MATERIAL AND METHODS
Sixty patients who performed open septorhinoplasty (oSRP) with osteotomies were included to the study. Their ages were ranged from 21 to 42 (34 women and 26 men). This study was conducted in accordance with the Declaration of Helsinki and was approved by the local ethics committee. All patients were given about study and written informed consent was obtained from each of them.
Sixty patients were allocated into two groups: in group 1, 30 patients as control and in group 2, 30 patients as study group who were treated with topical bromelain-arnica gel after surgery. Bromelain-arnica gel was applied topically to each patients’ ecchymosis and edema around their eyes from postoperative first day to seventh day as three times in a day.
Patients with diabetes mellitus, hypertension, peptic ulcer, psychiatric disorders, known allergy any drug, preoperative use of anticoagulant therapy, before 5 days to the operation, hematologic disorders and fibrinolytic disorders were excluded from the study. We avoided to operate the female patients during or immediately before their menstrual period. In both groups, the patients with complaints of nasal obstruction were diagnosed with nasal septal deviation by means of anterior rhinoscopy and endoscopic nasal examination by the first and second authors.
All the oSRP operations were performed under intubation and general anesthesia. To reduce the introduction of confounding factors, all operations were done by the first and second authors (O Sakallioglu and E Gulmez) using the same technique and equipment. After dorsal hump removal, guided and curved 4-mm lateral osteotomies were used for lateral osteotomies. Lateral osteotomies were made bilaterally without subperiosteal elevation and endonasally by performing a small incision at pyriform apertura just above the level of the anterior end of the inferior turbinate in all patients. Each surgeon operated on an equal number of patients in each group. During the operation, the mean arterial blood pressure was maintained at 70 to 90 mm Hg with esmolol infusion. Namely, dorsal hump extraction and medial and lateral osteotomies were done in all patients.
After completing the oSRP operation, antibiotic soaked nonabsorbable packs (Merocel; Medtronic Xomed) were put into the nose bilaterally. The external nasal cast splints were routinely used for all patients. During the first 24 hours postoperatively, patients lied down at 45 degrees head elevated position and ice packs were applied. The nonabsorbable packs of all patients were removed on the second postoperative day. All patients were given the same antibiotics (amoxicilline 1 gr twice in a day for 10 days) and the same analgesics (paracetamol 4 times in a day dor 10 days).
Scoring of eyelid edema and periorbital ecchymosis were evaluated on the first, third and seventh postoperative days using scale of 0 to 4 used by observers, Kara and Gokalan (Figures 1, 2) [1].
The IBM SPSS Statistics 21 was used for all statistical analysis. One-way analysis of variance (ANOVA) or Kruskal-Wallis ANOVA was used to compare variables between the groups. P values < 0.05 was considered as statistically significant.