Abstract
BackgroundPeriorbital edema and ecchymosis following rhinoplasty is disturbing for both the patients and their surgeons. The study aim was to determine whether nasal packing after lateral osteotomies in rhinoplasty surgery increases the risk of periorbital ecchymosis post-operatively.MethodsThis was a prospective self-controlled single-blinded study. Seventy four patients who underwent rhinoplasty with bilateral lateral osteotomies by a single surgeon were enrolled in the study. Nasal cavity packing for one side was done while the other side was left unpacked. Periorbital ecchymosis was evaluated by the operating surgeon and a separate surgeon who is unaware of the packing side separately on the first, fourth and seventh day post-operatively. A 4-grade scale was utilized to assess the ecchymosis with grade 4 being the most severe.ResultsNasal packing was found to significantly increase the severity and duration of periorbital ecchymosis post rhinoplasty. While no difference was observed between the packed and unpacked sides on the first post-operative day, significant difference was noted on the 4th day (mean score 2.36 and 1.15 for the packed and unpacked sides, respectively) and on the 7th day after surgery in favor of the unpacked side (score 1.24 and 0.61 for the packed and unpacked sides, respectively).ConclusionWe advise against the routine use of nasal packing in rhinoplasty unless necessary as it contributes to worsen the periorbital ecchymosis from lateral osteotomies and thereby increases the patients’ “down time” after surgery.
Highlights
Periorbital edema and ecchymosis following rhinoplasty is disturbing for both the patients and their surgeons
This study aims to explore whether nasal packing has an effect on periorbital ecchymosis following osteotomies
Patients who underwent other concomitant facial surgeries, needed multiple lateral osteotomies, underwent any turbinate surgery apart from simple outfracturing/ radio frequency ablation, were known to have bleeding/ coagulation disorders, using anticoagulants/antiplatelets or herbal supplements that may increase the risk of bleeding along with those who had significant epistaxis intra or post-operatively that necessitated the use of nasal packing, were excluded from the study
Summary
Periorbital edema and ecchymosis following rhinoplasty is disturbing for both the patients and their surgeons. The study aim was to determine whether nasal packing after lateral osteotomies in rhinoplasty surgery increases the risk of periorbital ecchymosis post-operatively. Cosmetic surgery has been gaining more popularity in our modern world. This may be attributed to the increased safety profile of anesthesia techniques as well as improved outcome of cosmetic surgeries. Patient dissatisfaction rates range between 10 and 25 % and is highest in the early post-op period [4,5,6]. This can be partially attributed to nasal obstruction, facial edema, periorbital swelling and ecchymosis.
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