Rhinoplasty without nasal packing and splinting
Sažetak
Abstract
Background/Aim. Most surgeons, at the end of corrective rhinoplasty, use endonasal tamponade and external splinting, primarily because of hemostasis and immobilization. Possible complications of this surgery are various. Pain, nose edema, palpebral swelling and ecchymosis, are the most common and usual. The aim of our study was to evaluate the incidence of nonaesthetic complications and the efficiency of corrective rhinoplasty without the use of tamponade and external splint. Methods. One hundred and fifty-one patients, who underwent primary corrective rhinoplasty without endonasal tamponade and without an external splint, were analyzed at the Clinical Centre “Kragujevac” in Kragujevac, Serbia, in the period 1999–May 2016. The surgeries were done by the same surgeon. Instead of a splint, sterile skin adhesive tapes were used. Study was prospective, consecutive case-series type. We analyzed the possible complications and subjective estimates of the patients who underwent primary corrective rhinoplasty in described fashion. In assessing postoparative pain, the visual analogue scale (VAS) in a range of 1 to 5 was used. Palpebral swelling and ecchymosis, were estimated 24h after surgery, by the Surgeon Periorbital Rating of Edema and Ecchymosis (SPREE) scale ranging from 0 to 5. The degree of restriction of nasal respiration was evaluated by the scale 1–4. The overall comfort of patients in the postoperative period was evaluated according to a scale: good, no opinion, bad. The patient satisfaction with the aesthetic result was analyzed on 7th and 30th day after surgery, by a scale from 1 (very satisfied) to 5 (very dissatisfied). Results. There were 151 patients aged between 18–47 years. Females were more frequent (72.18%). Most of the patients (40.39%) had moderate pain. None of the patients had neither severe nor the worst pain and 59 patients had no pain at all. Eyelid edema and periorbital ecchymosis were moderate in all patients (100%). The other complications did not occur, apart from one (0.66%) unilateral epistaxis, on postoperative day 10. Most of the patients (52.97%), immediately after surgery, could freely breathe through the nose. The general impression of the patient comfort after surgery was mainly good (74.17%). The majority of patients (52.28%), were satisfied with aesthetic result after 7 days, and 52.32% after 1 month. There were very satisfied patients: on day 7 - 27.15% and on day 30 - 39.73%. Conclusion. We concluded that the rhinoplasty without using tamponade and immobilization was safe, comfortable and economical. The degree of pain, edema and ecchymosis were low, as well as the incidence of other complications.
Reference
References
Christophel JJ, Park SS. Complications in rhinoplasty. Facial Plast Surg Clin North Am 2009; 17(1): 145 – 56, vii.
Holt GR, Garner ET, McLarey D. Postoperative sequelae and complications of rhinoplasty. Otolaryngol Clin North Am 1987; 20(4): 853 – 76.
Donald PJ. Postoperative care of the rhinoplasty patient. Otolaryngol Clin North Am 1975; 8(3): 797 ̶ 806.
Cochran CS, Landecker A. Prevention and management of rhi-noplasty complications. Plast Recon Surg 2008; 122(2): 60 ̶ 7.
Cochran CS, Ducic Y, DeFatta RJ. Current concepts in the post-operative care of the rhinoplasty patient. South Med J 2008; 101(9): 935 ̶ 9.
Kamer FM, Parkes ML. An absorbent, non-adherent nasal pack. Laryngoscope 1975; 85(2): 384 – 8.
Fernbach JC. Nasal packing after surgery. JAMA 1982; 248(19): 2452.
Bernal-Sprekelsen M. The postoperative nasal dressing. A new intranasal splint. Rhinology 1990; 28(3): 197 – 203.
Salassa JR, Pearson BW. Polyethylene oxide gel. A new intranasal dressing after septorhinoplasty. Arch Otolaryngol Head Neck Surg 1991; 117(12): 1365 – 7.
Egelund E, Jeppesen F. Respiratory tubes with nasal packings following septorhinoplasty. Rhinology 1992; 30(3): 193 – 204.
