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Tumescent steroid infiltration to reduce postoperative swelling after craniofacial surgery
J G Neil-Dwyer1, R D Evans, B M Jones
1Craniofacial Centre, Great Ormond Street Hospital for Children, London, UK.
Insights
Preoperative tumescent infiltration significantly reduced facial swelling in pediatric craniomaxillofacial surgery patients. This technique offers a safer alternative to traditional steroid use for managing post-operative swelling.
Area of Science:
- Plastic Surgery
- Pediatric Surgery
- Anesthesiology
Background:
- Perioperative steroids are commonly used for pediatric craniomaxillofacial swelling with limited evidence.
- Severe facial swelling can impede monitoring for complications.
Purpose of the Study:
- To evaluate the efficacy of preoperative tumescent infiltration in reducing facial swelling.
- To assess the clinical benefits of minimizing post-operative swelling.
Main Methods:
- Retrospective case-controlled study (n=20) of fronto-orbital remodeling for craniosynostosis.
- Tumescent infiltration: 7 ml/kg of triamcinolone acetate, bupivacaine, lignocaine, hyaluronidase, and adrenaline in Hartmann's solution.
- Eye closure was used as a primary outcome measure for severe facial swelling.
Main Results:
- Patients receiving tumescent infiltration showed significantly less eye closure (P < 0.005).
- This indicates a significant reduction in facial swelling.
- Avoidance of eye closure facilitated better monitoring for neurological and ophthalmological issues.
Conclusions:
- Preoperative tumescent infiltration is effective in reducing post-operative facial swelling in pediatric craniomaxillofacial surgery.
- The technique uses a lower corticosteroid dose, minimizing metabolic side effects.
- This method is recommended for managing facial swelling in these patients.
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.