title: Tumescent steroid infiltration to reduce postoperative swelling after craniofacial surgery.
abstract: 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.
authors.affiliation: Craniofacial Centre, Great Ormond Street Hospital for Children, London, UK.
authors.forename: J G
authors.initials: JG
authors.lastname: Neil-Dwyer
authors.forename: R D
authors.initials: RD
authors.lastname: Evans
authors.forename: B M
authors.initials: BM
authors.lastname: Jones
authors.forename: R D
authors.initials: RD
authors.lastname: Hayward
mesh_terms: 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*
chemical_list: D000779:Anesthetics, Local; D000893:Anti-Inflammatory Agents; D014221:Triamcinolone; D006821:Hyaluronoglucosaminidase; D004837:Epinephrine