Effects of Periosteal Elevation Before Lateral Osteotomy in Rhinoplasty: A Meta-Analysis of Randomized Controlled Trials

Abstract

Objectives. Although osteotomy is an important part of rhinoplasty, it is known to be closely related to postoperative eyelid edema and ecchymosis. We aimed to evaluate the effects of periosteal elevation prior to osteotomy on eyelid edema and ecchymosis.Methods. Two authors reviewed studies in the Medline, Scopus, and Cochrane databases published through May 2019. Randomized controlled trials comparing periosteal elevation (subperiosteal tunneling) with periosteal preservation that reported eyelid edema or ecchymosis or subconjunctival hemorrhage as outcomes of interest were included. From each study, the baseline characteristics of the study subjects, the quality of the study, the number of patients in the treatment and control groups, and outcomes were extracted.Results. Data for meta-analysis were identified in six studies with a total of 208 patients. Eyelid ecchymosis and edema within 3 days postoperatively were significantly more common in the periosteal elevation group than in the preservation group, although such an association was not found for edema on postoperative day 7 (standardized mean difference [SMD], 0.21; 95% confidence interval [CI], –0.09 to 0.50; I<sup>2</sup> =0%). There was no significant difference in subconjunctival hemorrhage on day 1 (SMD, 0.31; 95% CI, –0.09 to 0.72; I<sup>2</sup> =0%).Conclusion. Periosteal preservation during lateral osteotomy may reduce eyelid edema and ecchymosis compared to periosteal elevation. Further studies with rigorous research methods should be carried out to determine the effectiveness of different techniques in lateral osteotomy.

Subperiosteal Tunneling in Lateral Osteotomy: Truth Versus Mere Facts

“…In a recent meta-analysis published in Clinical and Experimental Otorhinolaryngology, Kim et al [1] reviewed six selected articles and concluded that osteotomy without periosteal tunneling is associated with less periorbital ecchymosis and edema than osteotomy with periosteal tunneling. The authors [1] used the term "periosteal preservation" to indicate the absence of periosteal tunneling, but in fact, the osteotome eventually shears the periosteum during osteotomy when 4-mm or 6-mm osteotomes are used.…”