Supraperiosteal injection of dexamethasone not effective in reducing edema and ecchymosis after rhinoplasty
The nose is the most important organ in facial beauty; for this reason, various surgeries have been performed throughout history to modify the shape in attempts to improve the appearance of the nose. The critical role of the nose in face aesthetics is due to its central location. A common type of nasal cosmetic surgery is rhinoplasty, which requires interventions to positionally manipulate the bone, cartilage, and soft tissue. Due to the forces required as part of rhinoplasty to reshape the nose, in 10% of cases, skin and soft tissue complications occur. Rhinoplasty is divided into two categories, including open surgery or external technique and close surgery or endonasal technique. Ecchymosis (the discoloration of the skin as a consequence of subsurface bleeding associated with bruising) and edema (swelling resulting from fluid trapped in tissue surrounding the nose) tend to be the common complications following open or closed rhinoplasty. Consequently, efforts made to prevent ecchymosis and edema are priorities for the medical team and the rhinoplasty patients.
Different types of osteotomy are conducted as part of distinct rhinoplasty treatments. All types of osteotomy can result in associated edema and ecchymosis. The rate and magnitude of edema and ecchymosis vary from patient to patient, even when applying the same techniques and/or taking the same length of time to perform the surgery. In addition to adverse visual consequences, edema and/or ecchymosis tend to prolong recovery times after surgery and delay a patient’s return to work and normal social activities. Moreover, such outcomes lead to anxiety and patient dissatisfaction with the results. Avoidance of edema and ecchymosis after surgery, or fast recovery from it, is clearly beneficial for the patients. Surgical accuracy acts to limit tissue impacts and reduce negative effect on the blood vessels. However, it is almost impossible to fully prevent edema and/or ecchymosis.
Various methods have been employed to reduce edema and ecchymosis following rhinoplasty. These methods include the application of corticosteroids, injections of lidocaine and epinephrine solution (typically in a ratio of 1 : 100,000), cold compresses, and intravenous injections of tranexamic acid. The objective of all of these treatments is to reduce bleeding during surgery by creating vasoconstriction and inhibiting fluid extravasation, thereby reducing edema and preorbital ecchymosis.
Corticosteroids are one of the most commonly used drugs to reduce edema and ecchymosis. Due to their anti-inflammatory effects, corticosteroids prevent the onset of the inflammatory process, including lymphocyte migration, fibrin accumulation, vasodilation, and phagocytic activity. However, various studies recommend the use of dexamethasone as a more favourable alternative to antisteroid drugs due to their higher comparative potency, half-life, and cost-effectiveness.
This study by Mahboubeh Jafari et al was designed and performed because dexamethasone has not previously been used topically in any of the studies that evaluate and compare its effects with those of corticosteroids in reducing edema and ecchymosis in patients undergoing rhinoplasty.
The primary objective was to reduce edema and ecchymosis in rhinoplasty patients by administering a subcutaneous injection of dexamethasone and thereby prevent unwanted systemic side effects of corticosteroid treatments. Authors conducted a hospital-based nonrandomised study of rhinoplasty patients, with their informed consent treated over the course of one year. Dexamethasone was injected on one side of consenting patient’s face immediately before surgery and the results were compared with the opposite side that was not injected. The face images of patients were taken on the front view on the first, third, seventh, and fourteenth days following the treatment. The grade of edema and ecchymosis encountered in each patient was determined by three ENT specialists. The degree of edema and ecchymosis was compared on the injected and noninjected sides and the findings were statistically analysed.
The nonrandomised study considered 42 rhinoplasty patients. The mean age of patients was 27.9 years and their age ranged between 17 and 52 years. For 20 patients (47.6%), injection was performed on the right side, and for 22 patients (52.3%), injection was performed on the left side.
The results and their analysis indicated that supraperiosteal dexamethasone injection did not have a positive or negative effect on edema and ecchymosis after rhinoplasty surgery for the 42 patients studied. In both injected and uninjected cases (opposite sides of the same face), the rate of edema and ecchymosis on day 14 was significantly reduced but the dexamethasone injection did not appear to play any role in that development.
According to the statistical analysis and evidence reviewed from the results of this nonrandomised study, subcutaneous dexamethasone has no positive or negative effect on edema and ecchymosis development in rhinoplasty patients in the first two weeks after surgery. Differences in the rate of improvement in edema and ecchymosis 14 days after surgery on the side of the face where dexamethasone was injected and the opposite side of the same face receiving no injection were found to be statistically insignificant. These results indicate that the use of subcutaneous dexamethasone injections is not worthwhile as part of rhinoplasty procedures.
Source: Mahboubeh Jafari, Mojtaba Maleki Delarestaghi, Hesam Jahandideh; Hindawi International Journal of Otolaryngology Volume 2022
