Tumescent steroid infiltration to reduce postoperative swelling after craniofacial surgery.
Steroids are often administered to paediatric craniomaxillofacial patients perioperatively to reduce postoperative facial swelling, although there is little evidence of their efficacy. Preoperative tumescent infiltration using 7 ml x kg(-1) of a solution consisting of 0.1 mg x ml(-1) triamcinolone acetate, 0.0125% bupivacaine, 0.025% lignocaine, 3 units x ml(-1) hyaluronidase and 1:1000000 adrenaline in Hartmann's solution was evaluated from a retrospective case controlled study of patients undergoing standard fronto-orbital remodelling for simple craniosynostosis (n = 20). Eye closure (i.e. inability to open the eyes) was used as a marker for severe facial swelling. Patients receiving the tumescent infiltration demonstrated significantly less eye closure (P < 0.005), implying that the tumescent infiltration had a significant effect on facial swelling. The avoidance of eye closure allowed more effective monitoring for neurological and ophthalmological complications, which is a significant clinical benefit. The infiltration solution has the advantage of a lower corticosteroid dose than previously reported dexamethasone-based perioperative regimens, thereby minimising any unwanted metabolic effects. The technique is advocated for the reduction of postoperative facial swelling in craniomaxillofacial surgical patients.
Neil-Dwyer
J G
JG
Craniofacial Centre, Great Ormond Street Hospital for Children, London, UK.
Evans
R D
RD
Jones
B M
BM
Hayward
R D
RD
D000779:Anesthetics, Local / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D001762:Blepharitis / Q000188:drug therapy* / Q000209:etiology; D016022:Case-Control Studies; D003398:Craniosynostoses / Q000601:surgery*; D004359:Drug Therapy, Combination; D004487:Edema / Q000517:prevention & control*; D004837:Epinephrine / Q000627:therapeutic use; D006801:Humans; D006821:Hyaluronoglucosaminidase / Q000627:therapeutic use; D007223:Infant; D007279:Injections, Subcutaneous; D007902:Length of Stay; D010149:Postoperative Pain / Q000209:etiology; D011183:Postoperative Complications / Q000517:prevention & control*; D011292:Premedication; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D016896:Treatment Outcome; D014221:Triamcinolone / Q000627:therapeutic use*
D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D014221:Triamcinolone; D006821:Hyaluronoglucosaminidase; D004837:Epinephrine