INTRODUCTION
Septorhinoplasty is a commonly performed procedure in the Ear-Nose-Throat (ENT) clinics. In standard septorhinoplasty, osteotomies can cause significant periorbital edema and ecchymosis which result from injury in the vessels passing through the osteotomy areas and broken nasal bones and lead to a significant increase in morbidity. Accordingly, rapid recovery is of prime importance for patients undergoing septorhinoplasty. On the other hand, although edema and ecchymosis can be reduced with careful surgical techniques, they cannot be prevented completely [1,2].
Arnica is a genus of herbaceous plants native to Europe and the mountains of Western North America which has gained increasing popularity in complementary and alternative medicine. Due to its hematopoietic properties, arnica plays a key role in reducing edema and ecchymosis [3,4]. Although its exact mechanism in the reduction of edema and ecchymosis remains unclear, various theories have been proposed. Among these, one theory posits that arnica reduces histamine release via mast cells and another theory proposes that arnica reduces the expression of proinflammatory cytokines as well [3-7]. On the other hand, some of the studies examining the efficacy of arnica have shown its favorable effects on edema, ecchymosis, and pain [8-12].
Bromelain is a mixture of protease enzymes derived from the stems of pineapples which is primarily used for its antiedema, antithrombotic, and fibrinolytic properties [3,13]. Although the exact mechanism of bromelain is not fully elucidated, its main mechanism of action is considered to be through NF-kB inhibition. In in-vitro studies, bromelain has been shown to reduce prostaglandin E2, thromboxane B2, and interleukin-8. Moreover, bromelain has also been shown to increase blood flow and oxygenation of the injured area [3,14-16]. On the other hand, several studies examining the efficacy of bromelain have shown its beneficial effects on edema, ecchymosis, and pain as well [17-20].
The present study was designed to investigate the effect of topical bromelain and arnica gel combination on periorbital edema and ecchymosis following septorhinoplasty, which to our knowledge, has never been examined in the literature.