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Original Investigation
AAFPRS Advances in Rhinoplasty Featured Article
December 27, 2018

Postoperative Ecchymosis and Edema After Creation of Subperiosteal Tunnels in Rhinoplasty: A Randomized Clinical Trial

Author Affiliations
  • 1Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
  • 2Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, University of Toronto, Toronto, Ontario, Canada
  • 3Department of Experimental Medicine, McGill University, Montreal, Quebec, Canada
  • 4Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology–Head and Neck Surgery, McGill University, Montreal, Quebec, Canada
JAMA Facial Plast Surg. 2019;21(2):133-136. doi:10.1001/jamafacial.2018.1716
Key Points

Question  Does creating subperiosteal tunnels prior to lateral osteotomies in rhinoplasty affect postoperative ecchymosis and edema?

Findings  In this randomized blinded clinical trial of 34 patients, there were no significant differences in terms of postoperative ecchymosis and edema after creation of a periosteal tunnel in one side compared with the side without tunnels.

Meaning  The creation of subperiosteal tunnels may not be an effective technique to reduce postoperative edema and ecchymosis.

Abstract

Importance  Periorbital ecchymosis and edema are commonly associated with rhinoplasty and are the principal limiting factors for return to daily activities after rhinoplasty. Several methods have been evaluated to minimize these sequelae including creation of subperiosteal tunnels, which involves elevating the vascular periosteal layer, preserving it from trauma when creating osteotomies.

Objective  To assess the efficacy of the creation of subperiosteal tunnels prior to lateral osteotomies during rhinoplasty for reducing postoperative ecchymosis and edema.

Design, Setting, and Participants  A randomized, blinded, matched-paired, prospective, clinical trial took place between April 1 and August 30, 2015, in a private practice in a stand-alone clinic and surgical center. All patients who were undergoing aesthetic rhinoplasty requiring bilateral lateral osteotomies were offered inclusion in the trial. All 34 enrolled patients completed the follow-up requirements.

Intervention  Creation of subperiosteal tunnels prior to lateral osteotomies on 1 randomly selected side.

Main Outcomes and Measures  Three blinded evaluators independently graded the degree of ecchymosis and edema on a visual analog scale of 0 to 10 on each side of the nose on postoperative days 2 and 7. Each patient had 1 side that was randomly selected to undergo creation of subperiosteal tunnels. A difference in mean score between sides of the nose was calculated for each patient using a paired t test.

Results  Of the 34 patients (28 females and 6 males; mean [SD] age, 27.3 [9.2]), the mean (SD) difference in ecchymosis scores between sides on day 2 was –0.05 (1.94) (95% CI, –0.43 to 0.33) and on day 7 was –0.22 (1.23) (95% CI, –0.47 to 0.02), favoring the side without tunnels. The mean (SD) difference in edema scores on day 2 was –0.21 (1.66) (95% CI, 0.53-0.12) and on day 7 was –0.29 (1.11) (95% CI, –0.51 to –0.07). There were no clinically significant differences between sides in terms of postoperative ecchymosis and edema.

Conclusions and Relevance  Ecchymosis and edema can have significant postoperative practical, emotional, and financial effects on patients. Creation of subperiosteal tunnels prior to lateral osteotomies showed no clinically significant differences in edema and ecchymosis after the procedure.

Level of Evidence  1.

Trial Registration  isrctn.org Identifier: ISRCTN42741475

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