Kim Ji-Sun, Kim Sun Hong, Lee Hyesook, Kim Byung Guk, Hwang Se Hwan
Department of Otolaryngology-Head and Neck Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Clin Exp Otorhinolaryngol. 2020 Aug;13(3):268-273. doi: 10.21053/ceo.2019.01599. Epub 2020 May 12.
Although osteotomy is an important part of rhinoplasty, it is known to be closely related to postoperative eyelid edema and ecchymosis. We aimed to evaluate the effects of periosteal elevation prior to osteotomy on eyelid edema and ecchymosis.
Two authors reviewed studies in the Medline, Scopus, and Cochrane databases published through May 2019. Randomized controlled trials comparing periosteal elevation (subperiosteal tunneling) with periosteal preservation that reported eyelid edema or ecchymosis or subconjunctival hemorrhage as outcomes of interest were included. From each study, the baseline characteristics of the study subjects, the quality of the study, the number of patients in the treatment and control groups, and outcomes were extracted.
Data for meta-analysis were identified in six studies with a total of 208 patients. Eyelid ecchymosis and edema within 3 days postoperatively were significantly more common in the periosteal elevation group than in the preservation group, although such an association was not found for edema on postoperative day 7 (standardized mean difference [SMD], 0.21; 95% confidence interval [CI], -0.09 to 0.50; I2 =0%). There was no significant difference in subconjunctival hemorrhage on day 1 (SMD, 0.31; 95% CI, -0.09 to 0.72; I2 =0%).
Periosteal preservation during lateral osteotomy may reduce eyelid edema and ecchymosis compared to periosteal elevation. Further studies with rigorous research methods should be carried out to determine the effectiveness of different techniques in lateral osteotomy.
尽管截骨术是鼻整形术的重要组成部分，但已知它与术后眼睑水肿和瘀斑密切相关。我们旨在评估截骨术前骨膜剥离对眼睑水肿和瘀斑的影响。
两位作者检索了截至2019年5月发表在Medline、Scopus和Cochrane数据库中的研究。纳入比较骨膜剥离（骨膜下隧道形成）与保留骨膜并将眼睑水肿或瘀斑或结膜下出血作为感兴趣结局的随机对照试验。从每项研究中提取研究对象的基线特征、研究质量、治疗组和对照组的患者数量以及结局。
六项研究中确定了用于荟萃分析的数据，共有208例患者。术后3天内，骨膜剥离组的眼睑瘀斑和水肿比保留组更常见，尽管术后第7天未发现水肿存在这种关联（标准化均值差[SMD]，0.21；95%置信区间[CI]，-0.09至0.50；I² = 0%）。术后第1天结膜下出血无显著差异（SMD，0.31；95% CI，-0.09至0.72；I² = 0%）。
与骨膜剥离相比，外侧截骨术中保留骨膜可能会减少眼睑水肿和瘀斑。应采用严格的研究方法进行进一步研究，以确定外侧截骨术中不同技术的有效性。
