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Khan M, AlRajhi B, Turkistani L, Alzubaidi FA, Almosa W, Abu Alqam R, Mortada H, Obeid FM, Alarfaj A. Efficacy and Safety of Triamcinolone Acetonide Injections Following Rhinoplasty: A Systematic Review of Recommended Doses, Complications, and Outcomes. Aesthetic Plast Surg 2024:10.1007/s00266-024-03967-6. [PMID: 38519572 DOI: 10.1007/s00266-024-03967-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Accepted: 02/27/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Triamcinolone acetonide injections (TAIs) have been suggested to decrease complications following rhinoplasty. This systematic review aimed to assess the efficacy and safety of TAIs following rhinoplasty. METHODS We performed a systematic literature search on Medline, Embase, Google Scholar, and Cochrane Central Register of Controlled Trials from inception to May 2023, without any timeframe limitations. The following terms were used: (Triamcinolone OR steroid injections OR triamcinolone acetonide) AND (Skin thickness OR supratip edema OR supratip deformity OR Pollybeak deformity) AND (rhinoplasty OR external rhinoplasty). We included randomized controlled trials and observational studies (prospective, retrospective, and case series). RESULTS In total, six of the 1604 articles met our inclusion criteria. A total of 1524 patients were included in this study. Our results included patient demographics, type of rhinoplasty, post-injection follow-up period, site of injection, type of syringe used, timing of the first dose, volume and concentration used, time interval between doses, response to the injection, and complications of injection. CONCLUSION To our knowledge, this is the first systematic review to address this issue. Our results demonstrate the ease and safety of TAIs as a first-line treatment, with positive outcomes and limited complications. TAIs can be used early postoperatively to minimize the need for revision surgery. Despite the limited number of studies on TAIs, this study provides the best available evidence that can help surgeons decide when to use the injection, the intervals between doses, and the duration of use. Further randomized controlled trials are required to confirm our findings. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Mohammed Khan
- Department of Otolaryngology, Head and Neck Surgery, King Saud University, Riyadh, Saudi Arabia
- Department of Otolaryngology, Head and Neck Surgery, King Abdulaziz Specialist Hospital, Taif, Saudi Arabia
| | - Bassam AlRajhi
- College of Medicine, King Saud bin Abdulaziz University for Health Science, Jeddah, Saudi Arabia.
| | - Leenah Turkistani
- Department of Otolaryngology Head and Neck Surgery, King Abdulaziz University Hospital, Jeddah, Saudi Arabia
| | - Fatimah Ali Alzubaidi
- Department of Otolaryngology, Head and Neck Surgery, King Abdullah Medical City, Mecca, Saudi Arabia
| | - Wedyan Almosa
- Department of Otorhinolaryngology, Head and Neck Surgery, Alnoor Specialist Hospital, Makkah, Saudi Arabia
| | - Rakan Abu Alqam
- College of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hatan Mortada
- Division of Plastic Surgery, Department of Surgery, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
- Department of Plastic Surgery and Burn Unit, King Saud Medical City, Riyadh, Saudi Arabia
| | - Faisal M Obeid
- Department of Surgery, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
| | - Ahmed Alarfaj
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, King Saud University, Riyadh, Saudi Arabia
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Wu TJ, Huang YL, Kang YN, Chiu WK, Chen JH, Chen C. Comparing the efficacy of different steroids for rhinoplasty: A systematic review and network meta-analysis of randomized controlled trials. J Plast Reconstr Aesthet Surg 2023; 84:121-131. [PMID: 37329745 DOI: 10.1016/j.bjps.2023.04.087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 04/13/2023] [Accepted: 04/26/2023] [Indexed: 06/19/2023]
Abstract
BACKGROUND Rhinoplasty can cause tissue trauma and inflammatory responses. Edema and ecchymosis, especially on the face, accompanied by inflammation are common complications. The anti-inflammatory properties of steroids can reduce postoperative edema and ecchymosis. OBJECTIVE This review aims to determine the most effective type of steroids for preventing complications related to rhinoplasty. METHODS The study was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The population of comprised patients who underwent rhinoplasty or septorhinoplasty. Different types of steroids administrated intravenously during the perioperative period were compared. The primary outcome of postoperative edema and other outcomes were evaluated on postoperative day 1, 3, and 7. Random-effects model was performed. The means and standard deviations were extracted. RESULTS Eighteen randomized controlled trials were included. The network meta-analysis revealed that dexamethasone and methylprednisolone significantly reduced edema on postoperative day 1 compared with placebo. No significant differences between the effects of any of two types of steroids were noted. CONCLUSION At least one dose of intravenous steroid intervention is recommended during the perioperative period of rhinoplasty. However, in terms of reducing edema and ecchymosis, no significant differences were noted among dexamethasone, methylprednisolone, and betamethasone.
