Randomized Comparative Study of the Peripalpebral Edema and Ecchymosis Caused By Internal Continuous and External Perforating Osteotomy Procedures in Rhinoplasty

Background:There is a direct relationship between the lateral osteotomy procedures and the edema and the ecchymosis occurring in the postoperative period (1). These undesirable effects of surgery cause anxiety and dissatisfaction in the operated patient and extends the period in which the individual must abstain from working (2). Therefore, a technique of osteotomy should not only be precise, reproducible and safe, but should also minimize postoperative sequelae, including ecchymosis and edema (3). The ideal nasal osteotomy technique remains controversial (4). The objective of this study is to compare, at the end of the 1st postoperative week, the peripalpebral edema and ecchymosis caused by internal continuous and external perforating osteotomy.

Methods: A randomized prospective longitudinal study was conducted. Inclusion criteria: Rhinomegaly, need for lateral osteotomy defined preoperatively, normal hematological and cardiopulmonary screening tests and signing of the written consent form agreeing with its items following the explanation of the study by the assistant physician. Exclusion criteria for the study: Transoperative need for medial osteotomy, history of use of dermal fillers in the nose, systemic arterial hypertension, combined surgery, the need for septoplasty in conjunction and Diabetes Mellitus. The randomization process occurred by alternate allocation. Each patient was assigned to one of the two groups. In group I patients underwent rhinoplasty with external osteotomy. In group II internal osteotomy was performed. When patients returned for the 1 week review photography was done. The photos were analyzed by two blinded plastic surgeons. In their analysis they rated the degree of edema and ecchymosis utilizing a scale (5).

Results: 63 patients were studied. 22 patients in group I and 41 patients in group II. The characteristics of both groups were comparable. Group II showed statistically significant lower rates compared to Group I reflecting a lower perception of ecchymosis when the external osteotomy was performed. No statistically significant difference between them was found when compared for ecchymosis.

Conclusions: Internal continuous osteotomy produces more ecchymosis at the end of the initial postoperative week than that of external perforating osteotomy. No difference between the two groups was found in terms of peripalpebral postoperative edema.

1- Rohrich RJ, Janis JE, Krueger JK, Adams WP. Importance of Lateral Nasal Osteotomy: An External Perforated Approach. In: Gunter JP, Rohrich RJ, Adams WP (eds.), Dallas Rhinoplasty: Nasal Surgery By The Masters, 2nd ed. St. Louis, Quality Medical Publishing, 2007: 269-286.

2- van Loon B, van Heerbeek N, Maal TJ et al. Postoperative volume increase of facial soft tissue after percutaneous versus endonasal osteotomy technique in rhinoplasty using 3D stereophotogrammetry. Rhinology. 2011;49(1):121-6.

3- Gryskiewicz JM, Gryskiewicz KM. Nasal osteotomies: a clinical comparison of the perforating methods versus the continuous technique. Plast Reconstr Surg. 2004;15;113(5):1445-56.

4- Gruber R, Chang TN, Kahn D, Sullivan P. Broad nasal bone reduction: an algorithm for osteotomies. Plast Reconstr Surg. 2007;119(3):1044-53.

5- Kara CO, Gökalan I, Effects of single-dose steroid usage on edema, ecchymosis and intraoperative bleeding in rhinoplasty. Plast. Reconstr. Surg. 1999; 104(7):2213-8.