Thirty-six pediatric patients (age range, 6 to 18 years; mean, 15 years) undergoing mandibular and/or maxillary osteotomies were examined in a randomized double-blind study to determine objectively whether steroids are therapeutic in such operations. Dexamethasone or a saline placebo was administered immediately preoperatively (0.5 mg/kg) and for 48 hours postoperatively (0.25 mg/kg/day). Standardized surgical techniques and fluid administration were used. Photographs of the patient taken on admission and 24 hours postoperatively were compared by three independent observers familiar with maxillofacial surgery to rate facial swelling. Mean intubation period (until an audible leak around the endotracheal tube was present), time until oral intake was satisfactory, and facial swelling ratings were compared between the two groups. The results seemed better for the patients receiving steroids but the difference was not significant. This study did not confirm the subjective belief of many surgeons that steroid administration reduces facial swelling after maxillofacial surgery.