis included the sensitivity, specificity, positive likelihood ratio, negative likelihood ratio, and pooled studies' diagnostic odds ratio outcomes. The analyses were conducted using the Open Meta-analyst software. This meta-analysis pooled the results of 110 studies. The overall sensitivity of IFS for SLN metastasis was 74.7%; 95% CI [72.0, 77.2], P < 0.001. It was 31.4% 95% CI [25.2, 38.3], P < 0.001 for the micro-metastasis, and 90.2%; 95% CI [86.5, 93.0], P < 0.001 for the macro-metastasis. The overall specificity was 99.4%; 95% CI [99.2, 99.6], P < 0.001. The overall positive likelihood ratio was 121.4; 95% CI [87.9, 167.6], P < 0.001, and the overall negative likelihood ratio was 0.226; 95% CI [0.186, 0.274], P < 0.001. The overall diagnostic odds ratio of IFS for diagnosing SLN metastasis was 569.5; 95% CI [404.2, 802.4], P < 0.001. The intraoperative frozen section of SLN has good sensitivity for diagnosing breast cancer macro-metastasis. However, the sensitivity is low for micro-metastasis. The specificity is very satisfactory.