1
|
Wu B, Chen S, Sun K, Xu X. Complications Associated with Rhinoplasty: An Umbrella Review of Meta-analyses. Aesthetic Plast Surg 2022; 46:805-817. [PMID: 34590168 DOI: 10.1007/s00266-021-02612-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2021] [Accepted: 09/19/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND An increasing number of studies have investigated the effect of various methods in avoiding complications in rhinoplasty. Our study aims to analyze the connections between various choices in rhinoplasty and the rate of multiple complications by summarizing results in related meta-analyses. MATERIALS AND METHODS Through Pubmed, MEDLINE, Embase, and the Cochrane Database were associated systematic reviews searched to gather and review the available evidence of different plans and health outcomes in rhinoplasty for this umbrella review. RESULTS The study included 14 systematic reviews with 128 meta-analyses of randomized clinical trials. Edema and ecchymosis were the two most investigated outcomes. The implementations of steroid, tranexamic acid, periosteal preservation, external approach in lateral osteotomy, and piezoelectric osteotomy were linked with significantly lower incidence of several complications. Multiple administration of steroids was found to be associated with fewer complications in a prolonged time. CONCLUSIONS With summarized evidence of complications related to rhinoplasty, this research can help surgeons to avert patients from suffering complications and optimize cosmetic outcomes. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
|
2
|
Aldhabaan SA, Hudise JY, Obeid AA. A meta-analysis of pre- and postoperative corticosteroids for reducing the complications following facial reconstructive and aesthetic surgery. Braz J Otorhinolaryngol 2022; 88:63-82. [PMID: 32605829 PMCID: PMC9422590 DOI: 10.1016/j.bjorl.2020.05.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/29/2020] [Accepted: 05/06/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Edema and ecchymosis after facial plastic surgery are a troublesome concern for both patients and surgeons. Corticosteroid administration is thought to shorten the recovery period and reduce these sequelae. Data regarding the efficacy of corticosteroid administration remains controversial among surgeons. OBJECTIVE We conducted this systematic review and meta-analysis to determine the effect of pre- and postoperative corticosteroids on postoperative complications in patients undergoing facial reconstructive surgery supported with different subgroup analysis. METHODS A comprehensive literature search of articles was conducted in PubMed, Cochrane Central, SCOPUS, and EBSCO through October 2019. We included all clinical trials in which patients underwent any type of facial plastic surgery to study the effect of corticosteroids on postoperative complications. We performed subgroup analysis according to the types and doses of corticosteroid preparation, in addition to a subgroup analysis of pre- or postoperative corticosteroid usage. All statistical analysis was performed using the RevMan software. RESULTS Nineteen studies were included in this systematic review, but only 10 of them were eligible for meta-analysis. The periorbital edema and ecchymosis scores were significantly reduced in the corticosteroids group compared to placebo -0.82, 95% CI (-1.37, -0.26), and -0.95, 95% CI (-1.32, -0.57), respectively. However, these significant differences were not maintained at day 3 and 7. Smaller doses of corticosteroid (8 mg and 10 mg) were associated with smaller differences in the mean score of upper and lower eyelid edema and ecchymosis, while the higher doses were associated with greater differences. Furthermore, preoperative corticosteroid usage significantly reduced the intraoperative bleeding when compared to placebo for higher doses > 50 mg per day (p < 0.0001), but not for 8 mg corticosteroid (p = 0.06). Adding postoperative steroid dose to the preoperative one was associated with less edema and ecchymosis than preoperative administration alone. CONCLUSION This comprehensive meta-analysis confirms a statistically significant benefit of preoperative corticosteroids. Furthermore, continuing the steroids postoperatively is associated with long-term reduction of complications. Higher doses of corticosteroids are associated with a more significant reduction in edema and ecchymosis, but further studies are recommended to determine the postoperative side effects, including surgical site infection and delayed healing.
