Preoperative Use of Dexamethasone in Rhinoplasty: A Randomized, Double-blind, Placebo-Controlled Clinical Trial

Overview

Swelling and bruising after rhinoplasty distress patients and can obscure the result. Corticosteroids have been used to limit both, but with weak supporting evidence. This trial gave patients either intravenous dexamethasone or salt water before surgery, with neither patients nor assessors knowing which, then compared photographs taken a week later.

Sections of note

• Randomised, double-blind, placebo-controlled trial at an institutional referral centre in patients with an enlarged nose.
• Group 1 received intravenous dexamethasone sodium phosphate before surgery. Group 2 received normal saline.
• Randomisation by lottery gave 20 patients in group 1 and 22 in group 2, 42 in total.
• Standardised photographs were taken at the one week visit.
• Five plastic surgeons blinded to the assignment rated the degree of swelling and bruising.
• Bruising scores were lower with dexamethasone by 0.62 (p = 0.02) and swelling scores lower by 0.68 (p = 0.01). Level of evidence 1.

What it means for a patient

• A single steroid dose before the operation reduced visible bruising and swelling in the first week.
• The design is the strongest kind used in surgery, with random assignment, a dummy injection and blinded raters, so the difference is unlikely to be chance.
• The differences are small on the rating scales used, and the abstract does not state what those scales were out of.
• Only 42 patients, one centre, and assessment only at seven days, so nothing is reported about the final result or the risks of the steroid.

Why this paper matters

Most rhinoplasty evidence is retrospective case series. A blinded randomised trial on a simple, cheap intervention is unusual in this field and gives a firmer basis for a routine that many surgeons already follow. What is not settled is the best dose, whether the benefit persists past the first week, and how it affects the eventual shape of the nose.

Terms

• Dexamethasone: a corticosteroid drug that suppresses inflammation.
• Edema: fluid swelling in tissue.
• Ecchymosis: bruising, blood visible under the skin.
• Randomised controlled trial: a study assigning patients to treatments by chance to allow fair comparison.
• Double-blind: neither the patient nor the person assessing the result knows which treatment was given.
• Placebo: an inactive substance given in place of the drug being tested.