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

Abstract

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.

Is Nasal Skin Thickness a Prognostic Indicator to Postoperative Edema and Ecchymosis?

“…It involves several diverse approaches according to the specific deformities. [1][2][3][4] Rhinoplasty involving osteotomy of the nasal bones is one of the riskiest processes and results in a less controllable outcome. Osteotomy is generally performed in cases of correction of open roof deformity, reduction in the nasal pyramid, removal of convexity or unevenness, and straightening of the nasal bones.…”

Perioperative Dexamethasone and Post-Rhinoplasty Edema: A Prospective Observational Study

“…In contrast, clinical evidence suggests that nasal packing is ineffective and precipitates complications. Nasal packing compresses nasal capillaries, blocks venous return, and forces blood into the eyelid, leading to increased severity of periorbital edema and ecchymosis [32].…”

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

“…A significantly more severe and prolonged periorbital ecchymosis was found on the fourth and seventh postoperative day on the packed side. 51 The authors concluded that nasal packing should be avoided if possible.…”