Collapse
Affiliation(s)
- Saud A Aldhabaan
- King Saud Univeristy, King Abdulaziz University Hospital, Department of Otolaryngology, Head and Neck Surgery, Riyadh, Saudi Arabia.
| | - Jibril Y Hudise
- King Saud Univeristy, King Abdulaziz University Hospital, Department of Otolaryngology, Head and Neck Surgery, Riyadh, Saudi Arabia
| | - Amani A Obeid
- King Saud Univeristy, King Abdulaziz University Hospital, Department of Otolaryngology, Head and Neck Surgery, Riyadh, Saudi Arabia
| |
Collapse
|
3
|
Efficacy of Dexamethasone for Reducing Edema and Ecchymosis After Rhinoplasty: A Systematic Review and Meta-analysis. Aesthetic Plast Surg 2020; 44:1672-1684. [PMID: 32383002 DOI: 10.1007/s00266-020-01743-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 04/21/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Rhinoplasty is one of the most challenging cosmetic surgical operations. The procedure has been known to precipitate higher levels of edema and ecchymosis in the periorbital and paranasal regions. The literature recommends the use of corticosteroids such as dexamethasone to alleviate these postoperative morbidities. In this review, we aim to provide a current state of evidence concerning the influence of dexamethasone together with rhinoplasty on intraoperative and postoperative morbidities. METHODS A systematic identification of the literature was performed according to PRISMA guidelines on four academic databases: MEDLINE, Scopus, EMBASE and CENTRAL. A meta-analysis compared the influence of dexamethasone and normal saline administered during rhinoplasty on the amount of intraoperative blood loss, postoperative edema and ecchymosis. RESULTS Out of 1045 records, ten articles including 374 participants (mean age: 25.8 ± 2.5 years) were included in this review. This systematic review presents a 1b level of evidence supporting the use of dexamethasone during rhinoplasty to reduce the amount of intraoperative blood loss, edema and ecchymosis as compared to normal saline. The meta-analysis reveals beneficial effects for dexamethasone interventions by demonstrating medium to large effect reduction of the amount of intraoperative blood loss (Hedge's g: - 0.69), mean edema score (- 1.09) and mean ecchymosis score (- 1.03) as compared to placebo groups using normal saline. CONCLUSION The current systematic review and meta-analysis recommend the administration of dexamethasone with rhinoplasty. The review reports beneficial effects of dexamethasone's administration as compared to normal saline for reducing the amount of intraoperative blood loss, postoperative edema and ecchymosis. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
|
4
|
Incidence of Postoperative Adverse Events after Rhinoplasty: A Systematic Review. Plast Reconstr Surg 2020; 145:669-684. [DOI: 10.1097/prs.0000000000006561] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
|
5
|
Saedi B, Amali A, Arabpor M. Comparison of two concentrations of triamcinolone injection in the prevention of supratip edema after external rhinoplasty: A randomized trial. Am J Rhinol Allergy 2018; 31:412-415. [PMID: 29122087 DOI: 10.2500/ajra.2017.31.4479] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
BACKGROUND A comparison of the two methods of corticosteroid (triamcinolone) use in reducing supratip edema (pollybeak deformity) after rhinoplasty. METHODS Ninety patients who were candidates for rhinoplasty were randomly divided into three groups. Group A received no treatment, group B received 8 mg/mL of triamcinolone, and group C received 16 mg/mL of triamcinolone. Their effects on dorsal edema were evaluated by using the patients' and surgeons' visual analog scale scores. Also, dorsal edema was measured by using photo editing software. RESULTS There was no significant difference in the patients' characteristics in the study groups. The surgeons' visual analog scale scores were significantly better in those patients who received triamcinolone injection than in the control group (p = 0.02). However, none of the other assessment methods showed significant differences among the study groups. There was no significant difference between the two evaluated concentrations. CONCLUSION Triamcinolone injection had positive temporary effects on reducing supratip edema without any important complications.
