King Saud Univeristy, King Abdulaziz University Hospital, Department of Otolaryngology, Head and Neck Surgery, Riyadh, Saudi Arabia.
King Saud Univeristy, King Abdulaziz University Hospital, Department of Otolaryngology, Head and Neck Surgery, Riyadh, Saudi Arabia.
Braz J Otorhinolaryngol. 2022 Jan-Feb;88(1):63-82. doi: 10.1016/j.bjorl.2020.05.015. Epub 2020 Jun 20.
Edema and ecchymosis after facial plastic surgery are a troublesome concern for both patients and surgeons. Corticosteroid administration is thought to shorten the recovery period and reduce these sequelae. Data regarding the efficacy of corticosteroid administration remains controversial among surgeons.
We conducted this systematic review and meta-analysis to determine the effect of pre- and postoperative corticosteroids on postoperative complications in patients undergoing facial reconstructive surgery supported with different subgroup analysis.
A comprehensive literature search of articles was conducted in PubMed, Cochrane Central, SCOPUS, and EBSCO through October 2019. We included all clinical trials in which patients underwent any type of facial plastic surgery to study the effect of corticosteroids on postoperative complications. We performed subgroup analysis according to the types and doses of corticosteroid preparation, in addition to a subgroup analysis of pre- or postoperative corticosteroid usage. All statistical analysis was performed using the RevMan software.
Nineteen studies were included in this systematic review, but only 10 of them were eligible for meta-analysis. The periorbital edema and ecchymosis scores were significantly reduced in the corticosteroids group compared to placebo -0.82, 95% CI (-1.37, -0.26), and -0.95, 95% CI (-1.32, -0.57), respectively. However, these significant differences were not maintained at day 3 and 7. Smaller doses of corticosteroid (8 mg and 10 mg) were associated with smaller differences in the mean score of upper and lower eyelid edema and ecchymosis, while the higher doses were associated with greater differences. Furthermore, preoperative corticosteroid usage significantly reduced the intraoperative bleeding when compared to placebo for higher doses > 50 mg per day (p < 0.0001), but not for 8 mg corticosteroid (p = 0.06). Adding postoperative steroid dose to the preoperative one was associated with less edema and ecchymosis than preoperative administration alone.
This comprehensive meta-analysis confirms a statistically significant benefit of preoperative corticosteroids. Furthermore, continuing the steroids postoperatively is associated with long-term reduction of complications. Higher doses of corticosteroids are associated with a more significant reduction in edema and ecchymosis, but further studies are recommended to determine the postoperative side effects, including surgical site infection and delayed healing.
面部整形手术后出现水肿和瘀斑是患者和外科医生都关心的问题。皮质类固醇的应用被认为可以缩短恢复期并减少这些后遗症。然而，外科医生对皮质类固醇应用的疗效仍存在争议。
我们进行了这项系统评价和荟萃分析，以确定在接受不同亚组分析的面部重建手术后，皮质类固醇的应用对术后并发症的影响。
通过 PubMed、Cochrane Central、SCOPUS 和 EBSCO 全面检索了截至 2019 年 10 月的文献。我们纳入了所有接受任何类型面部整形手术的临床试验，以研究皮质类固醇对术后并发症的影响。我们根据皮质类固醇制剂的类型和剂量进行了亚组分析，此外还根据皮质类固醇的使用时间（术前或术后）进行了亚组分析。所有统计分析均使用 RevMan 软件进行。
这项系统评价共纳入了 19 项研究，但只有 10 项符合荟萃分析的纳入标准。与安慰剂组相比，皮质类固醇组的眶周水肿和瘀斑评分明显降低（分别为-0.82，95%CI（-1.37，-0.26）和-0.95，95%CI（-1.32，-0.57））。然而，这些显著差异在第 3 天和第 7 天并未持续。较小剂量的皮质类固醇（8mg 和 10mg）与上、下眼睑水肿和瘀斑的平均评分差异较小，而较高剂量则差异较大。此外，与安慰剂相比，较高剂量（>50mg/天）的皮质类固醇术前使用可显著减少术中出血（p<0.0001），但 8mg 皮质类固醇则不然（p=0.06）。与术前单独使用皮质类固醇相比，将术后皮质类固醇剂量加入术前剂量可减少水肿和瘀斑。
这项全面的荟萃分析证实了术前皮质类固醇具有统计学上的显著益处。此外，术后继续使用皮质类固醇与长期减少并发症相关。较高剂量的皮质类固醇与水肿和瘀斑的减少更为显著，但需要进一步的研究来确定术后副作用，包括手术部位感染和愈合延迟。
