Effect of Steroids on Edema, Ecchymosis, and Intraoperative Bleeding in Rhinoplasty

Abstract

A double-blind, randomized study was designed to determine the efficacy of dexamethasone in decreasing periorbital edema and ecchymosis after rhinoplasty. Sixty rhinoplasty patients undergoing hump resection and lateral osteotomy were included in the study and were divided into 6 groups: group 1 (n = 10), single dose of 8 mg intravenous (IV) dexamethasone 1 hour before the operation; group 2 (n = 10), single dose of 8 mg IV dexamethasone at the beginning of the operation; group 3 (n = 10), 3 doses of 8 mg IV dexamethasone 1 hour before the operation, and 24 and 48 hours after the operation; group 4 (n = 10), 3 doses of 8 mg IV dexamethasone at the beginning of the operation, and 24 and 48 hour after the operation; group 5 (n = 10), 3 doses of 8 mg IV dexamethasone immediately after the operation, and 24 and 48 hours after the operation; group 6 (n = 10), control, no dexamethasone administration before or after the operation. Intraoperative blood loss was recorded for each patient. Patients were evaluated at 24 hours and days 2, 5, 7, and 10. For the postoperative evaluation of periorbital ecchymosis and edema, a scale of 0 to 4 points was used. There was no significant difference between groups in terms of bleeding (P > 0.05). In the groups using steroid before osteotomy, edema and ecchymosis were significantly lower during the first 2 days compared with the control group (P < 0.05). No significant difference was seen between groups 1 and 2. When patients were evaluated on day 5, edema and ecchymosis were significantly lower in groups 3 and 4 (P < 0.05) compared with other groups, but there was no difference between them. Group 5 had a significantly higher level of edema and ecchymosis compared with groups 1 through 4 at 24 hours and at days 2, 5, and 7 (P > 0.05). There was no significant difference between groups on day 10. In conclusion, if the first dose is given before osteotomy, triple-dose steroid application is the best bet for decreasing postoperative edema and ecchymosis. None of the patients had any complications related to the use of dexamethasone.

Results of intravenous steroid injection on reduction of postoperative edema in rhinoplasty

“…Moreover they did not report swelling increment on the 2nd day because they continued steroid use for 5 days and the infl ammatory response might be overcome and the increment of edema on the 2nd day would not appear. Kargi et al [14] designed different administration patterns of dexamethasone to assess Statistical analysis was performed using STATA (SE 8.2, StataCorp, College Station, TX, USA). Five percent was used as the threshold for statistical signifi cance.…”

Testing the effects of long-acting steroids in edema and ecchymosis after closed rhinoplasty

“…Previous randomized controlled trials have implemented prednisone (4,17), methylprednisolone (2,9-11), betamethasone (2) and dexamethasone (2)(3)(4)(5)14,16), among others, and have suggested better results if high and repeated doses are given versus placebo, in most cases (1)(2)(3)(4)(5)9,10). Most reports present isolated findings of one type of steroid compared with placebo; two studies, however, have reported conflicting results.…”

“…Although no complications have been reported in different series (1,2,4,5,7,(9)(10)(11)(13)(14)(15), it is our opinion that we should consider the side effects that high doses of methylprednisolone could have if used frequently in our practice.…”

The Role of Corticosteroids in Today's Oral and Maxillofacial Surgery

“…[52] In the same line, Kargi et al, and Kara and Gokalan showed that the perioperative use of corticosteroids reduced edema and ecchymosis associated with rhinoplasty surgery. [53,54] In contrast, Hoffmann et al did not observe any increase either in the edema or the ecchymosis after rhinoplasty surgery. [55] Regarding orthognathic surgery, several investigations demonstrated that perioperative corticosteroid administration significantly reduced post-operative inflammation and edema.…”