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Published in: Aesthetic Plastic Surgery 1/2018

01-02-2018 | Original Article

Comparison of the Effect of Dexamethasone and Tranexamic Acid, Separately or in Combination on Post-Rhinoplasty Edema and Ecchymosis

Authors: Mohammad Mehdizadeh, Alireza Ghassemi, Mohammad Khakzad, Mehrafza Mir, Leili Nekoohesh, Aliakbar Moghadamnia, Ali Bijani, Zahra Mehrbakhsh, Hosein Ghanepur

Published in: Aesthetic Plastic Surgery | Issue 1/2018

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Abstract

Background

Dexamethasone and tranexamic acid are used to decrease post-rhinoplasty periorbital edema and ecchymosis. We compared the impact of each medication separately or in combination in this regard.

Methods

A prospective, randomized triple-blinded study was undertaken on 60 patients who underwent primary open rhinoplasty. They were divided into four groups: Group D (n = 15) received 8 mg dexamethasone, group T (n = 15) received 10 mg/kg tranexamic acid, group DT (n = 15) received both 8 mg dexamethasone and 10 mg/kg tranexamic acid, and group P (n = 15) received neither medication and served as the placebo control group. The medications were given intravenously (IV) 1 h before and three doses every 8 h postoperatively. Digital photographs were taken on the first, third and seventh postoperative days. One expert examiner blinded to the study evaluated the periorbital edema and ecchymosis on a scale of 0–4. Periorbital edema and ecchymosis were examined in all groups.

Results

In group D, group T and group DT, periorbital edema and ecchymosis ratings were significantly lower compared with the control group (p < 0.01). No statistically significant difference was seen in preventing or decreasing both periorbital edema and ecchymosis among group D, group T and group DT.

Conclusion

Tranexamic acid and dexamethasone, separately or in combination, had similar effects in reducing periorbital edema and ecchymosis in open rhinoplasty. Combined application did not show a significantly higher beneficial effect in this regard.

