Intraoperative complications – These are complications that arise directly in the process of surgical intervention. All intraoperative complications of rhinoplasty are divided into general and local complications. The leading role in the development of intraoperative complications of rhinoplasty is played by the competence of the plastic surgeon, his sufficient knowledge of the techniques of the operation being performed, as well as the use of high-quality surgical instruments. Intraoperative complications can be quite serious and dangerous for the health and life of the patient, therefore, special care should be taken to prevent the development of such intraoperative complications even in the preoperative period.
Intraoperative complications of general rhinoplasty
Intraoperative complications of general rhinoplasty are most often associated with hypoxia, hypertension and nasocardial reflex. General intraoperative complications affect the work of the entire patient's body, and the key to their prevention is the coordinated work of the plastic surgeon and the anesthesiologist. There are four main anesthetic errors that can lead to the development of intraoperative complications:
- Too superficial anesthesia: a variant when the patient is immobilized, but in pain during surgical procedures. As a result, hormones are released into the blood, blood pressure, heartbeat and muscle tone increase, and tissue bleeding increases significantly.
- Using inhalational anesthetics instead of narcotic drugs: inhalational anesthetics are peripheral vasodilators, they increase nasal congestion and cause an intraoperative complication such as increased bleeding.
- Inadequate anesthesia with development of hypoxia and hypercapnia: the patient's blood pressure and cardiac output increase, resulting in increased bleeding.
Intraoperative complications of local rhinoplasty
Intraoperative complications of local rhinoplasty include bleeding, traumatic injuries of the skin and mucous membranes, burns with an electrocoagulator, damage to the paranasal sinuses and lacrimal ducts. Bleeding as an intraoperative complication of rhinoplasty most often occurs when performing manipulations on the nasal septum and turbinates.
In the event of such an intraoperative complication of rhinoplasty as a hematoma, it is necessary to install a drain. Traumatic injuries of the skin and mucous membranes, such as notches on the caudal edge of the lower lateral cartilage and tears on the skin of the columella, must be sutured during rhinoplasty. Damage to the lacrimal ducts and the development of persistent lacrimation during rhinoplasty occurs if, during lateral osteotomy, the line of bone dissection is in the cephalic direction from the level of the medial canthus.
What will help prevent the development of intraoperative complications of rhinoplasty
In order to prevent the development of intraoperative complications of rhinoplasty, the plastic surgeon must perform careful preparation for this operation. It is important to report the study of the anatomical features of the structure of the nose of each individual patient, including on the basis of the results of radiography and computed tomography. Strict adherence to the subperichondral and subaponeurotic layers during dissection also helps to prevent the development of intraoperative complications of rhinoplasty. The use of adequate, sufficiently sharp surgical instruments prevents tissue damage during the operation, as well as knowledge of special surgical techniques that ensure the atraumaticity of surgical intervention, to avoid unnecessary tissue trauma during rhinoplasty. In this way,
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