Collapse
Affiliation(s)
- Babak Saedi
- Otolaryngology Department, Tehran University of Medical Sciences, Tehran, Iran
| | | | | |
Collapse
|
6
|
Venoplant Effect in the Management of the Post-operative Oedema in Plastic Surgery: Results of a Randomized and Controlled Clinical Trial. Aesthetic Plast Surg 2018; 42:877-885. [PMID: 29508020 PMCID: PMC5945761 DOI: 10.1007/s00266-018-1108-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 02/06/2018] [Indexed: 12/02/2022]
Abstract
Background Post-operative oedema and ecchymosis represent early post-operative complications, impacting negatively on the final aesthetic outcome of each surgical procedure. In particular, such complications are very frustrating for patients and—sometimes—are difficult to be managed by surgeons. Several strategies are available for managing oedema, although some side effects have been reported. A new promising compound for the management of oedema is Venoplant, and this study aims to assess its effectiveness in decreasing post-operative oedema. Methods Patients were randomly allocated for receiving three different treatments: (1) Venoplant tablets and Venoplant gel; (2) only Venoplant tablets; and (3) not treated with Venoplant. The aesthetical outcome has been evaluated using the Global Aesthetic Improvement Scale (GAIS), compiled by both patient and clinician. The GAIS scale was administered several times: the day following the surgical procedure (T0) after 3 days (T1), after 7 days (T2), after 15 days (T3) and after 1 month (T4). Results Forty-three patients participated in the study. According to patient’s evaluations, at T0 in Group 1 and in Group 2 a significant statistical difference was found compared to the control group (p < 0.001 and p < 0.05, respectively). Over time, a significant reduction in swelling and ecchymosis was reported by patients treated with Venoplant (tablets alone or in combination with gel) compared to the control group. According to the physician’s assessment, during the different time points of evaluation, a significant reduction in post-operative oedema in Group 1 and in Group 2 compared to the control group was found. Conclusion Venoplant represents a valid therapeutic strategy for the management of post-operative oedema, guaranteeing a good level of patient satisfaction, in the absence of common side effects which are often associated with other therapies. Level of Evidence I This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
Collapse
|
7
|
Ishii LE, Tollefson TT, Basura GJ, Rosenfeld RM, Abramson PJ, Chaiet SR, Davis KS, Doghramji K, Farrior EH, Finestone SA, Ishman SL, Murphy RX, Park JG, Setzen M, Strike DJ, Walsh SA, Warner JP, Nnacheta LC. Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty. Otolaryngol Head Neck Surg 2017; 156:S1-S30. [PMID: 28145823 DOI: 10.1177/0194599816683153] [Citation(s) in RCA: 57] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Objective Rhinoplasty, a surgical procedure that alters the shape or appearance of the nose while preserving or enhancing the nasal airway, ranks among the most commonly performed cosmetic procedures in the United States, with >200,000 procedures reported in 2014. While it is difficult to calculate the exact economic burden incurred by rhinoplasty patients following surgery with or without complications, the average rhinoplasty procedure typically exceeds $4000. The costs incurred due to complications, infections, or revision surgery may include the cost of long-term antibiotics, hospitalization, or lost revenue from hours/days of missed work. The resultant psychological impact of rhinoplasty can also be significant. Furthermore, the health care burden from psychological pressures of nasal deformities/aesthetic shortcomings, surgical infections, surgical pain, side effects from antibiotics, and nasal packing materials must also be considered for these patients. Prior to this guideline, limited literature existed on standard care considerations for pre- and postsurgical management and for standard surgical practice to ensure optimal outcomes for patients undergoing rhinoplasty. The impetus for this guideline is to utilize current evidence-based medicine practices and data to build unanimity regarding the peri- and postoperative strategies to maximize patient safety and to optimize surgical results for patients. Purpose The primary purpose of this