Supercooled Liquid Serum Physiologic Solution Instantly Crystallized on the Nurse Table Used for Cooling of Periorbital Region During Rhinoplasty

Overview

Cooling the area around the eyes during and after rhinoplasty is used to reduce bruising. Solid ice must be broken out of its bag and crushed, which is slow. This technique note describes preparing saline in a supercooled liquid state that turns to soft ice on demand.

Sections of note

• Supercooling means water stays liquid below its freezing point; tap water will not supercool because impurities act as nucleation sites.
• At freezer temperatures of -4, -6 and -8 degrees C, nucleation was not observed and pure water remained supercooled for a long time.
• Sterile saline at +5 degrees C can be supercooled in a -14 degrees C freezer only between 257 and 277 minutes.
• At -8 degrees C it can be kept in liquid form for at least 7 days, as observed in the authors' trials.
• The sterile inner bag is held tight and struck on the sterile nurse table, crystallizing within a few seconds.
• At the moment of nucleation the fluid is at zero degrees C, so the authors state there is no risk of frostbite.
• The crystallized solution keeps its ice-gel form for nearly 25 minutes. Level of evidence IV.

What it means for a patient

• This concerns how cold is applied during surgery, not a change to the operation itself.
• The claimed advantage over frozen bags is convenience and a moldable texture that conforms to the face.
• The authors state the temperature at crystallization is zero degrees, avoiding frostbite risk from colder solid ice.
• Limits: no patient numbers, no comparison against conventional ice, and no measurement of bruising or swelling outcomes.

Why this paper matters

Bruising around the eyes is what patients find most bothersome after rhinoplasty, and cooling is the standard countermeasure. This addresses the practical handling of that cooling. It presents no evidence that the method reduces bruising more than conventional ice.

Terms

• Supercooling: Cooling a liquid below its freezing point without it turning solid.
• Nucleation: The trigger point at which a supercooled liquid begins to crystallize.
• Serum physiologic: Sterile saline solution.
• Periorbital: Around the eye.
• Ecchymosis: Bruising under the skin.