Effects of different corticosteroids on edema and ecchymosis in open rhinoplasty

Ultrasonographic evaluation of long-term results of nasal tip defatting in rhinoplasty cases

OBJECTIVES/HYPOTHESIS

Nasal skin thickness has an important role in aesthetic results of rhinoplasty. The aim of this study was to evaluate the long-term results of tip and supratip skin defatting technique in rhinoplasty subjects using ultrasonography.

STUDY DESIGN

Prospective, randomized, case-control study.

METHODS

Among 111 rhinoplasty cases referred to a university hospital between February 2010 and September 2011, after physical examination and measuring the nasal tip and supratip skin thickness by ultrasonography, a total of 55 patients with thick and moderate skin were randomly allocated for rhinoplasty using one of the following methods: rhinoplasty with (case group) and without (control group) defatting tip and supratip skin. Ultrasonographic evaluation of the skins was repeated 1 and 12 months after surgery, and the data were analyzed by Wilcoxon and repeated measure tests using SPSS 17 software.

RESULTS

Twenty-eight of 55 candidates (10 men, 45 women; mean age, 25.1 ± 7.6 years) underwent skin defatting during rhinoplasty; the other 27 patients did not undergo this procedure. Forty-four patients completed the study. Thickness of tip and supratip skin was not statistically different before surgery and during follow-up evaluations in defatting and nondefatting technique groups (P = .7).

CONCLUSIONS

Defatting techniques have no effect on reducing tip and supratip skin thickness after rhinoplasty in moderate to thick skins.

Efficacy of dexamethasone with controlled hypotension on intraoperative bleeding, postoperative oedema and ecchymosis in rhinoplasty

PURPOSE

The aim of this retrospective study was to evaluate the efficacy of dexamethasone with controlled hypotension on intraoperative bleeding and postoperative morbidity in rhinoplasty.

MATERIALS AND METHODS

Sixty rhinoplasty patients required hump resection and lateral osteotomy were included in this study. The patients were randomized into four groups. In group I (n=15), a single dose of 10mg/kg dexamethasone was intravenously administered at the beginning of the operation. In group II (n=15), the patients were given 2 doses of 10mg/kg intravenously dexamethasone at the beginning of the operation, and 24 hours after the operation. In group III (n=15), 3 doses of 10mg/kg intravenously dexamethasone were given at the beginning of the operation, before osteotomy and 24 hours after the operation. Group IV (n=15) was assigned as control group and the patients were neither administered dexamethasone nor applied hypotension. All cases in groups I, II and III were operated under controlled hypotension. Systolic arterial pressure was aimed to keep between 65 and 75 mmHg for controlled hypotensive anaesthesia. Controlled hypotension was achieved by a remifentanil infusion of 0.1-0.5 microg/kg/min, following a bolus of 1 microg/kg. Degree of eyelid oedema and periorbital soft-tissue ecchymosis was evaluated separately using a scale of 0-4. Intraoperative blood loss was recorded for each patient. Patients were evaluated at 24 hours and postoperative days 2, 5, 7, and 10.

RESULTS

In groups I, II and III, intraoperative bleeding was more decreased and the operation time was significantly shorter compared with control group (P<0.001). Eyelid oedema and periorbital ecchymosis were significantly decreased in groups I, II and III at the following postoperative 7 and 10 days (P<0.001). There was statistically significant difference between group III and other groups at the postoperative 5 and 7 days in lower eyelid oedema (P<0.001), upper and lower eyelid ecchymosis (P<0.001 and 0.004, respectively). There were no postoperative complications with using steroid in any of the groups.

CONCLUSION

Three doses of dexamethasone with controlled hypotension considerably reduced postoperative morbidities of rhinoplasty with osteotomy as well as intraoperative bleeding. Thus, in group III receiving 3 doses of steroid, when compared to other groups, more uneventful postoperative period were provided for surgeon and the patients.

Comparison of the effect of corticosteroid therapy and decongestant on reducing rhinoplasty edema

BACKGROUND

Comparison of the two methods of decongestant and three doses of dexamethasone on reducing edema and ecchymosis after septorhinoplasty.

METHODS

Seventy-four patients who were candidates for rhinoplasty were randomly divided into three groups. Group A received 8 mg of i.v. dexamethasone preoperatively and again after 24 and 48 hours after surgery, group B received three pseudoephedrine tablets (60 mg) per day for 1 week, and group C received three pseudoephedrine tablets (60 mg) per day for 2 weeks. Finally, their effects on the eye, tip and dorsal edema, and ecchymosis were evaluated.

RESULTS

Our findings showed that both decongestant and corticosteroid had significant short-term effects on edema and ecchymosis, but only continuation of pseudoephedrine could reduce the evaluated variables after 1 week.

CONCLUSION

Pseudoephedrine can be effective for reducing eyelid edema and ecchymosis after rhinoplasty. Also, administration of three doses of dexamethasone in the postoperative care of nasal plastic surgery harmlessly diminished postsurgical edema.

