Effect of Lateral Osteotomy in Subperiostal Plan in Reducing Severity of Periorbital Edema and Ecchymosis after Rhinoplasty.

Introduction: Osteotomy is the main reason of periorbital edema and ecchymosis after rhinoplasty due to damage of angular vessels and fracture of the nasal bones and frontal process of maxilla. Several methods are suggested for reducing periorbital edema and ecchymosis. The main purpose of this study was to determine the effect of internal lateral osteotomy in subperiosteal plan in reducing periorbital edema and ecchymosis after rhinoplasty. Methods: This double-blinded clinical trial was conducted on 30 patients. Internal lateral osteotomy was performed in one side in subperiosteal plan and opposite side used as a control without elevation of periostium from the bone. The degree of edema/ecchymosis on both sides was compared on the 1st and 7th day postoperatively. Results: The severity of periorbital edema was more significant in one side with periosteal elevation 24 hours after operation (P. value=0.006). However, no significant difference was found in periorbital edema between both sides 7 days after the surgery (P. value=0.098). The severity of periorbital ecchymosis was also more significant in the side with periosteal elevation 24 hours (P. value= 0.023) and seven days after operation (P. value=0.004). Conclusion: Since lateral osteotomy in subperiosteal plan increased periorbital edema and ecchymosis after rhinoplasty, performing lateral osteotomies without subperiosteal tunneling during rhinoplasty operation is suggested.

Radiofrequency uvulopalatoplasty for primary snoring

Simple snoring is a social problem, one that can gravely affect the patient's married life. About 40% of men and 20% of women are affected, and it often goes along with sleep-disordered breathing. Up to now various surgical techniques have been defined such as UPPP[uvulopalatopharyngo plasty], and laserassisted uvulopalatoplasty [LAUP]. Among the surgical methods, RAUP [radiofrequency assisted uvulopalatoplasty] is a minimal invasive, an easy performed, and time and cost effective one. We designed a before and after a clinical trial. The inclusion criteria were age >18 years, complaint of nocturnal snoring, have a bed partner to assess snoring, AHI<5 events per hour in the polysomnography, malampathy score [soft palate position] one or two, an elongated uvula, grade one and two of pharyngeal webbing and patient consent was needed too. A 10-score visual analog scale [VAS] of snoring severity was completed by bed partner. All of 35 included patients underwent RAUP under local anesthesia by the same expert surgeon. After 3 months, 6 months and one year, subjective snoring decreased significantly compared to the preoperative period. The decline in VAS in 6 month compared to 3 months postoperatively, was not significant [P=0.223]. When comparing 1 year and 6 months after treatment, the VAS scores were increased, but they were not significant [From 1.8 to 1.9, P=0.78]. Three months after treatment minor complications consisted of: nasal regurgitation in 2 patients [5.7%], nasal speech in 2 [5.7%] and exacerbation of snoring in 2 [5.7%] patients.There was no major complication including mucosal laceration, uvular damage and obstruction of the airway. The rate of snoring decrease did not correlate with age, sex and BMI. Based on this study and literature review, it seems RAUP is a safe surgery, which may decrease symptoms of snoring, at least, in short-term follow-up.