Effect of periosteum elevation on periorbital ecchymosis in rhinoplasty

Alarfaj, Ahmed; Al-Qattan, M. M.; Alharethy, Sami; Alzahrani, Khalid J.

doi:10.1016/j.bjps.2008.05.047

Cited by 27 publications

(30 citation statements)

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“…The addition of SPT prior to osteotomies is controversial. Few studies 3,4,6 in the literature have evaluated the effect of this surgical maneuver on postoperative ecchymosis and edema, with most studies showing conflicting evidence. 3,4,6 Our study did not demonstrate any clinically significant differences in ecchymosis or edema between the SPT and non-SPT sides on postoperative days 2 and 7.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Ecchymosis and Edema After Creation of Subperiosteal Tunnels in Rhinoplasty

Chan

Roskies

Jooya

et al. 2019

JAMA Facial Plast Surg

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and edema are commonly associated with rhinoplasty and are the principal limiting factors for return to daily activities after rhinoplasty. Several methods have been evaluated to minimize these sequelae including creation of subperiosteal tunnels, which involves elevating the vascular periosteal layer, preserving it from trauma when creating osteotomies.OBJECTIVE To assess the efficacy of the creation of subperiosteal tunnels prior to lateral osteotomies during rhinoplasty for reducing postoperative ecchymosis and edema. DESIGN, SETTING, AND PARTICIPANTSA randomized, blinded, matched-paired, prospective, clinical trial took place between April 1 and August 30, 2015, in a private practice in a stand-alone clinic and surgical center. All patients who were undergoing aesthetic rhinoplasty requiring bilateral lateral osteotomies were offered inclusion in the trial. All 34 enrolled patients completed the follow-up requirements.INTERVENTION Creation of subperiosteal tunnels prior to lateral osteotomies on 1 randomly selected side.MAIN OUTCOMES AND MEASURES Three blinded evaluators independently graded the degree of ecchymosis and edema on a visual analog scale of 0 to 10 on each side of the nose on postoperative days 2 and 7. Each patient had 1 side that was randomly selected to undergo creation of subperiosteal tunnels. A difference in mean score between sides of the nose was calculated for each patient using a paired t test. RESULTSOf the 34 patients (28 females and 6 males; mean [SD] age, 27.3 [9.2]), the mean (SD) difference in ecchymosis scores between sides on day 2 was -0.05 (1.94) (95% CI, -0.43 to 0.33) and on day 7 was -0.22 (1.23) (95% CI, -0.47 to 0.02), favoring the side without tunnels. The mean (SD) difference in edema scores on day 2 was -0.21 (1.66) (95% CI, 0.53-0.12) and on day 7 was -0.29 (1.11) (95% CI, -0.51 to -0.07). There were no clinically significant differences between sides in terms of postoperative ecchymosis and edema. CONCLUSIONS AND RELEVANCEEcchymosis and edema can have significant postoperative practical, emotional, and financial effects on patients. Creation of subperiosteal tunnels prior to lateral osteotomies showed no clinically significant differences in edema and ecchymosis after the procedure.LEVEL OF EVIDENCE 1.

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Section: Discussionmentioning

confidence: 99%

Postoperative Ecchymosis and Edema After Creation of Subperiosteal Tunnels in Rhinoplasty

Chan

Roskies

Jooya

et al. 2019

JAMA Facial Plast Surg

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“…Factors that may exacerbate edema and ecchymosis include high osteotomy placement, vigorous rasping of nasal bones and using excessively large or blunt osteotomes [12, 13]. Many technical measures can be instituted to decrease the incidence and severity of post-operative edema and ecchymosis; these include the use of sharp small osteotomes [12, 14], preservation of the periosteal attachment [7], cold compresses [10], and the possible use of a looped drainage tube [15]. In addition, administration of perioperative steroids [9, 16] and remifentanil with controlled hypotension may further contribute to lessen periorbital edema and ecchymosis [17].…”

Section: Discussionmentioning

confidence: 99%

“…Multiple studies have attempted to address periorbital ecchymosis by modifying surgical techniques, using anti-inflammatory agents such as steroids, using cold compresses, etc. [7–11]. …”

Section: Introductionmentioning

confidence: 99%

The use of nasal packing post rhinoplasty: Does it increase periorbital ecchymosis? A prospective study

Arfaj

2015

Journal of Otolaryngology - Head & Neck Surgery

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BackgroundPeriorbital edema and ecchymosis following rhinoplasty is disturbing for both the patients and their surgeons. The study aim was to determine whether nasal packing after lateral osteotomies in rhinoplasty surgery increases the risk of periorbital ecchymosis post-operatively.MethodsThis was a prospective self-controlled single-blinded study. Seventy four patients who underwent rhinoplasty with bilateral lateral osteotomies by a single surgeon were enrolled in the study. Nasal cavity packing for one side was done while the other side was left unpacked. Periorbital ecchymosis was evaluated by the operating surgeon and a separate surgeon who is unaware of the packing side separately on the first, fourth and seventh day post-operatively. A 4-grade scale was utilized to assess the ecchymosis with grade 4 being the most severe.ResultsNasal packing was found to significantly increase the severity and duration of periorbital ecchymosis post rhinoplasty. While no difference was observed between the packed and unpacked sides on the first post-operative day, significant difference was noted on the 4th day (mean score 2.36 and 1.15 for the packed and unpacked sides, respectively) and on the 7th day after surgery in favor of the unpacked side (score 1.24 and 0.61 for the packed and unpacked sides, respectively).ConclusionWe advise against the routine use of nasal packing in rhinoplasty unless necessary as it contributes to worsen the periorbital ecchymosis from lateral osteotomies and thereby increases the patients’ “down time” after surgery.

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“…Creating subperiosteal tunnels before lateral osteotomy was found to increase periorbital ecchymosis on the second postoperative day, and the preservation of the periosteal attachment has been suggested. 37,38 In a study including a larger number of patients, no difference in swelling and bruising after osteotomies using a 2-mm osteotome or a piezoelectric device was found when the nasal soft tissues had been elevated in a subperiosteal plane on both sides. 39 Other authors considered the osteotomy with a piezo instrument less traumatic compared with conventional osteotomies, despite wide subperiosteal undermining.…”

Section: Subperiosteal Elevation and Piezoelectric Osteotomymentioning

confidence: 93%

Reducing Periorbital Edema and Ecchymosis after Rhinoplasty: Literature Review and Personal Approach

Tasman

2018

Facial plast Surg

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Postoperative periorbital edema and ecchymosis are most bothersome to rhinoplasty patients. The degree of swelling and bruising is influenced by several factors, and numerous prophylactic and therapeutic measures have been described in the literature. This article reviews the current literature and concludes with the author's suggestions on how to best minimize postoperative periorbital edema and ecchymosis.

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Effect of periosteum elevation on periorbital ecchymosis in rhinoplasty

Cited by 27 publications

References 1 publication

Postoperative Ecchymosis and Edema After Creation of Subperiosteal Tunnels in Rhinoplasty

Postoperative Ecchymosis and Edema After Creation of Subperiosteal Tunnels in Rhinoplasty

The use of nasal packing post rhinoplasty: Does it increase periorbital ecchymosis? A prospective study

Reducing Periorbital Edema and Ecchymosis after Rhinoplasty: Literature Review and Personal Approach

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