guideline is to provide evidence-based recommendations for clinicians who either perform rhinoplasty or are involved in the care of a rhinoplasty candidate, as well as to optimize patient care, promote effective diagnosis and therapy, and reduce harmful or unnecessary variations in care. The target audience is any clinician or individual, in any setting, involved in the management of these patients. The target patient population is all patients aged ≥15 years. The guideline is intended to focus on knowledge gaps, practice variations, and clinical concerns associated with this surgical procedure; it is not intended to be a comprehensive reference for improving nasal form and function after rhinoplasty. Recommendations in this guideline concerning education and counseling to the patient are also intended to include the caregiver if the patient is <18 years of age. Action Statements The Guideline Development Group made the following recommendations: (1) Clinicians should ask all patients seeking rhinoplasty about their motivations for surgery and their expectations for outcomes, should provide feedback on whether those expectations are a realistic goal of surgery, and should document this discussion in the medical record. (2) Clinicians should assess rhinoplasty candidates for comorbid conditions that could modify or contraindicate surgery, including obstructive sleep apnea, body dysmorphic disorder, bleeding disorders, or chronic use of topical vasoconstrictive intranasal drugs. (3) The surgeon, or the surgeon's designee, should evaluate the rhinoplasty candidate for nasal airway obstruction during the preoperative assessment. (4) The surgeon, or the surgeon's designee, should educate rhinoplasty candidates regarding what to expect after surgery, how surgery might affect the ability to breathe through the nose, potential complications of surgery, and the possible need for future nasal surgery. (5) The clinician, or the clinician's designee, should counsel rhinoplasty candidates with documented obstructive sleep apnea about the impact of surgery on nasal airway obstruction and how obstructive sleep apnea might affect perioperative management. (6) The surgeon, or the surgeon's designee, should educate rhinoplasty patients before surgery about strategies to manage discomfort after surgery. (7) Clinicians should document patients' satisfaction with their nasal appearance and with their nasal function at a minimum of 12 months after rhinoplasty. The Guideline Development Group made recommendations against certain actions: (1) When a surgeon, or the surgeon's designee, chooses to administer perioperative antibiotics for rhinoplasty, he or she should not routinely prescribe antibiotic therapy for a duration >24 hours after surgery. (2) Surgeons should not routinely place packing in the nasal cavity of rhinoplasty patients (with or without septoplasty) at the conclusion of surgery. The panel group made the following statement an option: (1) The surgeon, or the surgeon's designee, may administer perioperative systemic steroids to the rhinoplasty patient.
Collapse
Affiliation(s)
- Lisa E Ishii
- 1 Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | - Travis T Tollefson
- 2 University of California Davis Medical Center, Sacramento, California, USA
| | - Gregory J Basura
- 3 University of Michigan Medical Center, Taubman Center, Ann Arbor, Michigan, USA
| | | | | | - Scott R Chaiet
- 6 The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kara S Davis
- 7 Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Karl Doghramji
- 8 Jefferson Sleep Disorder Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Edward H Farrior
- 9 Farrior Facial Plastic and Cosmetic Surgery, Tampa, Florida, USA
| | | | - Stacey L Ishman
- 11 Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Robert X Murphy
- 12 Lehigh Valley Health Network, Bethlehem, Pennsylvania, USA
| | - John G Park
- 13 Mayo Clinic Center for Sleep Medicine, Rochester, Minnesota, USA
| | - Michael Setzen
- 14 New York University School of Medicine, New York, New York, USA
| | - Deborah J Strike
- 15 Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Sandra A Walsh
- 10 Consumers United for Evidence-Based Healthcare, Fredericton, Canada
| | - Jeremy P Warner
- 16 Division Plastic and Reconstructive Surgery, Northshore University Health System, Northbrook, Illinois, USA
