Postoperative Ecchymosis and Edema After Creation of Subperiosteal Tunnels in Rhinoplasty

Abstract

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.

Early Postoperative Sequelae After Open Sky Access in Nasal Osteotomy

“…In a recent meta-analysis, Kim et al 19 have concluded that there was no significant difference in postoperative eyelid ecchymosis and edema whether osteotomy was done internally or externally. Many studies discussed the effect of periosteal tunneling on periorbital sequelae before osteotomy with conflicting results 20–23 . On the contrary, the effect of complete subperiosteal dissection before osteotomy (like we did in our present study) has not been measured objectively in the literature.…”

Effects of Periosteal Elevation Before Lateral Osteotomy in Rhinoplasty: A Meta-Analysis of Randomized Controlled Trials

“…Osteotomy is performed with the goals of straightening a deviated dorsum, narrowing the nasal dorsum, and opening the nasal vault [ 11 ]. Eyelid edema and ecchymosis, which are the most common postoperative complications of osteotomy, can be caused by damage to arteries or veins and soft tissue injuries during lateral osteotomy [ 5 ]. In lateral osteotomy, considerable force is delivered to the soft tissues and bones to mobilize the nasal bone.…”

“…Lateral osteotomy can be performed after periosteal elevation. A subperiosteal tunnel is formed by elevating the periosteum and upper layer from the bony cortex in the path of the osteotomy [ 5 ]. The goal of subperiosteal tunneling is to protect the blood vessels and to reduce periosteal injury during osteotomy [ 16 ].…”

“…Data from included studies were extracted using standardized forms. Primary outcomes were degree of eyelid edema [3][4][5][6], ecchymosis [3][4][5][6][7][8], and subconjunctival hemorrhage [3,4] comparing different osteotomy methods with another methods during the postoperative period (within 3 days or the seventh postoperative day). Eyelid edema and ecchymosis were assessed individually using visual grading scales.…”

Subperiosteal Tunneling in Lateral Osteotomy: Truth Versus Mere Facts

“…Of the six articles reviewed, one concluded that there were no significant differences in the measured parameters between the two methods, indicating that no single method was superior to the other [2]. Another of the articles that was analyzed, by El-Sisi et al [3], dealt with external perforating osteotomy, in which the tunneling method is totally different from that used in internal osteotomy.…”