Effects of high dose corticosteroids in open rhinoplasty

Although some studies about the effects of steroids on surgical trauma in closed or combined (closed and open together) rhinoplasty have been reported in the literature, still more information is needed in order to enlighten rhinoplasty surgeons. The purpose of this study is to evaluate the anti-inflammatory activity of steroids administered in high doses to prevent and decrease periorbital ecchymosis and oedema in patients who underwent open rhinoplasty with osteotomies by the same surgeon. This is the first study in open rhinoplasty alone.

The study was performed on 40 patients, under general anaesthesia. Patients were divided randomly into five groups (eight patients in each group); the groups comprised: a single 250 mg dose of methylprednisolone (Group I), a single 500 mg dose of methylprednisolone (Group II), four 250 mg doses of methylprednisolone (Group III), four 500 mg doses of methylprednisolone (Group IV) and placebo (Group V). Digital photographs were taken of each patient on the first, third and seventh postoperative days. Scorings of eyelid swelling and ecchymosis were evaluated separately using a graded scale from 0 to (+) 4 by three observers, independently. Additionally, blood samples were taken for the evaluations of C-reactive protein (CRP), white blood cell (WBC) and erythrocyte sedimentation rate (ESR) on the same days.

Clinically and statistically significant difference was observed in the decrease of both ecchymosis and oedema, between the placebo and high dose methylprednisolone groups, which is effective to prevent and to decrease both the ecchymosis and oedema in open rhinoplasty with osteotomies. CRP was the most sensitive acute phase reactant among CRP, ESR and WBC. No complication was observed due to steroid usage.

We can confidently say that high dose methylprednisolone is effective in preventing and reducing both the periorbital ecchymosis and oedema in open rhinoplasty with osteotomies and it can be used safely for this purpose.