Tehran University Medical Journal

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Background: In rhinoplasty, periorbital edema and ecchymosis is due to soft tissue trauma and small vessel injury with subsequent exudation and bleeding. The main purpose of this study is to determine the effect of dexamethasone in reducing periorbital edema and ecchymosis and intraoperative bleeding in rhinoplasty patients.

Methods: This double-blind study included 90 patients who underwent rhinoplasty from October 2004 to March 2005. In group A, 8 mg of intravenous dexamethasone was administered only preoperatively. In group B, 8 mg of dexamethasone was administered preoperatively and continued every 8 hours postoperatively. Group C, the control group, received no dexamethasone.

Results: The degree of upper lid edema in groups A and B was significantly less than that of group C. During the first and second day the severity of upper lid edema in group B was less than that of group A, but the difference was not significant. The degree of lower lid edema during the first and second days in groups A and B was significantly less than that of group C, although it was identical in all groups during the fifth and seventh days. The degree of upper lid ecchymosis during the first and fifth days in group C was significantly more than that of groups A and B, but it was similar on the seventh day in all groups. The degree of lower lid ecchymosis on the first day in groups A and B was significantly less than that of group C however, it was similar in all groups during the second, fifth and seventh days. The volume of intraoperative bleeding in the three groups was similar. The mean period of recovery (12 days) was comparable in all groups.

Conclusions: Dexamethasone administration leads to the reduction of upper lid edema, ecchymosis and lower lid edema during the first and second postoperative days, and reduction of lower lid ecchymosis on the first postoperative day.

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Background: Proper nasal tip control is a difficult step in rhinoplasty. The aim of this study was to compare the effects of two cartilage modifying methods, Septocolumellar Suture (SCS) and Lateral Crural Overlay (LCO), on nasal tip projection and rotation.
Methods: In a single-blinded clinical trial, 36 patients who were scheduled for nasal tip deprojection were enrolled. A profile photograph of face was taken from all the patients before and three months post operation. Nasofacial angles, TP:Ln ratio for assessing nasal tip projection, tip columellar angle and nasolabial angles for nasal tip rotation assessment were measured by a computer software. The patients were randomly divided into two groups that underwent open rhinoplasty.
Results: Both the LCO and SCS methods were accompanied by a significant reduction in nasofacial angle and TP:Ln ratio, there was raised nasolabial and rotation angle in comparison to preoperative values. The use of LCO method in comparison to SCS resulted in more increase in the nasolabial angle (11.83±3.05 Vs. 4.56±1.62 degree) and Rotation Angle (11.44±3.22 Vs. 1.56±1.04 degree) and resulted in more reduction in post-operative TP:Ln ratio in comparison to preoperative measures (-0.05±0.01 Vs. -0.03±0.01), however, the difference in the nasofacial angle was not significant.
Conclusion: Both cartilage modifying techniques resulted in significant reduction in the projection and increasing in the tip rotation. Lateral Crural Overlay (LCO) seems to be more effective than Septocolumellar Suture (SCS). Therefore, the SCS method is recommended for patients who need more nasal tip rotation and deprojection in rhinoplasty.

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Background: The aim of this study was to minimize edema and ecchymosis following rhinoplasty through a closed drainage system to address concealed hemorrhage.
Methods: This study was designed as a prospective، double blinded, randomized contr-olled study. Fifty one patients who underwent septorhinoplasty were included in this study and divided in two groups. In group A, a closed drainage system was applied in the most dependent posterior septal area following septal harvesting. Concealed bloody secretions were drained out of mouth in a vacutaner tube during three concecutive post operative days. In control group, group B, exactly the same classic rhinoplasty opera-tion by the same surgeon was done as for study group except omitting the closed drainage system. Degree of supra-tip and eyelid edema was evaluated on post operative days through photographic and software image analysis. Edema and ecchymosis rating of eyelids and ecchymosis of paranasal and cheek area done based on photographic analysis by independent plastic surgeons using a defined grading system.
Results: Eyelid ecchymosis was reduced significantly on post operative day 14 in the study group (P=0.03). Ecchymosis of paranasal and check was reduced considerably likewise on days 7 and 14 in group A using Mann-Whitney test (P=0.03). There was no significant deference regarding supra tip edema on post operative days. The same hold true for the eyelids edema.
Conclusion: Significant decrement observed in eyelids ecchymosis on day 14 and para-nasal and cheek ecchymosis on postoperative days 7 and 14 in study group. There were no positive effects regarding supra tip and eyelid edema reduction using closed drainage system to evacuate concealed haemorrhage in posterior septum space. There could be different etio-pathologies for two common morbidities following rhinoplasty that should be addressed separately.

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Results: The results of this study showed that from the fifth minute after auditory sensory stimulation, the mean arterial pressure (MAP) in the intervention group was significantly higher than the control group (P<0.05). So that MAP in recovery (as the last follow-up) in the intervention group with a mean of 86.85±4.11 mmHg was significantly higher than the control group with a mean of 81.88±6.68 mmHg (P<0.001). Besides, the duration of recovery from anesthesia in the intervention group was significantly less than the control group (mean time: 24.05±3.39 min vs. 34.70±70.73 min; P<0.001). Finally, nausea was observed in only 7.5% of patients in the control group and agitation was reported in 5% of the control group and 5% of the intervention group (P>0.05). Conclusion: According to the results, the use of auditory sensory stimuli with a familiar voice can significantly decrease the duration of recovery from anesthesia. Also, it plays a crucial role in changing the SBP, DBP, and MAP of these patients to normal levels.

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