Lusthaus SN, Benmeir P, Neuman A, Weinberg A, Talisman R, Wexler MR. Nasal tampon packing in rhinoplasty: A simple and safe method of hemostasis. Ann Plast Surg 1992; 29(5): 469 – 70.
Weber R, Hochapfel F, Draf W. Packing and stents in endonasal surgery. Rhinology 2000; 38(2): 49 – 62.
Gryskiewicz JM. Intranasal splint obtained from X-ray film. Plast Reconstr Surg 2001; 108(7): 2161.
Kim MG, Baek RM, Minn KW, Heo CY, Kwon SS, Park CY. Nasal packs with X-ray indicators. Ann Plast Surg 2006; 56(3): 342 – 3.
Sariguney Y, Demir Y, Kandal S, Ozmen S, Latifoglu O. Vertically split merocel tampon has advantages in nasal packing. Plast Reconstr Surg 2006; 117(5): 1646 – 7.
Rettinger G, Masing H. Nasal splinting with thermoplastic ma-terial. HNO 1980; 28(9): 320. (German)
Kalisman M. An easy method of nasal splinting. Plast Reconstr Surg 1981; 68(5): 793.
Webster RC, Smith RC, Smith KF, Barrera A, Hamdan US. External splinting of the nose. Laryngoscope 1983; 93(12): 1615 –6.
Mahler D. Securing of the nasal skin under the cast in rhinop-lasty. Aesthetic Plast Surg 1986; 10(4): 235 – 6.
Seitchik MW. A "safe", nasal splint lined with dental impres-sion compound. Plast Reconstr Surg 1986; 77(1): 164.
Matti BA, Nicolle FV. Use of Orthoplast as nasal splint. Br J Plast Surg 1986; 39(3): 414 – 6.
Reynaud JP, Baron JL, Penin M, Chadoint F. Heat-moulded plastic splint for the nose. Ann Chir Plast Esthet 1990; 35(6): 496 – 7. (French)
Ahn MS, Maas CS, Monhian N. A novel, conformable, rapidly setting nasal splint material: Results of a prospective study. Arch Facial Plast Surg 2003; 5(2): 189 – 92.
Lubianca-Neto JF, Sant'anna GD, Mauri M, Arrarte JL, Brinck-mann CA. Evaluation of time of nasal packing after nasal sur-gery: A randomized trial. Otolaryngol Head Neck Surg 2000; 122(6): 899 – 901.
Lachanas VA, Karatzias GT, Pinakas VG, Hatziioannou JK, San-dris VG. The use of tetracaine 0. 25% solution in nasal pack-ing removal. Am J Rhinol 2006; 20(5): 483 – 4.
Karaasian K, Yilmaz F, Gulcu N, Yigit B, Kocoglu H. The effect of prilocaine and prilocaine plus meperidine infiltration on the pain during nasal packing removal. Rhinology 2007; 45(4): 321 – 4.
Yilmazer C, Sener M, Yilmaz I, Erkan AN, Cagici CA, Donmez A, et al. Pre-emptive analgesia for removal of nasal packing: A double-blind placebo controlled study. Auris Nasus Larynx 2007; 34(4): 471 – 5.
Georgiou I, Farber N, Mendes D, Winkler E. The role of antibio-tics in rhinoplasty and septoplasty: A literature review. Rhinology 2008; 46(4): 267 – 70.
Becker H. Paraffinoma as a complication of nasal packing. Plast Reconstr Surg 1983; 72(5): 735 – 6.
Montgomery PQ, Khan JI, Feakins R, Nield DV. Paraffinoma revisited: A post-operative condition following rhinoplasty nasal packing. J Laryngol Otol 1996; 110(8): 785 – 6.
Liu ES, Kridel RW. Postrhinoplasty nasal cysts and the use of petroleum-based ointments and nasal packing. Plast Reconstr Surg 2003; 112(1): 282 – 7.
Bracaglia R, Fortunato R, Gentileschi S. Endoscopic excision for postrhinoplasty mucous cyst of the nose. Br J Plast Surg 2005; 58(2): 271 – 4.
Toback J, Fayerman JW. Toxic shock syndrome following sep-torhinoplasty. Implications for the head and neck surgeon. Arch Otolaryngol 1983; 109(9): 627 – 9.
