Basic and patient-oriented research
Does Creating a Subperiosteal Tunnel Influence the Periorbital Edema and Ecchymosis in Rhinoplasty?

https://doi.org/10.1016/j.joms.2005.04.008Get rights and content

Purpose

The study goal was to determine whether creating a subperiosteal tunnel before lateral osteotomy had an effect on postoperative periorbital edema, ecchymosis, and subconjunctival ecchymosis.

Patients and Methods

Eighteen consecutive patients who underwent septorhinoplasty were included in the study. In all patients lateral osteotomies were carried out bilaterally, after creating a subperiosteal tunnel on a randomly chosen side and without creating a subperiosteal tunnel on the other side. The patients were seen on the second postoperative day, and a different surgeon who was unaware of the side with the periosteal tunnel determined the side of the face with more edema and ecchymosis. Subconjunctival ecchymosis was evaluated and recorded, as well.

Results

Creating subperiosteal tunnels before lateral osteotomy statistically increased periorbital ecchymosis. Although there was no statistically significant difference, creating subperiosteal tunnels also increased development and severity of subconjunctival ecchymosis and edema.

Conclusions

We suggest performing lateral osteotomy without creating subperiosteal tunnels.

Section snippets

Materials and Methods

Eighteen consecutive patients were included in the study. Informed consent was obtained from the patients. Each patient was questioned for a history of systemic hypertension and antiaggregant drug use. For female patients, operating during or immediately before the menstrual period was avoided. Dexamethasone (10 mg) was given intravenously just prior to the surgery. The operations were carried out under general anesthesia or local anesthesia with sedation. Local anesthesia was achieved with 2%

Results

Eighteen patients (3 females and 15 males) who underwent rhinoplasty with osteotomies were evaluated. The mean age of the patients was 26 years (range, 18 to 53 years). Although open rhinoplasty was performed in 5 patients, closed technique was preferred in 13 patients. Subperiosteal tunnel was created on the right side of 9 patients, and on the left of the remaining 9.

In 3 patients, no differences were noted between sides regarding ecchymosis. While in 3 patients ecchymosis was more severe on

Discussion

Edema and ecchymosis are the usual results of the bony and soft tissue trauma during rhinoplastic surgery. Their characteristics and behavior were well documented in a previous study.3 It always appears just after the operation, and recovery may last until the ninth postoperative day. Periorbital ecchymosis is not limited to the lax skin of the eyelids and sometimes moves through the periorbital fatty tissues and results in a subconjunctival ecchymosis.6 In particular, disruption of the angular

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