Perioperative steroids for minimizing edema and ecchymosis after rhinoplasty: a meta-analysis

BACKGROUND

Minimizing complications after rhinoplasty is a priority for every surgeon performing the procedure. Perioperative steroid administration has been shown to decrease postoperative edema and ecchymosis in a number of prospective randomized trials.

OBJECTIVES

In an effort to further elucidate the significance of the data and develop an evidence-based algorithm for steroid administration, the authors offer a meta-analysis of the existing literature.

METHODS

A systematic review of the literature was performed. All articles were reviewed for relevant data, which were extracted, pooled, and compared. Seven prospective randomized trials investigating perioperative steroid use in rhinoplasty have been conducted and reported. Four of these studies had the same method of patient edema and ecchymosis assessment, and their data were compared.

RESULTS

Based on results from the four relevant studies, perioperative steroid use significantly reduces postoperative edema and ecchymosis of the upper and lower eyelids at one day and seven days postoperatively (P < .0001). Preoperative steroid administration decreases postoperative upper and lower eyelid edema at one day preoperatively, when compared to postoperative administration (P < .05). Extended dosing is superior to one-time dosing (P < .05).

CONCLUSIONS

Perioperative steroid use decreases postoperative edema and ecchymosis associated with rhinoplasty. Preoperative administration is superior to postoperative, and extended dosing is superior to singular. Based on these results, evidence-based guidelines for perioperative steroid administration can be given.

The Effectiveness of Steroids for Edema, Ecchymosis, and Intraoperative Bleeding in Rhinoplasty

Background

The aim of this study was to investigate the dose-related effectiveness of steroids on periorbital edema, ecchymosis, and intraoperative bleeding in patients who underwent open rhinoplasty with osteotomy.

Methods

Forty patients were divided into three groups: those in group 1 (n = 15) were given a single dose of 1-mg/kg intravenous (i.v.) methylprednisolone, those in group 2 (n = 15) were given a single dose of 3-mg/kg i.v. methylprednisolone preoperatively, and group 3 (n = 10) was the control group. Eyelid edema and periorbital soft-tissue ecchymosis were evaluated separately using a scale of 0–4.

Results

In groups using the steroid preoperatively, periorbital edema and ecchymosis were significantly lower compared with the control group (p < 0.05). No significant differences were seen clinically or statistically in preventing or reducing either the periorbital ecchymosis or the periorbital edema between groups 1 and 2. Also, there was no significant difference among the groups in terms of bleeding (p > 0.05). No complications with regard to the operation or steroid use were observed.

Conclusion

Our results support that steroids significantly decrease periorbital ecchymosis and periorbital edema in open rhinoplasty with osteotomy. Additionally, our results suggest that if the dose of steroids is adjusted according to body weight, there is no significant benefit in a single dose of 3 mg/kg of methylprednisolone over a lower dose of 1 mg/kg and there is no need for higher doses of methylprednisolone administration.

Efficacy of the Combination of Intraoperative Cold Saline-Soaked Gauze Compression and Corticosteroids on Rhinoplasty Morbidity

Objective. The basic aim of this study was to minimize intraoperative bleeding, postoperative eyelid edema, and periorbital ecchymosis and to reduce morbidity with a combination of cold saline-soaked gauze compression and intraoperative single-dose corticosteroids.

Study Design. The study was designed as a prospective, double-blind, randomized controlled study. Three hundred patients who underwent septorhinoplasty were included.

Setting. A tertiary referral hospital in Turkey.

Subjects and Methods. Three hundred patients undergoing septorhinoplasty were divided into 2 groups. A single dose of 10 mg dexamethasone was intravenously administered in all cases at the beginning of the operation. In the study group, the nasal dorsum was continuously compressed with cold saline-soaked gauze during the operation. In the control group, the nasal dorsum was compressed with dry gauze continuously during surgery. The operation time and amount of bleeding were recorded during surgery. Degree of eyelid edema and periorbital soft tissue ecchymosis was recorded at 24 hours and on postoperative days 2, 3, 5, and 7 by 2 investigators.

Results. The operation time was significantly shorter in the study group than in the control group. Eyelid edema and periorbital ecchymosis were significantly decreased in the study group at the following postoperative days 1, 3, 5, and 7 ( P < .05).

Conclusion. Bleeding, edema, and ecchymosis are the main morbidities of rhinoplasty. It is highly probable that cold compression and intraoperative corticosteroids have synergistic effects on these morbidities, especially by the intraoperative control of bleeding.

Problems in rhinoplasty

In this review, the complications of rhinoplasty are examined in terms of their timing of presentation. An algorithmic approach to postoperative problems is discussed. Complications can frequently be avoided by meticulous technique, recognition of pitfalls, and early attention to perioperative morbidity. Reoperative rates can be minimized with good patient education and proper command of the postoperative situation, so that unnecessary procedures are not undertaken.

