Role of Corticosteroids in Reduction of Post-Operative Oedema in Craniofaciomaxillary Surgery

Abstract

Postoperative oedema and ecchymosis are common complaints following facial plastic surgical procedures. The resulting oedema and ecchymosis is socially disturbing and sometimes frightening for the patient. Serious consequences of oedema include airway obstruction, conjunctival chemosis with possible transient loss of vision and pain. Perioperative administration of steroids has been used in Craniofaciomaxillary procedures with a belief that it reduces postoperative swelling and shortens time to recovery after surgery. Various perioperative regimens of systemic corticosteroid administration have been reported to result in a significant reduction in postoperative facial oedema following cranioplasty, orbital floor exploration, mandibular and maxillary osteotomy, facial plasty, hair transplant and rhinoplasty. A number of experimental animal studies have demonstrated decreased oedema in flap models or replants. However, several clinical studies evaluating the use of steroids perioperatively in a variety of orthognathic and facial surgical procedures have failed to provide concrete evidence for or against steroid usage. Proponents of steroid use (Nordstrom et al, Flood et al and Gurlek et al) claim, it decreases postoperative oedema, decreases ecchymosis, improves surgical outcome, reduces home convalescence, decreases hospital stay and causes euphoria. Opponents of steroid use (Munro et al, Rapaport et al, and Owsley et al) claim lack of evidence, serious complications like inhibition of Hypothalamic Pituitary-Adrenal axis, avascular necrosis of hip and humerus, alter blood sugar levels, increased risk of hypertension, increase in the incidence of wound infection and lack of cost effectiveness. A prospective double-blind study conducted to evaluate the role of Dexamethasone 8 mg intravenous administration and Triamcinolone 0.7 mg/kg administration at the end of procedure in reduction of postoperative facial oedema in Craniofaciomaxillary surgeries. Thirty-four consecutive patients were randomized to Dexamethasone, Triamcinolone administration and control group. Facial size was measured on POD1, POD2 and POD3. Facial oedema scores were derived from comparison of photographs on admission and 48 hrs. postoperatively. Findings were tabulated and statistically analysed. Following observations were noted. The duration of surgery and postoperative facial oedema did not correlate. We found that oedema was maximum in the periorbital region in all the three groups followed by oedema on forehead, malar and mandibular regions. We also observed that there was direct correlation between forehead and periorbital oedema. We observed that there was postoperative facial oedema on POD1, reached its peak on POD2 and then started declining within each group. The use of steroids either intravenous (8 mg Dexamethasone) or local infiltration (Triamcinolone 0.7 mg/kg) did not significantly reduce the postoperative facial oedema in our patient when compared to the control.