Barbour SD, Shlaes DM, Guertin SR. Toxic-shock syndrome as-sociated with nasal packing: Analogy to tampon-associated ill-ness. Pediatrics 1984; 73(2): 163 – 5.
Jacobson JA, Kasworm EM. Toxic shock syndrome after nasal surgery. Case reports and analysis of risk factors. Arch Otola-ryngol Head Neck Surg 1986; 112(3): 329 – 32.
Wagner R, Toback JM. Toxic shock syndrome following septop-lasty using plastic septal splints. Laryngoscope 1986; 96(6): 609 – 10.
Yanagisawa E, Latorre R. Choking spells following septorhinoplasty secondary to displaced nasal packing. Ear Nose Throat J 1995; 74(11): 744 – 6.
Stucker FJ, Ansel DG. A case against nasal packing. Laryngos-cope 1978; 88((8 Pt 1): 1314 – 7.
Guyuron B. Is packing after septorhinoplasty necessary? A ran-domized study. Plast Reconstr Surg 1989; 84(1): 41 – 4; discussion 45 – 6.
Reiter D, Alford E, Jabourian Z. Alternatives to packing in septorhinoplasty. Arch Otolaryngol Head Neck Surg 1989; 115(10): 1203 – 5.
Camirand A. Nasal packing in rhinoplasty and septorhinoplas-ty: It is wiser to avoid. Plast Reconstr Surg 1999; 104(4): 1198.
Camirand A, Doucet J, Harris J. Nose surgery (rhinoplasty) without external immobilization and without internal packing: A review of 812 cases. Aesthetic Plast Surg 1998; 22(4): 245 – 52.
Lemmens W, Lemkens P. Septal suturing following nasal septoplasty, a valid alternative for nasal packing?. Acta Otorhinolaryngol Belg 2001; 55(3): 215 – 21.
Al-Arfai AA, Al-Swiahb JN, Al-Harthy S, Al-Essa M. Nasal packing in cosmetic and functional nasal surgery. Saudi Med J 2008; 29(7): 994 – 7.
Erisir F, Oktem F, Inci E. Effect of steroids on eodema and ecchymosis in rhinoplasty. Turck Arch ORL 2001; 39(3): 171 – 5.
Koc S, Gürbüzler L, Yaman H, Eyibilen A, Süren M, Kaya Z, et al. The effectiveness of steroids for edema, ecchymosis, and intraoperative bleeding in rhinoplasty. Am J Rhinol Allergy 2011; 25(2): e95 – 8.
Kelley BP, Koshy J, Hatef D, Hollier LH Jr, Stal S. Packing and postoperative rhinoplasty management: A survey report. Aes-thet Surg J 2011; 31(2): 184 – 9.
Gun R, Yorgancılar E, Yıldırım M, Bakır S, Topcu I, Akkus Z. Effects of lidocaine and adrenaline combination on postop-erative edema and ecchymosis in rhinoplasty. Int J Oral Maxillofac Surg 2011; 40(7): 722 – 9.
Zayyan E, Bajin MD, Aytemir K, Yılmaz T. The effects on car-diac functions and arterial blood gases of totally occluding nasal packs and nasal packs with airway. Laryngoscope 2010; 120(11): 2325 – 30.
Günaydın RÖ, Aygenc E, Karakullukcu S, Fidan F, Celikkanat S. Nasal packing and transseptal suturing techniques: Surgical and anaesthetic perspectives. Eur Arch Otorhinolaryngol 2011; 268(8): 1151 – 6.
Cukurova I, Cetinkaya EA, Mercan GC, Demirhan E, Gumussoy M. Retrospective analysis of 697 septoplasty surgery cases: Packing versus trans-septal suturing method. Acta Otorhinolaryngol Ital 2012; 32(2): 111 – 4.
Sakallioğlu Ö, Polat C, Soylu E, Düzer S, Orhan İ, Akyiğit A. The efficacy of tranexamic acid and corticosteroid on edema and ecchymosis in septorhinoplasty. Ann Plast Surg 2015; 74(4): 392 – 6.