How to prevent rhinoplasty complications in the early postoperative period

Complications of the early postoperative period after rhinoplasty occur in the first weeks after surgery. All of them are divided into three large groups: hemorrhagic complications, complications of an infectious nature and traumatic complications. Complications of the early period are currently not so common, which is associated with the development of modern plastic surgery, the use of high-quality technologies in the process of surgical intervention and the high competence of operating surgeons. Nevertheless, the responsibility for the development of early postoperative complications is largely the responsibility of the patients themselves, who in the postoperative period must strictly follow the recommendations of the plastic surgeon.

Hemorrhagic complications of the early postoperative period

The most common early postoperative complication of rhinoplasty is bleeding, the incidence of this complication is about 2% of all patients operated on for rhinoplasty. Bleeding often occurs after the cessation of vasoconstrictors and begins in the first 2 days of the early postoperative period. The second critical moment for the occurrence of bleeding – 10 days of the early postoperative period. There are several ways to stop postoperative bleeding, most often tamponade of the nasal passages is used. The most effective way to prevent bleeding in the early postoperative period after rhinoplasty is electrocoagulation of vessels with open access.

Infectious complications of the early postoperative period

Infectious complications of the early postoperative period after rhinoplasty constitute the second most frequent group of complications. They occur in less than 2% of cases and are provoked by several factors: proximity to the area of ​​surgical intervention of the paranasal sinuses, the presence of microflora in the nasal cavity, as well as the installation of tampons in the nasal cavity after rhinoplasty, which contribute to the development of the infectious process. Such complications include exacerbations of chronic sinusitis after rhinoplasty, the appearance of skin pustules in the back of the nose, which is explained by the application of external dressings and thus creating an optimal environment for the development of infection. Much less often, abscesses and phlegmon of the nasal tissues develop, which occurs after the infection has spread to nearby tissues. If the lacrimal sac is damaged during rhinoplasty, dacryocystitis may develop. To date, there are practically no such severe complications of the early postoperative period after rhinoplasty as septic and intracranial complications.

Traumatic complications of the early postoperative period

Traumatic complications constitute the third group of postoperative complications in the early postoperative period after rhinoplasty. The most common such complication is long-term postoperative edema. This condition occurs as a result of traumatic manipulations on the underlying structures of the nose, as well as hemorrhages. It is important to differentiate long-term edema from the usual postoperative edema that occurs after any surgical procedure. Swelling that persists for more than 6 weeks after rhinoplasty is often the result of surgical trauma and in some cases may require a second surgical intervention. Other traumatic complications of the early postoperative period include rhinoliquorrhea, pneumocephalus, epiphora, orbital hematoma, and blindness,

Recommendations for preventing the development of early complications of rhinoplasty

In order to prevent the development of complications of rhinoplasty in the early postoperative period, in 1991 I. Padovan and S. Jugo developed a list of the following recommendations:

careful selection of patients for rhinoplasty should be carried out and special attention should be paid to patients with high blood pressure;

• it is important to be careful to rule out bleeding disorders;
• it is strictly forbidden to perform rhinoplasty during menstruation or while taking aspirin;
• hypotensive anesthesia recommended;
• surgical technique should be applied very carefully and only by highly qualified surgeons;
• It is important to use surgical instruments of good quality and suitable for rhinoplasty;
• narrow straight osteotomes are not recommended;
• if tamponade is necessary, it must be performed very carefully and only the anterior half of the nasal cavity should be tamponed;
• in the postoperative period, it is necessary to prescribe antibacterial and hormonal therapy to the patient.
Compliance with all these recommendations will help prevent complications in the early postoperative period after rhinoplasty.