Triological thesis: concurrent endoscopic sinus surgery and cosmetic rhinoplasty: rationale, risks, rewards, and reality

OBJECTIVES/HYPOTHESIS

To examine the effect of concurrent endoscopic sinus surgery (ESS) on the postoperative course of cosmetic rhinoplasty (CR), identify any specific contraindications, and to develop more useful treatment regimen in patients undergoing concurrent ESS and CR.

STUDY DESIGN

Retrospective case-control study.

METHODS

Consecutive patients undergoing CR (performed by the principal investigator (PI) in a tertiary care academic practice) at the same operative setting as ESS from June 2004-June 2007 were identified. Additionally, patients undergoing CR (also by the PI) without ESS over the same time period (matched for gender, age, and rhinoplasty approach and techniques) were identified and used as control subjects. The office and hospital charts of these patients were reviewed for details of pre-, intra-, peri-, and postoperative care, preoperative CT scans as well as for patient and physician observations. Specifically noted were details regarding the type of cosmetic changes sought, course of symptoms of chronic sinusitis, prior treatment, surgical techniques used for both ESS and CR, and postoperative treatment with antibiotics and corticosteroids. Additionally, a literature review of articles describing concurrent CR and ESS was performed.

RESULTS

Thirteen patients were identified who underwent ESS at the same time as CR. There were no cases of cerebrospinal fluid leak, epistaxis, orbital complications, septal perforation, cellulitis or saddle nose deformity. No correlation was found between sinus surgery performed and need for revision surgery (CR or ESS) or postoperative infections. However, the time to patient reported resolution of postoperative nasal swelling was significantly higher in patients undergoing concurrent ESS/CR compared to CR only (dorsal swelling: 9.62 +/- 6.18 (ESS/CR) vs. 5.85 +/- 1.95 (CR) weeks, P = .0469; nasal tip swelling: 19.31 +/- 13.02 (ESS/CR) vs. 10.38 +/- 2.96 (CR) weeks, P = .0240, unpaired t test). The same relation held true for doctor noted postoperative edema (nasal dorsal edema: 10.62 +/- 7.32 (ESS/CR) vs. 6.31 +/- 2.72 (CR) weeks, P = .0582; nasal tip edema: 21.46 +/- 15.66 (ESS/CR) vs. 12.23 +/- 4.10 (CR) weeks, P = .0508, unpaired t test). Among patients who underwent concurrent ESS and CR, this time was highly correlated with the severity of sinus disease on preoperative CT scanning (r(2) = 0.8573, P < .0001). A greater need for postoperative corticosteroid injections in the ESS/CR group was suggestive but not statistically significant (30.8% vs. 0%, P = .0957).

CONCLUSIONS

While our data supports concurrent ESS and CR as safe, our findings suggest that the presence and treatment of concurrent sinonasal disease prolongs the patients' recovery from CR. This may be due to the effects of sinus pathology and manipulation of sinonasal venous and lymphatic drainage patterns or could be due to subclinical infectious soiling of rhinoplasty tissue planes. We recommend a two-team approach to promote excellent surgical technique, avoid surgeon fatigue, and enhance patient care. We recommend adequate medical management of chronic sinusitis prior to surgery, pre, intra and postoperative antibiotic coverage, appropriate postoperative sinus toilet beginning 1 week after surgery and careful and close patient follow-up to optimize results. Most importantly, we advocate close coordination of sinonasal and rhinoplastic care in a two-team approach to maximize care.

The efficacy of melilotus extract in the management of postoperative ecchymosis and edema after simultaneous rhinoplasty and blepharoplasty

BACKGROUND

Melilotus extract has been used as a folk medicine in inflammation-related therapy. This study was undertaken to determine the potential benefits of this herbal extract in treating postoperative ecchymosis and edema after simultaneous rhinoplasty and blepharoplasty.

METHODS

Augmentation rhinoplasty and double-eyelid blepharoplasty were performed in one procedure by the same surgeon on 46 patients.

RESULTS

Postoperative edema and ecchymosis were evaluated independently by two investigators checking the upper eyelid, lower eyelid, and paranasal area at postoperative days 1, 4, and 7. Our data showed that the patients receiving melilotus extract (n = 16) had lower scores not only in upper-eyelid and lower-eyelid ecchymosis, but also in paranasal ecchymosis at postoperative day 7 when compared with those in the control group. No significant difference in postoperative ecchymosis was detected in the group receiving dexamethasone treatment (n = 16) when compared with the control group (n = 14) at postoperative days 1, 4, and 7. The mean scores of upper-eyelid, lower-eyelid, and paranasal edema at postoperative days 1 and 4 were significantly lower in the group receiving dexamethasone treatment (n = 16) than that in the control group. Although the scores of eyelid edema reduction in the patients receiving melilotus extract showed no difference when compared with the control group, paranasal edema was reduced much more at postoperative days 4 and 7 when compared with the control group.

CONCLUSION

We suggest the appropriate use of melilotus extract based on its beneficial effects on the postoperative results after simultaneous rhinoplasty and blepharoplasty.