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.