This article is a CME (continuing medical education) article. As such it is a review of complications of rhinoplasty. It is a good review and worth reading.
complications following nasal surgery.
- 60-degree head elevation
- gentle nostril pressure for 15 minutes
- application of topical decongestant nasal sprays such as oxymetazoline or phenylephrine.
- Remove the septal splints and gently suction the nasal passages remove blood clots and crusts.
- Cauterize focal areas of bleeding with silver nitrate or place a light hemostatic packing made of methylcellulose over the bleeding surface.
Bleeding that persists despite anterior packing may signify
a posterior bleed from a branch of the sphenopalatine
artery. If so, a posterior pack may be required.
- Patients should be observed for airway compromise while a posterior pack is in place.
- Antibiotics should be administered while packing is in place to reduce the risk of toxic shock syndrome.
- early recognition with prompt evacuation of the hematoma, either via needle aspiration or incision and drainage.
- Antimicrobial therapy should be initiated if a secondary nasal septal abscess is suspected.
rhinoplasty include the nasal dorsum, nasal tip, and septum.
L-Strut Fractures --
When L-strut fractures occur, they should be repaired immediately to prevent significant deformity. If it isn’t, the cartilaginous septal segment will tend to rock posteriorly, resulting in a loss of dorsal support and a saddle-nose deformity.
Epiphora -- after rhinoplasty is most commonly occurs due to compression of the lacrimal system by the soft-tissue edema. It normally resolves after 1 to 2 weeks.
whistling, and nasal airway obstruction due to disruption
of the normal laminar airflow through the nasal passages.
- Local hygiene with nasal saline irrigation
- Obturation with a Silastic septal button
- For small perforations, local advancement flaps with an interposed connective tissue autograft or an allograft can be
used to close the perforation.
Postoperative Septal Deviation -- whether new or uncorrected, following septorhinoplasty is a source of frustration for both the patient and the surgeon. Any significant septal deviation that persists and causes cosmetic or functional impairment may require revision surgery.
the intranasal mucosa. These patients are often effectively treated with topical anticholinergic preparations, such as 0.03% ipratropium bromide which act locally to decrease the watery rhinorrhea. The recommended dosing regimen is two sprays in each nostril two to three times a day as needed.
Postoperative deformities of the osseocartilaginous framework may be caused by overresection or underresection of the osseocartilaginous framework, incorrectly performed osteotomies, incorrect shaping of grafts and their edges, and migration of grafts due to insufficient or inaccurate fixation.
Supratip (“Pollybeak”) Deformity -- is a postoperative complication of rhinoplasty in which the nasal supratip assumes a convex shape in relation to the nasal dorsum. The deformity results either from inadequate resection of the lower dorsal septum and upper lateral cartilages or, paradoxically, from overresection of these supratip structures with subsequent scar tissue formation in the resulting dead space.
dermis in the supratip area. The injections may be repeated at 2-month intervals until an aesthetically pleasing supratip contour is obtained.
deformity of the skin. Other side effects include telangiectasias, depressions, color changes, and eventual visibility of the underlying cartilages or contour imperfections, which may be enhanced by the resulting decrease of skin thickness.
at least 1 year after the initial procedure.
The basic principles include judicious removal of the offending cartilage or scar tissue, adjustment of the osseocartilaginous framework so that the differential between the midvault and the tip is adequate, elimination of dead space by establishing direct contact between the underlying framework and the skin, and application of a dressing with selective compression over the supratip area.
Postrhinoplasty Nasal Cysts -- are a rare complication
of rhinoplasty. The most common site of occurrence for both types of cysts is the nasal dorsum. Both may require complete excision.
- Lipogranulomas or “paraffinomas” are foreign-body inclusion cysts that are thought to arise from the use of petroleum-based
ointments in conjunction with nasal packing.
- Mucous cysts are a second type of nasal cyst that can arise after rhinoplasty. They are thought to arise from ectopic or displaced mucosa and ointment extravasation into osteotomy sites.
- removal of the offending agent
- application of topical and potentially systemic steroids,
depending on the severity of the reaction.
Treatment of minor skin necrosis should initially be conservative.
- Daily wound care, allow the wound to close by secondary intention
- Protection from the sun
- After maturation of the scar, dermabrasion, filler substances, skin care, and laser treatment may be helpful.
Telangiectasias -- are small superficial vessels of the skin visible to the human eye and usually measure 0.1 to 1.0 mm in diameter. Argon and pulsed dye lasers have proven to
be an effective means of treatment.