| | - Lorraine C Nnacheta
- 17 Department of Research and Quality, American Academy of Otolaryngology-Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| |
Collapse
|
8
|
Ishii LE, Tollefson TT, Basura GJ, Rosenfeld RM, Abramson PJ, Chaiet SR, Davis KS, Doghramji K, Farrior EH, Finestone SA, Ishman SL, Murphy RX, Park JG, Setzen M, Strike DJ, Walsh SA, Warner JP, Nnacheta LC. Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty Executive Summary. Otolaryngol Head Neck Surg 2017; 156:205-219. [DOI: 10.1177/0194599816683156] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Lisa E. Ishii
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Gregory J. Basura
- University of Michigan Medical Center, Taubman Center, Ann Arbor, Michigan, USA
| | | | | | - Scott R. Chaiet
- The University of Tennessee Health Science Center, Memphis, Tennessee, USA
| | - Kara S. Davis
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - Karl Doghramji
- Jefferson Sleep Disorder Center, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | | | | | - Stacey L. Ishman
- Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio, USA
| | | | - John G. Park
- Mayo Clinic Center for Sleep Medicine, Rochester, Minnesota, USA
| | - Michael Setzen
- New York University School of Medicine, New York, New York, USA
| | - Deborah J. Strike
- Department of Otolaryngology–Head and Neck Surgery, University of Iowa Hospital and Clinics, Iowa City, Iowa, USA
| | - Sandra A. Walsh
- Consumers United for Evidence-Based Healthcare, Fredericton, Canada
| | - Jeremy P. Warner
- Division Plastic and Reconstructive Surgery, Northshore University Health System, Northbrook, Illinois, USA
| | - Lorraine C. Nnacheta
- Department of Research and Quality, American Academy of Otolaryngology—Head and Neck Surgery Foundation, Alexandria, Virginia, USA
| |
Collapse
|
9
|
Kizilcik N, Bilgen S, Menda F, Türe H, Aydın B, Kaspar EC, Koner O. Comparison of Dexamethasone-Dimenhydrinate and Dexamethasone-Ondansetron in Prevention of Nausea and Vomiting in Postoperative Patients. Aesthetic Plast Surg 2017; 41:204-210. [PMID: 28039501 DOI: 10.1007/s00266-016-0772-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2016] [Accepted: 10/31/2016] [Indexed: 01/03/2023]
Abstract
INTRODUCTION Postoperative Nausea and Vomiting is one of the most common problems after implementation of general anesthesia. The incidence can reach 80% in high-risk patients, depending on the type of surgery. In our study, we aimed to compare dexamethasone-dimenhydrinate and dexamethasone-ondansetron combinations in prevention of nausea and vomiting in postoperative patients. METHOD Sixty 18-65-year-olds ASAI-II females who underwent rhinoplasty were included in the study. Patients were randomly included in two groups: Dexamethasone-dimenhydrinate group (group DD) and dexamethasone-ondansetron group (group DO). All patients received dexamethasone 8 mg iv after endotracheal intubation. Anesthesia continuation was established with sevoflurane, air-oxygen mixture and remifentanil infusion. At the 30th minute of the operation, group DO received ondansetron 4 mg iv and group DD received dimenhydrinate 1 mg/kg iv. For postoperative analgesia tramadol (1.5 mg/kg) iv, tenoksikam (20 mg) and afterward for postoperative patient-controlled tramadol was used. In the postoperative recovery room, nausea and vomiting were evaluated at the 30th, 60th, 120th minutes and at the end of 24 h. Total amount of tramadol was recorded. All results were statistically evaluated. OBSERVATIONS Demographics and Apfel risk scores of both groups were similar. Surgical operation duration (p = 0.038) and total preoperative remifentanil consumption were higher in group DD (p = 0.006). In group DO, nausea at 30 and 60 min (p = 0.001, p = 0.007), retching at 30 and 60 min (p = 0.002, p = 0.006) were higher than group DD. The additional antiemetic need in group DO was significantly higher at 30 min (p = 0.001). Postoperative analgesic consumption was similar in both groups. RESULT Our study revealed that dexamethasone-dimenhydrinate combination was more effective than dexamethasone-ondansetron in prevention of nausea and vomiting after rhinoplasty operations. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
Collapse
Affiliation(s)
- Nurcan Kizilcik
- Department of Anesthesiology and Reanimation, Yeditepe University School of Medicine, Istanbul, Turkey.
