Methoxyflurane as an Analgesic and Sedative Agent in Oral and Maxillofacial Surgery: A Scoping Review.
INTRODUCTION Methoxyflurane (MOF) is a low-dose inhaled analgesic with rapid onset, patient-controlled titration, and an established safety profile at sub-anesthetic doses. Its potential role in oral and maxillofacial surgery (OMFS) has not been comprehensively mapped. OBJECTIVE To map and characterize available evidence on inhaled methoxyflurane in OMFS, including dento-alveolar surgery, acute oral pain emergencies, and outpatient analgesic-sedation. METHODS Scoping review conducted following JBI methodology and reported per PRISMA-ScR. Eligibility defined by PCC (Population, Concept, Context) framework. Searched: MEDLINE (PubMed), Embase, Cochrane CENTRAL, Scopus, and Web of Science, with no date restriction. Two independent reviewers screened records; data charted using a standardised form. RESULTS Twenty studies were identified: 10 with direct OMFS/dental relevance (2 RCTs, 2 case series, 1 clinical study, 2 narrative reviews, 1 systematic review, 1 feasibility review, 1 ongoing Phase 3 RCT) and 10 with indirect but clinically translatable relevance. MOF demonstrated comparable sedation and greater patient preference versus nitrous oxide in third molar surgery (p<0.05). Systematic reviews in outpatient procedural contexts reported satisfaction rates of 63%->98% and no serious adverse events at analgesic doses. The pivotal METODO trial (NCT06495372), a Phase 3 placebo-controlled RCT in adult dental emergencies, is currently enrolling (expected completion October 2026). CONCLUSION Available evidence supports the clinical feasibility of MOF in OMFS, particularly for third molar surgery and acute oral pain. High-quality OMFS-specific RCTs remain lacking. The METODO trial will provide pivotal data to guide practice. Future research should address OMFS-specific protocols and jurisdictions where MOF lacks regulatory approval.