Alpay Fariz

Effects of Different Corticosteroids on Edema and Ecchymosis in Open Rhinoplasty

A double-blind, randomized trial with placebo control was planned to evaluate the effects of corticosteroids (betamethasone, dexamethasone, methylprednisolone) in approximately equivalent doses (8 mg dexamethasone/day), and to compare their effects with that of tenoxicam, an antiinflammatory drug, on both the edema and ecchymosis in open rhinoplasty with osteotomies. For this study, 40 patients were divided randomly into five groups of 8 patients each, which received, respectively, betamethasone (group 1), dexamethasone (group 2), methylprednisolone (group 3), tenoxicam (group 4), and placebo (group 5). Open rhinoplasty with osteotomies was performed by the same surgeon with the patient under general anesthesia. Drugs were administered just before the induction of anesthesia and continued for 3 days. Only acetaminophen was used to control postoperative analgesia. Digital photographs of each patient were taken on postoperative days 1, 3, and 7. Scoring was performed separately for eyelid swelling and ecchymosis by three observers independently using a graded scale from 0 to 4. No statistically significant differences existed among the five groups in terms of age, sex, duration of surgery, amount of bleeding, and intravenous fluid administration during the surgery. On postoperative days 1, 3, and 7, no differences in the levels of ecchymosis or edema among the steroid groups, the tenoxicam group, and the control groups were observed. In conclusion, the authors observed no significant differences among the different kinds of steroids administered in equivalent doses (8 mg dexamethasone/day). Steroids used in these doses were not effective in preventing or reducing edema and ecchymosis after open rhinoplasty with osteotomies. Tenoxicam also was not effective. No complications caused by the use of steroids were observed during the 6-month follow-up period.

Effects of high dose corticosteroids in open rhinoplasty

BACKGROUND Although some studies about the effects of steroids on surgical trauma in closed or combined (closed and open together) rhinoplasty have been reported in the literature, still more information is needed in order to enlighten rhinoplasty surgeons. The purpose of this study is to evaluate the anti-inflammatory activity of steroids administered in high doses to prevent and decrease periorbital ecchymosis and oedema in patients who underwent open rhinoplasty with osteotomies by the same surgeon. This is the first study in open rhinoplasty alone. METHODS The study was performed on 40 patients, under general anaesthesia. Patients were divided randomly into five groups (eight patients in each group); the groups comprised: a single 250 mg dose of methylprednisolone (Group I), a single 500 mg dose of methylprednisolone (Group II), four 250 mg doses of methylprednisolone (Group III), four 500 mg doses of methylprednisolone (Group IV) and placebo (Group V). Digital photographs were taken of each patient on the first, third and seventh postoperative days. Scorings of eyelid swelling and ecchymosis were evaluated separately using a graded scale from 0 to (+) 4 by three observers, independently. Additionally, blood samples were taken for the evaluations of C-reactive protein (CRP), white blood cell (WBC) and erythrocyte sedimentation rate (ESR) on the same days. RESULTS Clinically and statistically significant difference was observed in the decrease of both ecchymosis and oedema, between the placebo and high dose methylprednisolone groups, which is effective to prevent and to decrease both the ecchymosis and oedema in open rhinoplasty with osteotomies. CRP was the most sensitive acute phase reactant among CRP, ESR and WBC. No complication was observed due to steroid usage. CONCLUSIONS We can confidently say that high dose methylprednisolone is effective in preventing and reducing both the periorbital ecchymosis and oedema in open rhinoplasty with osteotomies and it can be used safely for this purpose.

The use of high-density porous polyethylene as a custom-made nasal spreader graft.

The concept and technique of using high-density porous polyethylene (HDPP), a nonresorbable synthetic material, for nasal spreader grafts, are presented. This material is thought to be particularly useful in revision (secondary or tertiary) rhinoplasty, in which internal valve collapse frequently is confronted and septal cartilage often is unavailable because it has been harvested for spreader or other grafts. Sold as a thin plain sheet (0.85 × 38 × 50 mm) that can be cut to an appropriate size for spreader grafts, HDPP is a ready-to-use material commercially available on the market. Because HDPP permits ingrowths of fibrous tissue inside and around, it is a nonabsorbable material that stabilizes the upper lateral cartilages in their new position and maintains the appropriate internal valve angle. The authors used this material for 15 patients undergoing secondary (n = 12) and tertiary (n = 3) rhinoplasty because of valvular collapse. During the mean follow-up period of 16 months (range, 8–30 months), neither complication nor recurrence of airway obstruction occurred.

The use of lower turbinate bone grafts in the treatment of saddle nose deformities.

Saddle nose reconstruction is based on the use of support grafts to manage aesthetic and functional problems. Bone (calvarial, iliac crest, costal, nasal hump, ulnar, and heterogenous origin), cartilage (septal, costal, heterogenous), and synthetic materials (silicon, silastic, polyethylene) were used as support grafts. Three patients have been included in this study to define the surgical management and long-term aesthetic and functional results of patients undergoing rhinoplasty with support grafts for a saddle nose deformity. Open rhinoplasty was employed. Both the lower turbinates were excised and the bone dissected from the soft tissues in two cases and in one case, only mucosa was removed. The amountof support needed was measured by using bone wax. The bone was used shaped in layers, according to the defect, and sutured to each other by vycril suture, and wrapped around by surgicell. The graft was then inserted in its place and fixed with external prolene sutures. Results were satisfactory in both function and aesthetics. Ten to 16-month followups had no complications. Saddle nose surgery basically requires the use of a support graft to repair the nasal dorsum. A lower turbinate bone graftprocedure has some advantages: itis cheap and safe, it is ready to use and not time-consuming, there is no donor area and no additional donor site morbidity, and it enlarges the airway and the passage to prevent nasal airway obstruction.