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Affiliation(s)
- Ting-Ju Wu
- School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan.
| | - Ya-Li Huang
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
| | - Yi-No Kang
- Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taiwan; Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taiwan; Cochrane Taiwan, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, Taiwan.
| | - Wen-Kuan Chiu
- Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taiwan; Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, Taiwan.
| | - Jin-Hua Chen
- Graduate Institute of Data Science, College of Management, Taipei Medical University, Taipei, Taiwan; Biostatistics Center, College of Management, Taipei Medical University, Taipei, Taiwan.
| | - Chiehfeng Chen
- Department of Public Health, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Evidence-Based Medicine Center, Wan Fang Hospital, Taipei Medical University, Taiwan; Cochrane Taiwan, Taipei Medical University, 250 Wu-Hsing Street, Taipei City, Taiwan; Division of Plastic Surgery, Department of Surgery, Wan Fang Hospital, Taipei Medical University, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, Taipei Medical University, Taiwan.
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Coppey E, Loomans N, Mommaerts MY. Prevention and non-surgical treatment of soft tissue polly beak deformity after rhinoplasty: a scoping review. J Craniomaxillofac Surg 2023; 51:79-88. [PMID: 36805841 DOI: 10.1016/j.jcms.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 01/22/2023] [Accepted: 02/04/2023] [Indexed: 02/11/2023] Open
Abstract
The aim of this study is to map the available evidence of surgical preventive measures and postoperative methods for addressing supratip fibrosis (polly beak deformity) following rhinoplasty, to describe the postoperative results and to identify the most effective techniques. A scoping review was performed, selecting articles from the following medical electronic databases: PubMed, Cochrane Central, EMBASE, and Web of Science up to October 2022. The following keywords were used: supratip fullness, supratip deformity, polly beak deformity and supratip fibrosis. A total of 19 studies met the eligibility criteria. Of these 18 were included, and were divided into two categories: studies that solely used non-surgical management and studies that used operative techniques to prevent soft tissue polly beak deformity. Cartilaginous causes of polly beak deformity were excluded. Although a number of different methods are described in literature, the effectiveness and potential of each are still open to debate. Randomized controlled trials that use a standardized objective measurement method for soft tissue polly beak deformity are needed to objectively compare different methods.
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Affiliation(s)
- Erica Coppey
- European Face Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, 1090, Belgium.
| | - Natalie Loomans
- Departement of Maxillofacial Surgery, GZA Ziekenhuizen Antwerpen, Wilrijk, 2610, Belgium
| | - Maurice Y Mommaerts
- European Face Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Brussels, 1090, Belgium; Departement of Maxillofacial Surgery, GZA Ziekenhuizen Antwerpen, Wilrijk, 2610, Belgium
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Kucukguven A, Konas E. Fine-Tuning of the Supratip in Rhinoplasty: An External Approach. Aesthetic Plast Surg 2022; 46:2938-2946. [PMID: 36042029 DOI: 10.1007/s00266-022-03067-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 08/08/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Supratip deformity, also known as the pollybeak deformity, accounts for one of the most common iatrogenic deformities requiring revision surgery in rhinoplasty. We aimed to present a novel technique to prevent supratip deformity and increase the tip definition, especially in patients with thick skin. METHODS A total of eighty-three patients were included in the study. In control group, thirty-three consecutive patients with thick skin underwent structured primary rhinoplasty without any additional maneuvers. In study group, thirty-one consecutive patients with thick skin underwent the same operation with an additional "External supratip suture (ESS)." Nineteen patients with moderate skin were also operated using the ESS to accentuate the supratip break and control the soft tissue response. Patients' supratip regions were analyzed with reference to a tangent line from the tip defining point to the nasion. Two independent blinded plastic surgeons rated the supratip aesthetics on a 5-point scale. RESULTS The ESS maneuver had better results in the supratip region according to the two parameters which were statistically significant (p < 0.05). No ischemic complications were observed. CONCLUSION This simple and reliable external approach is a powerful maneuver which can be an effective technique not only in patients with thick skin, but also in moderate skin patients who requires better supratip definition. It enables surgeon to reduce the nasal volume efficiently in patients with noncompliant skin by controlling skin redraping by adhering to Auersvald's hemostatic net principles. We believe that this approach will find a place in the armamentarium of rhinosurgeons. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.
