Practice Patterns in the Perioperative Treatment of Patients Undergoing Septorhinoplasty

Shadfar, Scott; Deal, Allison M.; Jarchow, Andrea M.; Yang, Hojin; Shockley, W.

doi:10.1001/jamafacial.2013.2050

Cited by 18 publications

(18 citation statements)

References 35 publications

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“…Despite being unnecessary for most cases [19], nearly one third of rhinoplasty surgeons continue to regularly employ packing following rhinoplasty [20, 21]. Kara et al reported subconjunctival ecchymosis following rhinoplasty in almost 20 % of their patients, whom were packed bilaterally for a couple of days [22].…”

Section: Discussionmentioning

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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Section: Discussionmentioning

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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“… 13 , 15 The potential for complications, including postoperative infections and toxic shock syndrome (TSS), following rhinoplasty motivates surgeons to administer prophylactic antibiotics. 6 , 16 , 17 Data support the abstinence of antibiotic use in patients undergoing septal surgery; however, conflicting evidence exists for the rhinoplasty population. 18 – 20 …”

Section: Role Of Perioperative Antibioticsmentioning

confidence: 99%

The More the Merrier? Should Antibiotics be Used for Rhinoplasty and Septorhinoplasty?—A Review

Kullar

Frisenda

Nassif

2018

Plastic and Reconstructive Surgery - Global Open

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Background:With antimicrobial resistance a global threat, optimizing antibiotic usage across the surgical continuum is vital. The American Academy of Otolaryngology—Head and Neck Surgery Foundation recently published the first guidelines addressing management in rhinoplasty. The authors reviewed pertinent literature on the role of systemic antibiotics in rhinoplasty and septorhinoplasty.Methods:The authors performed a MEDLINE search through PubMed using the key terms rhinoplasty, septorhinoplasty, infection, antimicrobials, and antibiotics.Results:Ten studies met criteria. Studies evaluating antibiotics perioperatively showed similar infection and/or bacteremia rates (0–13.3%) in those receiving or not receiving antibiotics. No patients experienced significant local/systemic infections regardless of antibiotic use. In the 3 studies evaluating antibiotics postoperatively, antibiotics decreased the infection rate from 27% to 8% in complex revision cases. In a study evaluating postoperative antibiotics in noncomplex cases, there were no significant differences in infection rates between those receiving only a preoperative dose and those receiving preoperative in addition to 7 days of postoperative antibiotics, with the latter experiencing higher rates of antibiotic-related adverse events and costs.Conclusions:Peri- and postoperative antibiotics in noncomplex rhinoplasty and septorhinoplasty are not beneficial in decreasing infection risk. Antibiotics, with a first-generation cephalosporin such as cefazolin (non–β-lactam, such as clindamycin, if β-lactam allergy), should be considered in patients with comorbidities/undergoing complex surgery. If perioperative antibiotics are used, antibiotics should be administered within 1 hour of incision and discontinued within 24 hours of the operation. Further research is warranted to evaluate the optimal duration of postoperative antibiotics in complex cases.

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“…[2][3][4] In the vast majority of cases, external nasal splints are routinely used as part of the postprocedural care in patients who undergo rhinoplasty and nasal fracture reduction procedures. 3,[5][6][7][8][9][10][11][12] The external nasal splint is considered an integral component of rhinoplasty and nasal fracture reduction procedural aftercare and has numerous functions. During the healing period, it is important to maintain the corrected anatomy in the intended position with appropriate stabilization and immobilization.…”

Section: Introductionmentioning

confidence: 99%

A Novel External Nasal Splint

2018

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Every year, hundreds of thousands of individuals suffer from nasal bone fractures, and in 2016, more than 780 000 rhinoplasty surgeries were performed globally. As part of the comprehensive care for these patients, external nasal splints are routinely used during the healing process. Nasal splints stabilize the bony and cartilaginous nasal framework and provide compression to the nose, thereby reducing nasal edema and hastening recovery. In this article, we present a novel external nasal splint that addresses some of the shortcomings of other commercially available nasal splints.

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Practice Patterns in the Perioperative Treatment of Patients Undergoing Septorhinoplasty

Cited by 18 publications

References 35 publications

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

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

The More the Merrier? Should Antibiotics be Used for Rhinoplasty and Septorhinoplasty?—A Review

A Novel External Nasal Splint

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