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

Journal of Otolaryngology-Head & Neck Surgery

Ahmed M. Al Arfaj¹ 

[1] Otolaryngology and facial plastic surgery consultant, college of medicine, King Saud University, Riyadh 11515, Saudi Arabia

关键词: Complications;    Packing;    Ecchymosis;    Septorhinoplasty;    Rhinoplasty;   

Others  :  1219108
DOI  :  10.1186/s40463-015-0075-5

 received in 2015-02-19, accepted in 2015-05-28,  发布年份 2015

【 摘 要 】

Background

Periorbital 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.

Methods

This 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.

Results

Nasal 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).

Conclusion

We 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.

【 授权许可】

   
2015 Al Arfaj.

【 图 表 】

Fig. 1.

【 参考文献 】

• [1]Gun R, EY E, MY M, SB S, Topcu I, Akkus Z. Effects of lidocaine and adrenaline combination on postoperative edema and ecchymosis in rhinoplasty. Int J Oral Maxillofacial Surg. 2011; 40(7):722-9.
• [2]Gubisch W, Dacho A. Aesthetic rhinoplasty plus brow, eyelid and conchal surgery: pitfalls–complications–prevention. GMS Current Topics in Otorhinolaryngology. Head Neck Surgery. 2013; 13:12.
• [3]Holt G, ET G, McLarey D. Postoperative sequelae and complications of rhinoplasty. Otolaryngol Clin North Am. 1987; 20(4):853-76.
• [4]Biggs T, Fraser L, Ward M, Sunkaraneni V, Harries P, Salib R. Patient reported outcome measures in septorhinoplasty surgery. Ann R Coll Surg Engl. 2015; 97(1):63-5.
• [5]Balikci HH, Gurdal MM. Satisfaction outcomes in open functional Septorhinoplasty: prospective analysis. J Craniofac Surg. 2014; 25(2):377-9.
• [6]Günel C, Omurlu IK. The effect of rhinoplasty on psychosocial distress level and quality of life. Arch Otorhinolaryngol. 2014.
• [7]Al-Arfaj A, Al-Qattan M, Al-Harethy S, Al-Zahrani K. Effect of periosteum elevation on periorbital ecchymosis in rhinoplasty. J Plast Reconstr Aesthet Surg. 2009; 62(11):e538-9.
• [8]Gürlek A, Fariz A, Aydogan H, Ersoz-Ozturk A, Eren AT. Effects of different corticosteroids on edema and ecchymosis in open rhinoplasty. Aesthet Plast Surg. 2006; 30(2):150-4.
• [9]Hatef DA, Ellsworth WA, Allen JN, Bullocks JM, Hollier LH, Stal S. Perioperative steroids for minimizing edema and ecchymosis after rhinoplasty: a meta-analysis. Aesthet Surg J. 2011; 31(6):648-57.
• [10]Hettige R, Mansell N. Limiting oedema, ecchymosis and haemorrhage in septorhinoplasty with ice cooled swabs. Ann R Coll Surg Engl. 2014; 96(5):395-6.
• [11]Totonchi A, Guyuron B. A randomized, controlled comparison between arnica and steroids in the management of postrhinoplasty ecchymosis and edema. Plastic Reconstrutive Surgery. 2007; 120(1):271-4.
• [12]Becker DG, McLaughlin RB, Loevner LA, Mang A. The lateral osteotomy in rhinoplasty: clinical and radiographic rationale for osteotome selection. Plast Reconstr Surg. 2000; 105(5):1806-16.
• [13]McCharthy JG, Wood-Smith D. Rhinoplasty. In: Plastic surgery. 3rd ed. McCharthy JG, editor. W.B. Saunders Company, Philadelphia, PA; 1990: p.1785-894.
• [14]Erişir F, Tahamiler R. Lateral osteotomies in rhinoplasty: a safer and less traumatic method. Aesthet Surg J. 2008; 28(5):518-20.
• [15]Cil Y. Loop drainage tube for reduction of edema and ecchymosis after rhinoplasty. Aesthet Plast Surg. 2008; 32(6):937-8.
• [16]Hwang SH, Lee JH, Kim BG, Kim SW, Kang JM. The efficacy of steroids for edema and ecchymosis after Rhinoplasty: a meta-analysis. Laryngoscope. 2014; 125(1):92-8.
• [17]Koşucu M, SO S, Beşir A, Uraloğlu M, MT M, Livaoğlu M. Effects of perioperative remifentanil with controlled hypotension on intraoperative bleeding and postoperative edema and ecchymosis in open rhinoplasty. J Craniofac Surg. 2014; 25(2):471-5.
• [18]Zojajy M, Alani N, Abdi-Soofi S, Akbari-Delmaghani N. Does injection of lidocaine with 1/100000 epinephrine immediately before lateral osteotomy reduce post-operative periorbital edema and ecchymosis in rhinoplasty? Novelty Biomedicine. 2014; 2(2):59-63.
• [19]Al-Arfaj A, Al-Swiahb JN, Al-Harthy S, Al-Essa M. Nasal packing in cosmetic and functional nasal surgery. Saudi Med J. 2008; 29(7):994-7.
• [20]Kelley BP, Koshy J, Hatef D, Hollier LH, Stal S. Packing and postoperative rhinoplasty management: a survey report. Aesthet Surg J. 2011; 31(2):184-9.
• [21]Shadfar S, Deal AM, Jarchow AM, Yang H, Shockley WW. Practice patterns in the perioperative treatment of patients undergoing septorhinoplasty: a survey of facial plastic surgeons. JAMA Facial Plast Surg. 2014; 16(2):113-9.
• [22]Kara CO, Kara IG, Yaylali V. Subconjunctival ecchymosis due to rhinoplasty. Rhinology. 2001; 39(3):166-8.