| | - Sevgi Bilgen
- Department of Anesthesiology and Reanimation, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Ferdi Menda
- Department of Anesthesiology and Reanimation, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Hatice Türe
- Department of Anesthesiology and Reanimation, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Bilgehan Aydın
- Department of Aesthetic and Plastic Surgery, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Elif Cigdem Kaspar
- Department of Biostatistics, Yeditepe University School of Medicine, Istanbul, Turkey
| | - Ozge Koner
- Department of Anesthesiology and Reanimation, Yeditepe University School of Medicine, Istanbul, Turkey
| |
Collapse
|
10
|
Coroneos CJ, Voineskos SH, Cook DJ, Farrokyar F, Thoma A. Perioperative Corticosteroids Reduce Short-Term Edema and Ecchymosis in Rhinoplasty: A Meta-Analysis. Aesthet Surg J 2016; 36:136-46. [PMID: 26773090 DOI: 10.1093/asj/sjv138] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND A number of randomized controlled trials (RCTs) have investigated the role of perioperative corticosteroids in rhinoplasty. Each of these trials however has an insufficient sample sizes to reach definitive conclusions and detect harms. Three recent reviews have analyzed edema and ecchymosis outcomes following rhinoplasty; each arrived at a different conclusion and recommendation. OBJECTIVE To estimate the effectiveness of systemic perioperative corticosteroid treatment compared to placebo for clinical outcomes in rhinoplasty using a methodologically rigorous meta-analysis. METHODS Electronic databases were searched without language restriction. Included trials were randomized controlled trials of systemic perioperative corticosteroid treatment vs placebo in rhinoplasty evaluating at least one of: edema, ecchymosis, bleeding, cosmetic outcome, and patient satisfaction. The Cochrane risk of bias tool was applied to included trials, and the quality of evidence for each outcome was assessed using the GRADE approach. RESULTS Analyses included 336 patients from eight trials. Perioperative corticosteroids reduced the worst edema (SMD: -1.03, 95%CI -1.30 to -0.76, P < .001) and ecchymosis (SMD: -0.78, 95%CI -1.09 to 0.47, P < .001) after rhinoplasty. At one day postoperative, a single dose of perioperative corticosteroid reduced edema (SMD -1.15, 95%CI -1.42 to -0.87, P < .001) and ecchymosis (SMD -0.79, 95%CI -1.05 to -0.52, P < .001). No clinical benefit in edema or ecchymosis was found seven days postoperatively, nor did intraoperative bleeding increase. CONCLUSIONS There is high quality evidence to support perioperative systemic corticosteroid treatment in rhinoplasty to reduce short-term edema and ecchymosis without increased intraoperative bleeding. These findings are not present at seven days. For future trials, we suggest evaluation of patient satisfaction, and correlation with long-term cosmetic outcome. LEVEL OF EVIDENCE 2: Therapeutic.
