title: Testing the effects of long-acting steroids in edema and ecchymosis after closed rhinoplasty.
abstract: BACKGROUND
  Steroids have proven to be of some benefit in rhinoplasty edema and ecchymosis when administered at a high and repeated dose.
  
  
  OBJECTIVE
  To evaluate the effects of single-dose, long-acting intramuscular steroids on postoperative edema and ecchymosis after closed rhinoplasty with osteotomies compared with placebo.
  
  
  METHODS
  A randomized, double-blinded, placebo-controlled trial was performed. Fifty-four patients were randomly assigned to two groups: 28 received a single dose of long-acting dexamethasone (mean [± SD] dose 16±4 mg) immediately before anesthetic induction; the remaining 26 received an intramuscular injection of saline solution. The same surgeon performed all surgeries, with patients under general anesthesia. Acetaminophen was the only analgesic used to control postoperative pain. High-resolution digital photographs were taken on postoperative days 1, 3, 7 and 14. Scoring was performed separately for eyelid swelling and ecchymosis by an independent observer using a graded scale (0 to 5) for edema and a scoring system (0 to 13) for ecchymosis.
  
  
  RESULTS
  No statistically significant differences in terms of age, sex or amount of bleeding during surgery were found between the two groups. No statistically significant difference was observed in the decrease of both ecchymosis and edema between placebo and high-dose, long-acting dexamethasone. A statistically significant difference in operation time was found, favouring the steroid group. No severe complications were observed due to steroid use.
  
  
  CONCLUSIONS
  Osteotomies are basically a form of (controlled) trauma, with considerable disruption of the abundant blood vessels in this facial region and, therefore, are associated with with undesirable effects. A recent meta-analysis failed to show benefits of the use of steroids after postoperative day 3. Only a trend toward reduction in edema and ecchymosis with the use of long-acting steroids compared with placebo was demonstrated in the present study.
  
  
  CONCLUSIONS
  There was no benefit in administering single-dose, long-acting steroids in patients undergoing closed rhinoplasty with osteotomies.
authors.affiliation: Otolaryngology and Maxillofacial Surgery Department, San Ignacio University Hospital - Pontificia Universidad Javeriana, Bogotá, Colombia;
authors.forename: Santiago
authors.initials: S
authors.lastname: Gutierrez
authors.affiliation: Otolaryngology and Maxillofacial Surgery Department, San Ignacio University Hospital - Pontificia Universidad Javeriana, Bogotá, Colombia; ; University of Toronto Health Network, Toronto, Ontario.
authors.forename: Carolina
authors.initials: C
authors.lastname: Wuesthoff
keywords: Ecchymosis; Edema; Rhinoplasty; Steroids
references.citation: Adv Ther. 2006 Sep-Oct;23(5):809-16
references.pmid: 17142217
references.citation: Eye Ear Nose Throat Mon. 1952 Oct;31(10):548-50
references.pmid: 12989143
references.citation: Arch Otolaryngol Head Neck Surg. 1994 Oct;120(10):1137-41
references.pmid: 7917196
references.citation: Aesthet Surg J. 2011 Aug;31(6):648-57
references.pmid: 21813878
references.citation: Am J Rhinol Allergy. 2011 Mar-Apr;25(2):e95-8
references.pmid: 21679511
references.citation: J Craniomaxillofac Surg. 2013 Mar;41(2):124-8
references.pmid: 22795164
references.citation: Plast Reconstr Surg. 1999 Dec;104(7):2213-8
references.pmid: 11149790
references.citation: Drug Saf. 2000 Nov;23(5):449-61
references.pmid: 11085349
references.citation: Aesthetic Plast Surg. 2006 Mar-Apr;30(2):150-4
references.pmid: 16547634
references.citation: Otolaryngol Head Neck Surg. 2011 May;144(5):698-702
references.pmid: 21493314
references.citation: J Plast Reconstr Aesthet Surg. 2009 May;62(5):650-5
references.pmid: 18359280
references.citation: Arch Otolaryngol Head Neck Surg. 1991 Sep;117(9):990-3; discussion 994
references.pmid: 1910730
references.citation: Plast Reconstr Surg. 2007 Jul;120(1):271-274
references.pmid: 17572575
references.citation: Laryngoscope. 1989 Nov;99(11):1161-4
references.pmid: 2811556
references.citation: Ear Nose Throat J. 1998 Jan;77(1):40-3
references.pmid: 9473831
references.citation: Eur Arch Otorhinolaryngol. 2013 Mar;270(4):1189-93
references.pmid: 22875065
references.citation: Otolaryngol Head Neck Surg. 2000 Jul;123(1 Pt 1):44-7
references.pmid: 10889480
references.citation: Rhinology. 1976 Dec;14(4):163-6
references.pmid: 1006069
references.citation: Ann Plast Surg. 2003 Dec;51(6):570-4
references.pmid: 14646651