Clin Exp Otorhinolaryngol.  2020 Aug;13(3):268-273. 10.21053/ceo.2019.01599.

Effects of Periosteal Elevation Before Lateral Osteotomy in Rhinoplasty: A Meta-Analysis of Randomized Controlled Trials

Affiliations
  • 1Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea

Abstract


Objectives
. Although osteotomy is an important part of rhinoplasty, it is known to be closely related to postoperative eyelid edema and ecchymosis. We aimed to evaluate the effects of periosteal elevation prior to osteotomy on eyelid edema and ecchymosis.
Methods
. Two authors reviewed studies in the Medline, Scopus, and Cochrane databases published through May 2019. Randomized controlled trials comparing periosteal elevation (subperiosteal tunneling) with periosteal preservation that reported eyelid edema or ecchymosis or subconjunctival hemorrhage as outcomes of interest were included. From each study, the baseline characteristics of the study subjects, the quality of the study, the number of patients in the treatment and control groups, and outcomes were extracted.
Results
. Data for meta-analysis were identified in six studies with a total of 208 patients. Eyelid ecchymosis and edema within 3 days postoperatively were significantly more common in the periosteal elevation group than in the preservation group, although such an association was not found for edema on postoperative day 7 (standardized mean difference [SMD], 0.21; 95% confidence interval [CI], –0.09 to 0.50; I2 =0%). There was no significant difference in subconjunctival hemorrhage on day 1 (SMD, 0.31; 95% CI, –0.09 to 0.72; I2 =0%).
Conclusion
. Periosteal preservation during lateral osteotomy may reduce eyelid edema and ecchymosis compared to periosteal elevation. Further studies with rigorous research methods should be carried out to determine the effectiveness of different techniques in lateral osteotomy.

Keyword

Osteotomy; Periosteum; Edema; Ecchymosis; Systematic Review; Meta-analysis

Figure

  • Fig. 1. Diagram of study selection.

  • Fig. 2. Risk of bias assessment. (A) Risk of bias summary. (B) Risk of bias graph.

  • Fig. 3. Periosteal elevation versus periosteal preservation: standard mean difference of eyelid edema within 3 days postoperatively (A) and on postoperative day 7 (B). TE, treatment effect; seTE, standard error of treatment effect; SMD, standardized mean difference; CI, confidence interval.

  • Fig. 4. Periosteal elevation versus periosteal preservation: standard mean difference of eyelid ecchymosis within 3 days postoperatively (A) and on postoperative day 7 (B). TE, treatment effect; seTE, standard error of treatment effect; SMD, standardized mean difference; CI, confidence interval.

  • Fig. 5. Periosteal elevation versus periosteal preservation: standard mean difference of subconjunctival hemorrhage on day 1 postoperatively. TE, treatment effect; seTE, standard error of treatment effect; SMD, standardized mean difference; CI, confidence interval.


Cited by  1 articles

Subperiosteal Tunneling in Lateral Osteotomy: Truth Versus Mere Facts
Hong Ryul Jin
Clin Exp Otorhinolaryngol. 2020;13(3):213-214.    doi: 10.21053/ceo.2020.01214.


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