Collapse
Affiliation(s)
- Christopher J Coroneos
- Drs Coroneos and Voineskos are Residents, Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Dr Cook is a Professor, Department of Medicine, Academic Chair, Critical Care Medicine, and Associate Member, Department of Clinical Epidemiology and Biostatistics. Drs Farrokyar and Thoma are Clinical Professors, Department of Surgery, and Associate Members, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. Dr Thoma is also Evidence-Based Medicine Section Co-editor for Aesthetic Surgery Journal
| | - Sophocles H Voineskos
- Drs Coroneos and Voineskos are Residents, Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Dr Cook is a Professor, Department of Medicine, Academic Chair, Critical Care Medicine, and Associate Member, Department of Clinical Epidemiology and Biostatistics. Drs Farrokyar and Thoma are Clinical Professors, Department of Surgery, and Associate Members, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. Dr Thoma is also Evidence-Based Medicine Section Co-editor for Aesthetic Surgery Journal
| | - Deborah J Cook
- Drs Coroneos and Voineskos are Residents, Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Dr Cook is a Professor, Department of Medicine, Academic Chair, Critical Care Medicine, and Associate Member, Department of Clinical Epidemiology and Biostatistics. Drs Farrokyar and Thoma are Clinical Professors, Department of Surgery, and Associate Members, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. Dr Thoma is also Evidence-Based Medicine Section Co-editor for Aesthetic Surgery Journal
| | - Forough Farrokyar
- Drs Coroneos and Voineskos are Residents, Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Dr Cook is a Professor, Department of Medicine, Academic Chair, Critical Care Medicine, and Associate Member, Department of Clinical Epidemiology and Biostatistics. Drs Farrokyar and Thoma are Clinical Professors, Department of Surgery, and Associate Members, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. Dr Thoma is also Evidence-Based Medicine Section Co-editor for Aesthetic Surgery Journal
| | - Achilleas Thoma
- Drs Coroneos and Voineskos are Residents, Division of Plastic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada. Dr Cook is a Professor, Department of Medicine, Academic Chair, Critical Care Medicine, and Associate Member, Department of Clinical Epidemiology and Biostatistics. Drs Farrokyar and Thoma are Clinical Professors, Department of Surgery, and Associate Members, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada. Dr Thoma is also Evidence-Based Medicine Section Co-editor for Aesthetic Surgery Journal
| |
Collapse
|
11
|
Valente DS, Steffen N, Carvalho LA, Borille GB, Zanella RK, Padoin AV. Preoperative Use of Dexamethasone in Rhinoplasty. JAMA FACIAL PLAST SU 2015; 17:169-73. [DOI: 10.1001/jamafacial.2014.1574] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Denis S. Valente
- Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Niveo Steffen
- Division of Plastic Surgery, Santa Casa Hospital, Porto Alegre, Brazil
| | - Lauro A. Carvalho
- Division of Plastic Surgery, Santa Casa Hospital, Porto Alegre, Brazil
| | | | - Rafaela K. Zanella
- Division of Dermatologic Surgery, Mãe de Deus Health System, Porto Alegre, Brazil
| | | |
Collapse
|
12
|
|
13
|
Hwang SH, Lee JH, Kim BG, Kim SW, Kang JM. The efficacy of steroids for edema and ecchymosis after Rhinoplasty: A meta-analysis. Laryngoscope 2014; 125:92-8. [DOI: 10.1002/lary.24883] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 07/14/2014] [Accepted: 07/18/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Se H. Hwang
- Department of Otolaryngology-Head and Neck Surgery; The Catholic University of Korea, College of Medicine; Seoul Korea
| | - Joo H. Lee
- Department of Otolaryngology-Head and Neck Surgery; The Catholic University of Korea, College of Medicine; Seoul Korea
| | - Byung G. Kim
- Department of Otolaryngology-Head and Neck Surgery; The Catholic University of Korea, College of Medicine; Seoul Korea
| | - Soo W. Kim
- Department of Otolaryngology-Head and Neck Surgery; The Catholic University of Korea, College of Medicine; Seoul Korea
| | - Jun M. Kang
- Department of Otolaryngology-Head and Neck Surgery; The Catholic University of Korea, College of Medicine; Seoul Korea
| |
Collapse
|
14
|
