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.