Association of Periosteal Sweeping vs Periosteal Preservation With Early Periorbital Sequelae Among Patients Undergoing External Perforating Osteotomy During Rhinoplasty

El-Sisi H, Abdelwahab M, Most SP.

PubMed 30789649 Publisher (DOI)Free full text (PMC)

What this paper says

In 28 patients treated one way on each side of the nose, preserving the membrane over the bone rather than sweeping it produced significantly less eyelid swelling and bruising on day 1, though the difference faded by day 7.

Overview

Bruising and swelling around the eyes after nasal bone cuts are the main early problem patients face. This prospective cohort study compared two ways of handling the periosteum, the vascular membrane over the bone, using each patient as their own control with one method per side.

Sections of note

Prospective cohort study at a tertiary referral center in Mansoura, Egypt, January to May 2017; 28 patients having external perforating lateral osteotomy in open rhinoplasty.
Periosteal sweeping on one side, periosteal preservation on the other, in the same patient.
Two independent surgeons scored eyelid swelling 0 to 4, bruising 0 to 4, and subconjunctival hemorrhage 0 to 2, on days 1, 7 and 21.
19 men and 9 women, mean age 23.7 years SD 3.9.
All patients improved significantly on days 7 and 21 versus day 1 for eyelid swelling and bruising, both P below .05; subconjunctival hemorrhage improved by day 21.
Day 1 mean rank scores were significantly higher on the swept side for eyelid swelling, 33.18 versus 23.82, P .02, and for bruising, 33.59 versus 23.41, P .01.
Differences remained apparent but not statistically significant on days 7 and 21; periosteal preservation did not reduce subconjunctival hemorrhage. Level of evidence 2.

What it means for a patient

Preserving the membrane over the bone reduced early swelling and bruising, but the benefit was measurable mainly on the first day.
Bleeding into the white of the eye was unaffected by either technique.
Both sides improved substantially by three weeks regardless of technique.
Limits: 28 patients, single center, and the surgeon was necessarily aware which side received which technique.

Why this paper matters

The within-patient design controls for individual bleeding tendency, which is the main confounder in bruising studies. The finding supports periosteal preservation but shows its benefit is short-lived. Whether one day of reduced swelling changes recovery in practice is not addressed.

Terms

Periosteum: The living membrane wrapping bone, carrying its blood supply.
Periosteal sweeping: Lifting and pushing that membrane aside before cutting the bone.
Lateral osteotomy: A bone cut along the side of the nose.
Periorbital: Around the eye.
Subconjunctival hemorrhage: Bleeding into the white of the eye.

Summary written by rhinoplasty.cc from the abstract, 2026-09-09; not medical advice. The authors' own abstract follows.

Abstract

Importance: Periorbital sequelae are a significant source of early postoperative morbidity after rhinoplasty, particularly after an osteotomy is performed.

Objective: To compare postoperative periorbital sequelae after external perforating lateral osteotomy in rhinoplasty using a periosteal sweeping vs a periosteal preserving approach.

Design, Setting, And Participants: This prospective cohort study conducted at a tertiary referral center located in Mansoura, Egypt, included 28 patients who underwent external perforating lateral osteotomy in open rhinoplasty between January and May 2017.

Exposures: Periosteal sweeping was performed on one side of the nose and periosteal preservation was performed on the other side during external perforating lateral osteotomy.

Main Outcomes And Measures: Periorbital sequelae, including eyelid edema, periorbital ecchymosis, and subconjunctival hemorrhage, were assessed on both sides of the face on postoperative days 1, 7, and 21 by 2 independent surgeons using the scale first proposed by Kara and Gökalan in 1999. The scales for eyelid edema ranged from 0 to 4, for ecchymosis from 0 to 4, and for subconjunctival hemorrhage from 0 to 2, with higher values indicating greater edema, ecchymosis, and hemorrhage, respectively. Differences in the 3 time points and differences between the 2 osteotomy methods were analyzed.

Results: In total, 19 men and 9 women with a mean (SD) age of 23.7 (3.9) years were enrolled. All patients showed significant decreases in eyelid edema on postoperative days 7 and 21 compared with day 1 (1.71 and 1.39 vs 2.89 for the swept side, and 1.86 and 1.46 vs 2.68 for the preserved side; both P < .05) and in periorbital ecchymosis (2.02 and 1.13 vs 2.86 for swept side, and 2.05 and 1.13 vs 2.82 for the preserved side; both P < .05). A significant decrease in subconjunctival hemorrhage was observed on day 21 compared with days 1 and 7 (1.79 vs 2.11 and 2.11 for the swept side, and 1.71 vs 2.14 and 2.14 for the preserved side; both P < .05). The mean rank score for eyelid edema on day 1 for the swept side was significantly higher than that for the preserved side (33.18 vs 23.82, P = .02), and the mean rank score for periorbital ecchymosis on the swept side was significantly higher than that for the preserved side (33.59 vs 23.41, P = .01). Although both eyelid edema and periorbital ecchymosis appeared to remain greater on the swept side on postoperative days 7 and 21, the differences no longer reached statistical significance. Periosteal preservation was not associated with minimizing subconjunctival hemorrhage postoperatively.

Conclusions And Relevance: This study suggests that lateral nasal osteotomy is associated with varying degrees of eyelid edema, periorbital ecchymosis, and subconjunctival hemorrhage. Compared with sweeping the periosteum, preserving the periosteum in an external perforating lateral osteotomy was associated with less eyelid edema and periorbital ecchymosis in the early postoperative period.

Level Of Evidence: 2.

Abstract as indexed by PubMed; the article is open access (PubMed Central).