da Silva EMK, Hochman B, Ferreira LM. Perioperative corticosteroids for preventing complications following facial plastic surgery. Cochrane Database Syst Rev 2014; 2014:CD009697. [PMID: 24887069 PMCID: PMC11069365 DOI: 10.1002/14651858.cd009697.pub2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Early recovery is an important factor for people undergoing facial plastic surgery. However, the normal inflammatory processes that are a consequence of surgery commonly cause oedema (swelling) and ecchymosis (bruising), which are undesirable complications. Severe oedema and ecchymosis delay full recovery, and may make patients dissatisfied with procedures. Perioperative corticosteroids have been used in facial plastic surgery with the aim of preventing oedema and ecchymosis. OBJECTIVES To determine the effects, including safety, of perioperative administration of corticosteroids for preventing complications following facial plastic surgery in adults. SEARCH METHODS In January 2014, we searched the following electronic databases: the Cochrane Wounds Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid Embase; EBSCO CINAHL; and Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS). There were no restrictions on the basis of date or language of publication. SELECTION CRITERIA We included RCTs that compared the administration of perioperative systemic corticosteroids with another intervention, no intervention or placebo in facial plastic surgery. DATA COLLECTION AND ANALYSIS Two review authors independently screened the trials for inclusion in the review, appraised trial quality and extracted data. MAIN RESULTS We included 10 trials, with a total of 422 participants, that addressed two of the outcomes of interest to this review: swelling (oedema) and bruising (ecchymosis). Nine studies on rhinoplasty used a variety of different types, and doses, of corticosteroids. Overall, the results of the included studies showed that there is some evidence that perioperative administration of corticosteroids decreases formation of oedema over the first two postoperative days. Meta-analysis was only possible for two studies, with a total of 60 participants, and showed that a single perioperative dose of 10 mg dexamethasone decreased oedema formation in the first two days after surgery (SMD = -1.16, 95% CI: -1.71 to -0.61, low quality evidence). The evidence for ecchymosis was less consistent across the studies, with some contradictory results, but overall there was some evidence that perioperatively administered corticosteroids decreased ecchymosis formation over the first two days after surgery (SMD = -1.06, 95% CI:-1.47 to -0.65, two studies, 60 participants, low quality evidence ). The difference was not maintained after this initial period. One study, with 40 participants, showed that high doses of methylprednisolone (over 250 mg) decreased both ecchymosis and oedema between the first and seventh postoperative days. The only study that assessed facelift surgery identified no positive effect on oedema with preoperative administration of corticosteroids. Five trials did not report on harmful (adverse) effects; four trials reported that there were no adverse effects; and one trial reported adverse effects in two participants treated with corticosteroids as well as in four participants treated with placebo. None of the studies reported recovery time, patient satisfaction or quality of life. The studies included were all at an unclear risk of selection bias and at low risk of bias for other domains. AUTHORS' CONCLUSIONS There is limited evidence for rhinoplasty that a single perioperative dose of corticosteroids decreases oedema and ecchymosis formation over the first two postoperative days, but the difference is not maintained after this period. There is also limited evidence that high doses of corticosteroids decrease both ecchymosis and oedema between the first and seventh postoperative days. The clinical significance of this decrease is unknown and there is little evidence available regarding the safety of this intervention. More studies are needed because at present the available evidence does not support the use of corticosteroids for prevention of complications following facial plastic surgery.
Collapse
Affiliation(s)
- Edina MK da Silva
- Universidade Federal de São PauloEmergency Medicine and Evidence Based MedicineRua Borges Lagoa 564 cj 64Vl. ClementinoSão PauloSão PauloBrazil04038‐000
| | - Bernardo Hochman
- Universidade Federal de São PauloDepartment of SurgerySão PauloBrazil
| | - Lydia M Ferreira
- Universidade Federal de São Paulo (UNIFESP)Department of SurgeryRua Botucatu 59114o floorSao PauloSao Paulo SPBrazil04023062
| | | |
Collapse
|
15
|
Gutierrez S, Wuesthoff C. Testing the effects of long-acting steroids in edema and ecchymosis after closed rhinoplasty. Plast Surg (Oakv) 2014. [DOI: 10.1177/229255031402200213] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Santiago Gutierrez
- Otolaryngology and Maxillofacial Surgery Department, San Ignacio University Hospital – Pontificia Universidad Javeriana, Bogotá, Colombia
| | - Carolina Wuesthoff
- Otolaryngology and Maxillofacial Surgery Department, San Ignacio University Hospital – Pontificia Universidad Javeriana, Bogotá, Colombia
- University of Toronto Health Network, Toronto, Ontario
| |
Collapse
|
16
|
|
17
|
|