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Affiliation(s)
- Arda Kucukguven
- Department of Plastic, Reconstructive and Aesthetic Surgery, University of Health Sciences, Ankara Training and Research Hospital, 06080, Altindag, Ankara, Turkey.
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Karimi S, Sadeghi M, Amali A, Saedi B. Effect of Photobiomodulation on Ecchymosis after Rhinoplasty: A Randomized Single-Blind Controlled Trial. Aesthetic Plast Surg 2020; 44:1685-1691. [PMID: 32410200 DOI: 10.1007/s00266-020-01760-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/30/2020] [Indexed: 01/16/2023]
Abstract
BACKGROUND This study was conducted to compare the effect of photobiomodulation therapy (low-level laser therapy) on ecchymosis after rhinoplasty. SUBJECTS AND METHODS Sixty rhinoplasty candidates were randomly divided into two groups. Photobiomodulation, including red light (660 nm), infrared light (840 nm), and infrared laser, was used in the first group on the first postoperative day, and its effect on periorbital ecchymosis was evaluated. RESULTS The findings showed that low-power laser reduced ecchymosis significantly (p = 0.005*). CONCLUSION Photobiomodulation may be effectively used for reducing ecchymosis after rhinoplasty. LEVEL OF EVIDENCE II This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 . RCT registration number is IRCT20080820001056N3.
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Affiliation(s)
- Somaye Karimi
- Otolaryngology Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Bagherkhan Street, Chamran Highway, Tehran, 141973141, Iran
| | - Mohammad Sadeghi
- Otolaryngology Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Bagherkhan Street, Chamran Highway, Tehran, 141973141, Iran
| | - Amin Amali
- Otolaryngology Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Bagherkhan Street, Chamran Highway, Tehran, 141973141, Iran
| | - Babak Saedi
- Otolaryngology Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Bagherkhan Street, Chamran Highway, Tehran, 141973141, Iran.
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Hassan Y, Leveille CF, Gallo L, Santos J, Thoma A, McRae MH, McRae MC. Reporting Outcomes and Outcome Measures in Open Rhinoplasty: A Systematic Review. Aesthet Surg J 2020; 40:135-146. [PMID: 31051500 DOI: 10.1093/asj/sjz138] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Comparative studies have shown little statistical difference in outcomes following rhinoplasty, demonstrating near equivalent results across all surgical techniques. Cross-study comparisons of these trials are difficult because variation in outcome reporting prevents statistical pooling and analysis. OBJECTIVES The authors sought to identify all outcomes and outcome measures used to evaluate postoperative results in rhinoplasty. METHODS An extensive computerized database search of MEDLINE and EMBASE was performed; all trials involving n ≥ 20 patients, aged 18 years and older undergoing a primary, open rhinoplasty procedure, were included for review. RESULTS Of the 3235 citations initially screened, 72 studies met the stated inclusion criteria. A total of 53 unique outcomes and 55 postoperative outcome measures were identified. Outcomes were divided into 6 unique domains: objective signs, subjective symptom severity, physical function related to activities of daily living, patient satisfaction, surgeon satisfaction, and quality of life. The identified outcome measures consisted of 5 nasal-specific, author-reported instruments; 5 nasal specific, patient-reported instruments; 5 patient-reported, generic instruments; and 40 author-generated instruments. Of the outcome measures identified, the Rhinoplasty Outcomes Evaluation, Sino-Nasal Outcome Test-22, and FACE-Q were the only instruments to demonstrate adequate validity, reliability, and responsiveness to change in patients who underwent a rhinoplasty procedure. CONCLUSIONS There is heterogeneity in the outcomes and outcome measures employed to assess postsurgical outcomes following rhinoplasty. A standardized core outcome set is urgently needed to make it possible for future investigators to compare results of various techniques in rhinoplasty surgery. LEVEL OF EVIDENCE: 2
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Affiliation(s)
| | | | - Lucas Gallo
- McMaster University, Hamilton, Ontario, Canada
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Psaltis AJ. Beyond Borders and Sinuses: Rhinology and Allergy Research on a World Stage. Am J Rhinol Allergy 2017. [DOI: 10.2500/ajra.2017.31.4493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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