Preoperative Use of Dexamethasone in Rhinoplasty

Abstract

IMPORTANCE Postoperative edema and ecchymosis following rhinoplasty are a cause of anxiety for both patients and physicians and can affect the cosmetic results. Corticosteroids have been used to reduce these events. OBJECTIVE To determine whether preoperative use of dexamethasone sodium phosphate alters the occurrence of edema and ecchymosis following rhinoplasty. DESIGN, SETTING, AND PARTICIPANTS Randomized, double-blind, placebo-controlled clinical trial at an institutional referral center among a sample of individuals with rhinomegaly. INTERVENTIONS Patients were randomized into 2 groups. In group 1, dexamethasone was intravenously injected before surgery. In group 2, normal saline solution was intravenously injected before surgery. MAIN OUTCOMES AND MEASURES When patients returned at 1 week after surgery, standardized photographs were obtained. The photographs were analyzed by 5 plastic surgeons who were blinded as to whether dexamethasone or normal saline solution had been injected. The plastic surgeons rated the degree of edema and ecchymosis. RESULTS Forty-two patients participated in the study. Randomization by lottery resulted in 20 patients in group 1 and 22 patients in group 2. Group 1 showed lower rates of postoperative ecchymosis than group 2; the difference of 0.62 (P = .02) reflects less perceived ecchymosis when dexamethasone was administered. Group 1 also showed lower rates of postoperative edema than group 2; the difference of 0.68 (P = .01) reflects less perceived edema when dexamethasone was administered. CONCLUSIONS AND RELEVANCE Preoperative use of dexamethasone reduced edema and ecchymosis at 7 days after rhinoplasty. Rigorous methods in this trial demonstrate the beneficial effect of preoperative corticosteroid administration in this surgical procedure. LEVEL OF EVIDENCE 1.

Preoperative Tranexamic Acid for Treatment of Bleeding, Edema, and Ecchymosis in Patients Undergoing Rhinoplasty

“…In standard rhinoplasty procedures, the trauma of fracturing nasal bones and the injuries to angular vessels that cross the osteotomy sites lead to prolonged postoperative periorbital edema and ecchymosis and can affect the cosmetic results and patient's social life. 44 Recent studies have demonstrated that clinical outcomes in patients who undergo otolaryngologic-head and neck surgery may be improved using different surgical approaches, such as the piezoelectric surgery. 45,46 In addition, nonpharmacologic and pharmacologic interventions have been widely used to reduce periorbital edema and ecchymosis after facial plastic surgeries, but evidence for efficacy is conflicting.…”

Domestic three-dimensional scanner and printer in patients undergoing rhinoplasty

“…These techniques are difficult to learn, teach, quantify, or duplicate. They are a learned set of skills that come from watching, assisting, and performing rhinoplasties 9 . However, 3D planning can eliminate some of the guesswork for surgeons by simplifying and replicating certain surgical steps that have been more conceptual than physical.…”

The Effect of Subcutaneous Dexamethasone to Reduce Edema and Ecchymosis in Rhinoplasty Patients

“…Patients were photographed one week after surgery and the results were evaluated by five plastic surgeons. The results identified that periorbital edema and ecchymosis developments on the seventh day after surgery were much lower in the group that had received intravenous dexamethasone than in the control group [ 27 ].…”