Does Creating a Subperiosteal Tunnel Influence the Periorbital Edema and Ecchymosis in Rhinoplasty?

Kara, Cüneyt Orhan; Kara, İnci; Topuz, Bülent

doi:10.1016/j.joms.2005.04.008

Cited by 41 publications

(49 citation statements)

References 3 publications

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“…LAC is advised for easy dissection, pain relief in the immediate postoperative period, reduction in the degree of edema and ecchymosis, and clear dissection under both local and general anaesthesia 3,4,11,13,23 . The authors observed that LAC infiltration provides easier and cleaner dissection at the tip of the nose.…”

Section: Discussionmentioning

confidence: 99%

“…Both of these studies used the LAC preparation, but none of these researchers have made any suggestions regarding the effect of LAC on edema/ ecchymosis. KARA et al reported that the creation of a subperiosteal tunnel for the lateral osteotomies causes more edema and ecchymosis under both general and local anaesthesia 11 . They used a combination of 1% lidocaine with 1:100,000 adrenaline for local anaesthesia but did not describe any effect of this combination on postoperative edema/ecchymosis.…”

Section: Discussionmentioning

confidence: 99%

“…The other controversial issue is whether lateral osteotomy should be performed with or without a subperiosteal tunnel. Some authors have suggested that developing a subperiosteal tunnel carries a greater risk of damage to the overlying vessels 2,11,20 . Other authors have suggested that creation of a subperiosteal tunnel due to periosteal elevation lifts the vessels above the osteotomy plane 8,16,19 .…”

mentioning

confidence: 99%

“…Other authors have suggested that creation of a subperiosteal tunnel due to periosteal elevation lifts the vessels above the osteotomy plane 8,16,19 . Some studies have suggested that lidocaine and adrenaline combination (LAC) injection be performed prior to osteotomy, regardless of whether local or general anaesthesia is used 10,11,25 . As described above, it has been suggested that LAC injection reduces the extent of postoperative edema and ecchymosis, but many factors contributed to formation of the edema and ecchymosis.…”

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confidence: 99%

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Effects of lidocaine and adrenaline combination on postoperative edema and ecchymosis in rhinoplasty

Gün

Yorgancılar

Yıldırım

et al. 2011

International Journal of Oral and Maxillofacial Surgery

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Effects of lidocaine and adrenaline combination on postoperative edema and ecchymosis in rhinoplasty

Gün

Yorgancılar

Yıldırım

et al. 2011

International Journal of Oral and Maxillofacial Surgery

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“…Secondly it also lifts the angular artery and vein away from the osteotome and reduces the periorbital edema and ecchymosis. Those who do not develop the subperiosteal tunnel before the osteotomy believe that raising the subperiosteal tunnel carries a greater risk of disrupting the lacrimal sac or damage to the medial canthus ligament (10) and damage the overlying vessels causing periorbital ecchymosis, subconjunctival ecchymosis and edema (11) . Our findings suggest the same.…”

Section: Discussionmentioning

confidence: 99%

External vs. internal osteotomy in rhinoplasty

Sinha

Gupta

et al. 2007

Indian J Otolaryngol Head Neck Surg

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Postoperative Ecchymosis and Edema After Creation of Subperiosteal Tunnels in Rhinoplasty

Chan

Roskies

Jooya

et al. 2019

JAMA Facial Plast Surg

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and edema are commonly associated with rhinoplasty and are the principal limiting factors for return to daily activities after rhinoplasty. Several methods have been evaluated to minimize these sequelae including creation of subperiosteal tunnels, which involves elevating the vascular periosteal layer, preserving it from trauma when creating osteotomies.OBJECTIVE To assess the efficacy of the creation of subperiosteal tunnels prior to lateral osteotomies during rhinoplasty for reducing postoperative ecchymosis and edema. DESIGN, SETTING, AND PARTICIPANTSA randomized, blinded, matched-paired, prospective, clinical trial took place between April 1 and August 30, 2015, in a private practice in a stand-alone clinic and surgical center. All patients who were undergoing aesthetic rhinoplasty requiring bilateral lateral osteotomies were offered inclusion in the trial. All 34 enrolled patients completed the follow-up requirements.INTERVENTION Creation of subperiosteal tunnels prior to lateral osteotomies on 1 randomly selected side.MAIN OUTCOMES AND MEASURES Three blinded evaluators independently graded the degree of ecchymosis and edema on a visual analog scale of 0 to 10 on each side of the nose on postoperative days 2 and 7. Each patient had 1 side that was randomly selected to undergo creation of subperiosteal tunnels. A difference in mean score between sides of the nose was calculated for each patient using a paired t test. RESULTSOf the 34 patients (28 females and 6 males; mean [SD] age, 27.3 [9.2]), the mean (SD) difference in ecchymosis scores between sides on day 2 was -0.05 (1.94) (95% CI, -0.43 to 0.33) and on day 7 was -0.22 (1.23) (95% CI, -0.47 to 0.02), favoring the side without tunnels. The mean (SD) difference in edema scores on day 2 was -0.21 (1.66) (95% CI, 0.53-0.12) and on day 7 was -0.29 (1.11) (95% CI, -0.51 to -0.07). There were no clinically significant differences between sides in terms of postoperative ecchymosis and edema. CONCLUSIONS AND RELEVANCEEcchymosis and edema can have significant postoperative practical, emotional, and financial effects on patients. Creation of subperiosteal tunnels prior to lateral osteotomies showed no clinically significant differences in edema and ecchymosis after the procedure.LEVEL OF EVIDENCE 1.

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Does Creating a Subperiosteal Tunnel Influence the Periorbital Edema and Ecchymosis in Rhinoplasty?

Cited by 41 publications

References 3 publications

Effects of lidocaine and adrenaline combination on postoperative edema and ecchymosis in rhinoplasty

Effects of lidocaine and adrenaline combination on postoperative edema and ecchymosis in rhinoplasty

External vs. internal osteotomy in rhinoplasty

Postoperative Ecchymosis and Edema After Creation of Subperiosteal Tunnels in Rhinoplasty

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