Systemic and Other Complications

Abstract

SYSTEMIC A N D OTHER COMPLICATIONSSerious complications after rhinoplasty are rare but various. Much is written about cosmetic failures, but less has been written about life-threatening complications of nasal surgery. The incidence of all these complications are rarely reported in plastic surgery literature and ranges anywhere between 1.7% andThey are either local problems, depending on special nasal surgery techniques and implanted material; or systemic complications, like hemorrhage, infection, bacteremia and allergy, and complications of structures adjacent to the nose like traumatic, ophthalmic, and other problems. Most systemic complications arise from intraoperative and early problems from bleeding, general or local anesthesia, and infection.An excessive hemorrhage during or after rhinoplasty can cause cardiopulmonal problems with hypotension and circulation shock reaction. If electrocoagulation and intranasal packing is unsuccessful, specific vessel ligation is indicated. The ethmoid vessels are exposed through an incision midway through the medial canthus or by an endonasal approach. The internal maxillary artery should be reached endonasally at the dorsal wall of the maxillary cavity. Performed by intraartery angioigraphy or computerized subtraction angiography, a selective embolization to bleeding disorders and vascular abnormalities may be possible. Allergic reactions to local or systemic anesthetic drugs can cause serious effects like cardiopulmonary collapse, malignant hyperthermia, or anaphylactic shock.Reports of intracranial infection after septa1 surgery are frequently found in the preantibiotic era. They include meningitis, sinus cavernous thrombosis (CST), brain abscesses, endocarditis, and pulmonary embolism after bacteriemia. A further serious reaction, toxic shock syndrome, is relatively short noted. Iatrogenic traumatic injuries penetrating the cribiform plate with the olfactory nerves can also cause serious complications. A cerebrospinal fluid (CSF) leak will occur with rhinoliquorrhoe, anosmia, and following meningitis or frontal abscess if the leak is not recognized and repaired immediately by the surgeon.Other traumatic lesions are injuries of the bony wall of the orbita like the processus trochlearis, the nasolacrimal apparatus, or the infraorbital nerve and other intraorbital structures. Ocular complications to nasal surgery are attributed to two basic causes: vascular disturbances and direct mechanical trauma of the borders of the orbit and to the optic nerve. Finally, a few cases of asphyxiation as a result of aspiration of the nasal packing have been reported.Knowing these complications, it is essential for the surgeon doing septo-rhinoplasty as an elective intervention in plastic surgery to get further patient information to calculate the risk of the operation and

44 Complications in Rhinoplasty

“…Note must be made of possibly serious complications. 51,52 Intracranial complications may occur in association with septal surgery, as the perpendicular plate of the ethmoid has an attachment superiorly in the floor of the cranial cavity. Great care must be taken, particularly in the elderly, to avoid avulsing ethmoid bone and creating a fracture with cerebrospinal fluid leak.…”

Risiken und Komplikationen der Rhinoplastik

“…Intraoperativ entnommene Blutkulturen waren in einer Studie steril [59]. Allerdings können Staphylokokken durch ihr Exotoxin eine systemische Reaktion als toxisches Schocksyndrom hervorrufen [60,61]. Hierfür werden in aller Regel Nasentampo− naden angeschuldigt, aber auch Septumfolien können auslösend sein [60].…”

“…Orbitale Komplikationen der Rhinoplastik umfassen traumati− sche und entzündliche Prozesse [61]. ± Überresektion (Sattel), ± Unregelmäßigkeiten (nach Höckerabtragung), ± Verbreiterung (u. a.…”

“…Durch Schrumpfung des Kieferhöhlen− lumens wurde der Bulbus nach kaudal verlagert[65]. Eine Infek− tion mit hämolysierenden Streptokokken kann zu einer nekro− tisierenden periorbitalen oder orbitalen Entzündung führen[61,66,67]. Eine frühzeitige Abgrenzung der periorbitalen Entzündung zu einer postoperativen Schwellung durch Beach− tung von Schmerz, Fieber und Entzündungsparametern ist entscheidend, um durch rechtzeitige Penicillingabe eine Lid− nekrose zu vermeiden.…”

Does Septorhinoplasty-Related Periorbital Edema Affect Intraocular Pressure and Retina?

“…5 Periorbital and orbital complications can be vascular, infectious, or traumatic in rhinoplasty. [6][7][8] Lateral osteotomies cause most of the sudden orbital-periorbital complications. The shearing or tearing of the tissue involving the angular vessels can cause orbital hemorrhage.…”