The Efficacy Of Steroids For Edema And Ecchymosis After Rhinoplasty With Meta-analysis

Background and ObjectiveThe nose is located in the central of the face. The position is significant and independent, which makes it a decisive role in the whole facial aes thetics stereo structure. Because of the different race, the nose shape is also very different. Most of Asians’dorsum nasi collapsing like a "saddle", the tip of the nose have a thick skin, the appearance is mast and obtuse. Alar cartilage easily appears achondroplasia with a broad base, short columella, nasolabial angle acuteness, and nostril oval. Therefore, many Asians want to improve their nasal morphology through surgical operation. However, the procedure can result in significant intraoperative bleeding, periorbital edema, and ecchymosis, which frequently cause increased morbidity. Intraoperative bleeding may increase operation time, prevent the surgeon from attaining optimal aesthetic results, and increase the postoperative recovery time and resumption of one’s social life. In addition, the effects of periorbital edema and ecchymosis may be quite distressing for patients. But at present, domestic for post-operative complications’ discussion always focus on the infection, poor form, or exposure risk etc. There are few research on the edema and ecchymosis cases. Some retrospective studies with small case number was doing, but it is difficult to get a significant conclusion. Meta-analysis is a new way to combine the results of several independent studies and use statistical procedure to get the conclusion. As a popular method in clinical study, the Meta-analysis approach overcomes the drawback of independent study through combing smaller trials evaluating the same area, accurately reflects the mathematic results and achieves the interaction of literature evaluation and statistic method. Evidence based medicine was introduced in the study to explore appropriate surgical method for clinical activation.Matertials and Methods1. Detailed Meta-analysis standardization of the inclusion and exclusion criteria which was formed by the systematic review, including the type of research, interventions, data extracted and outcome of events.2. MEDLINE (1966-2015) was searched in English, and the keywords include rhinoplasty, steroid, corticosteroid, edema, ecchymosis. The related articles function was used to expand the search result from each relevant study identified, and quality of included studies were assessed.3. Meta-analysis of selected studies with a continuous measure was performed with R statistical software. The standardized mean difference (SMD) was chosen to calculate effect sizes to assess intraoperative bleeding, edema, and ecchymosis. Heterogeneity was calculated with the I2test. Using an Egger test simultaneously to detect publication bias. Additionally, sensitivity analyses were carried out to estimate the influence of each individual study in the meta-analysis results.ResultsThe lower and upper eyelid edema during the7days postoperatively was statistically decreased in the steroid group versus control group. The lower and upper eyelid ecchymosis in the steroid group was significantly decreased in comparison to the control group for the first4days follow surgery. Regarding the outcome comparison between single-dose and multiple-dose administration of steroids, the multiple-dose administration decreased edema and ecchymosis significantly compared to single-dose administration after the fourth day. Conclusion1. Perioperative administration of steroid during rhinoplasty could reduce the level of edema and eyelid ecchymosis.2. Multiple-dose administration of steroids has more advantages in terms of the outcomes of late postoperative edema and ecchymosis compared to a single-dose regimen.