Level of Evidence III

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.​springer.​com/​00266.
Literature
1.
go back to reference Tebbetts JB (2008) Primary Rhinoplasty, 2nd edn. Elsevier, canada Tebbetts JB (2008) Primary Rhinoplasty, 2nd edn. Elsevier, canada
2.
go back to reference Totonchi A, Guyuron B (2007) A Randomized, controlled comparison between arnica and steroids in the management of postrhinoplasty ecchymosis and edema. Plast Reconstr Surg 120:271–274CrossRefPubMed Totonchi A, Guyuron B (2007) A Randomized, controlled comparison between arnica and steroids in the management of postrhinoplasty ecchymosis and edema. Plast Reconstr Surg 120:271–274CrossRefPubMed
3.
go back to reference Sakallioglu O, Polat C, Soylu E, Duzer S, Orhan I, Akyigit A (2015) The efficacy of tranexamic acid and corticosteroid on edema and ecchymosis in septorhinolasty. Ann Plast Surg 74:392–396CrossRefPubMed Sakallioglu O, Polat C, Soylu E, Duzer S, Orhan I, Akyigit A (2015) The efficacy of tranexamic acid and corticosteroid on edema and ecchymosis in septorhinolasty. Ann Plast Surg 74:392–396CrossRefPubMed
4.
go back to reference Gutierrez S, Wuesthoff C (2014) Testing the effects of long-acting steroids in edema and ecchymosis after closed rhinoplasty. Plast Surg 22:83–87 Gutierrez S, Wuesthoff C (2014) Testing the effects of long-acting steroids in edema and ecchymosis after closed rhinoplasty. Plast Surg 22:83–87
5.
go back to reference Alajmi MA, Al- Abdulhadi KA, AL- Noumas HS, Kavitha G (2009) Results of intravenous steroid injection on reduction of postoperative edema in rhinoplasty. Indian J otolaryngol Head Neck Surg 61:266–269CrossRefPubMed Alajmi MA, Al- Abdulhadi KA, AL- Noumas HS, Kavitha G (2009) Results of intravenous steroid injection on reduction of postoperative edema in rhinoplasty. Indian J otolaryngol Head Neck Surg 61:266–269CrossRefPubMed
6.
go back to reference Ong AA, Farhood Z, kyle AR, Patal KG (2016) Interventions to decrease postoperative edema and ecchymosis after rhinoplasty: a systematic review of the literature. Plast Reconstr Surg 137:1448–1462CrossRefPubMed Ong AA, Farhood Z, kyle AR, Patal KG (2016) Interventions to decrease postoperative edema and ecchymosis after rhinoplasty: a systematic review of the literature. Plast Reconstr Surg 137:1448–1462CrossRefPubMed
7.
go back to reference Ghassemi A, Prescher A, Hilgers RD, Riediger D, Gerressen M (2011) Effect of the sequence of lateral osteotomy and hump removal on the aesthetic outcome. Aesthetic Plast Surg 35:603–607CrossRefPubMed Ghassemi A, Prescher A, Hilgers RD, Riediger D, Gerressen M (2011) Effect of the sequence of lateral osteotomy and hump removal on the aesthetic outcome. Aesthetic Plast Surg 35:603–607CrossRefPubMed
8.
go back to reference Rohrich RJ, Janis JE, Adams WP, Krueger JK (2003) An update on the lateral nasal osteotomy in rhinoplasty: an anatomic endoscopic comparison of the external versus the internal approach. Plast Reconstr Surg 111:2461–2462CrossRefPubMed Rohrich RJ, Janis JE, Adams WP, Krueger JK (2003) An update on the lateral nasal osteotomy in rhinoplasty: an anatomic endoscopic comparison of the external versus the internal approach. Plast Reconstr Surg 111:2461–2462CrossRefPubMed
9.
go back to reference Robiony M, Toro C, Costa F, Sembronio S, Polini F, Politi M (2007) Piezosurgery: a new method for osteotomies in rhinoplasty. J Craniofac Surg 18:1098–1100CrossRefPubMed Robiony M, Toro C, Costa F, Sembronio S, Polini F, Politi M (2007) Piezosurgery: a new method for osteotomies in rhinoplasty. J Craniofac Surg 18:1098–1100CrossRefPubMed
10.
go back to reference Ghassemi A, Ayoub A, Modabber A, Bohluli B, Prescher A (2013) Lateral nasal osteotomy: a comparative study between the use of osteotome and a diamond surgical burr—A cadaver study. Head face med 9:41–46CrossRefPubMedPubMedCentral Ghassemi A, Ayoub A, Modabber A, Bohluli B, Prescher A (2013) Lateral nasal osteotomy: a comparative study between the use of osteotome and a diamond surgical burr—A cadaver study. Head face med 9:41–46CrossRefPubMedPubMedCentral
11.
go back to reference Alzacko SM, Muttalib AA, Al- khayat N, Altakal FS (2010) The effects of single dose dexamethasone on periorbital oedema and ecchymosis after rhinoplasty. J plast reconstr surg 34:147–151 Alzacko SM, Muttalib AA, Al- khayat N, Altakal FS (2010) The effects of single dose dexamethasone on periorbital oedema and ecchymosis after rhinoplasty. J plast reconstr surg 34:147–151
12.
go back to reference McCormack PL (2012) Tranexamic acid: a review of its use in the treatment of hyperfibrino lysis. Drugs 72:585–617CrossRefPubMed McCormack PL (2012) Tranexamic acid: a review of its use in the treatment of hyperfibrino lysis. Drugs 72:585–617CrossRefPubMed
13.
go back to reference Langille MA, Chiarella A, Cote DWJ, Mulholland G, Sowerby LJ, Dziegielewski PT, Wright ED (2012) Intravenous tranexamic acid and intraoperative visualization during functional endoscopic sinus surgery: a double-blind randomized controlled trial. Int Forum of Allergy Rhinol 3(4):315–318CrossRef Langille MA, Chiarella A, Cote DWJ, Mulholland G, Sowerby LJ, Dziegielewski PT, Wright ED (2012) Intravenous tranexamic acid and intraoperative visualization during functional endoscopic sinus surgery: a double-blind randomized controlled trial. Int Forum of Allergy Rhinol 3(4):315–318CrossRef
14.
go back to reference Gurlek A, Fariz A, Aydogan H, Ersoz-Ozturk A, Eren AT (2006) Effects of different cortico steroids on edema and ecchymosis in open rhinoplasty. Aesthetic Plast Surg 30:150–154CrossRefPubMed Gurlek A, Fariz A, Aydogan H, Ersoz-Ozturk A, Eren AT (2006) Effects of different cortico steroids on edema and ecchymosis in open rhinoplasty. Aesthetic Plast Surg 30:150–154CrossRefPubMed
15.
go back to reference Jalali MM, Moosavi S, Fatemi S, Banan RA (2011) Comparison between dexamethasone and tranexamic acid on postoperative edema and ecchymosis after rhinoplasty operation. J Guilan Univ Med Sci 81:72–76 Jalali MM, Moosavi S, Fatemi S, Banan RA (2011) Comparison between dexamethasone and tranexamic acid on postoperative edema and ecchymosis after rhinoplasty operation. J Guilan Univ Med Sci 81:72–76
16.
go back to reference Owsley JQ, weibel TJ, Adams WA (1996) Does steroid medication reduce facial edema following face lift surgery? A prospective, randomized study of 30 consecutive patients. Plast Reconstr Surg 98:1–6CrossRefPubMed Owsley JQ, weibel TJ, Adams WA (1996) Does steroid medication reduce facial edema following face lift surgery? A prospective, randomized study of 30 consecutive patients. Plast Reconstr Surg 98:1–6CrossRefPubMed
17.
go back to reference Da silva EM, Hochman B, Ferreira LM (2014) Perioperative corticosteroids for preventing complications following facial plastic surgery. Sao Paulo Med J 132:316CrossRef Da silva EM, Hochman B, Ferreira LM (2014) Perioperative corticosteroids for preventing complications following facial plastic surgery. Sao Paulo Med J 132:316CrossRef
18.
go back to reference Berinstein TH, Bane SM, Cupp CL, Demarco JK, Hunsaker DH (1998) Steroid use in rhinoplasty: an objective assessment of postoperative edema. Ear Nose Throat J 77:40–43PubMed Berinstein TH, Bane SM, Cupp CL, Demarco JK, Hunsaker DH (1998) Steroid use in rhinoplasty: an objective assessment of postoperative edema. Ear Nose Throat J 77:40–43PubMed
19.
go back to reference Kara CO, Gokalan I (1999) Effects of single dose steroid usage on edema, ecchymosis, and intraoperative bleeding in rhinoplasty. Plast Reconstr Surg 104:2213–2218CrossRefPubMed Kara CO, Gokalan I (1999) Effects of single dose steroid usage on edema, ecchymosis, and intraoperative bleeding in rhinoplasty. Plast Reconstr Surg 104:2213–2218CrossRefPubMed
20.
go back to reference Hatef DA, Ellsworth WA, Allen JN, Bullocks JM, Hollier LH Jr, Stal S (2011) Perioperative steroids for minimizing edema and ecchymosis after rhinoplasty: a meta- analysis. Aesthet surg j 31:648–657CrossRefPubMed Hatef DA, Ellsworth WA, Allen JN, Bullocks JM, Hollier LH Jr, Stal S (2011) Perioperative steroids for minimizing edema and ecchymosis after rhinoplasty: a meta- analysis. Aesthet surg j 31:648–657CrossRefPubMed
21.
go back to reference Hwang SH, Lee JH, kim BG, Kim SW, Kang JM (2015) The efficacy of steroids for edema and ecchymosis after rhinoplasty: a meta- analysis. Laryngoscope 125:92–98CrossRefPubMed Hwang SH, Lee JH, kim BG, Kim SW, Kang JM (2015) The efficacy of steroids for edema and ecchymosis after rhinoplasty: a meta- analysis. Laryngoscope 125:92–98CrossRefPubMed
22.
go back to reference Kargi E, Hosnuter M, Babuccu O, Altunkaya H, Altinyazar C (2003) Effect of steroids on edema, ecchymosis, and intraoperative bleeding. Ann Plast Surg 51:570–574CrossRefPubMed Kargi E, Hosnuter M, Babuccu O, Altunkaya H, Altinyazar C (2003) Effect of steroids on edema, ecchymosis, and intraoperative bleeding. Ann Plast Surg 51:570–574CrossRefPubMed
23.
go back to reference Tengborn L, Blomback M, Berntorp E (2015) Tranexamic acid- an old drug still going strong and making a revival. Thromb Res 135:231–242CrossRefPubMed Tengborn L, Blomback M, Berntorp E (2015) Tranexamic acid- an old drug still going strong and making a revival. Thromb Res 135:231–242CrossRefPubMed
24.
go back to reference Dunn CJ, Goa KL (1999) Tranexamic acid: a review of its use in surgery and other indications. Drugs 57:1005–1032CrossRefPubMed Dunn CJ, Goa KL (1999) Tranexamic acid: a review of its use in surgery and other indications. Drugs 57:1005–1032CrossRefPubMed
25.
go back to reference Yaniv E, Shvero J, Hadar T (2006) Hemostatic effect of tranexamic acid in elective nasal surgery. Am J Rhinol 20:227–229PubMed Yaniv E, Shvero J, Hadar T (2006) Hemostatic effect of tranexamic acid in elective nasal surgery. Am J Rhinol 20:227–229PubMed
26.
go back to reference Eftekharian HR, Rajabzadeh Z (2015) The efficacy of preoperative oral tranexamic acid on intraoperative bleeding during rhinoplasty: a clinical trial study. J craniofac surg 27:97–100CrossRef Eftekharian HR, Rajabzadeh Z (2015) The efficacy of preoperative oral tranexamic acid on intraoperative bleeding during rhinoplasty: a clinical trial study. J craniofac surg 27:97–100CrossRef
27.
go back to reference Ghavimi MA, Taheri Talesh K, Ghoreishizadeh A (2017) Efficacy of tranexamic acid on side effects of rhinoplasty: a randomized double- blind study. J Craniomaxillofac Surg 45:897–902CrossRefPubMed Ghavimi MA, Taheri Talesh K, Ghoreishizadeh A (2017) Efficacy of tranexamic acid on side effects of rhinoplasty: a randomized double- blind study. J Craniomaxillofac Surg 45:897–902CrossRefPubMed
Metadata
Title
Comparison of the Effect of Dexamethasone and Tranexamic Acid, Separately or in Combination on Post-Rhinoplasty Edema and Ecchymosis
Authors
Mohammad Mehdizadeh
Alireza Ghassemi
Mohammad Khakzad
Mehrafza Mir
Leili Nekoohesh
Aliakbar Moghadamnia
Ali Bijani
Zahra Mehrbakhsh
Hosein Ghanepur
Publication date
01-02-2018
Publisher
Springer US
Published in
Aesthetic Plastic Surgery / Issue 1/2018
Print ISSN: 0364-216X
Electronic ISSN: 1432-5241
DOI
https://doi.org/10.1007/s00266-017-0969-x

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