Efficacy of Dexamethasone for Reducing Edema and Ecchymosis After Rhinoplasty: A Systematic Review and Meta-analysis

Background Rhinoplasty is one of the most challenging cosmetic surgical operations. The procedure has been known to precipitate higher levels of edema and ecchymosis in the periorbital and paranasal regions. The literature recommends the use of corticosteroids such as dexamethasone to alleviate these postoperative morbidities. In this review, we aim to provide a current state of evidence concerning the influence of dexamethasone together with rhinoplasty on intraoperative and postoperative morbidities. Methods A systematic identification of the literature was performed according to PRISMA guidelines on four academic databases: MEDLINE, Scopus, EMBASE and CENTRAL. A meta-analysis compared the influence of dexamethasone and normal saline administered during rhinoplasty on the amount of intraoperative blood loss, postoperative edema and ecchymosis. Results Out of 1045 records, ten articles including 374 participants (mean age: 25.8 +/- 2.5 years) were included in this review. This systematic review presents a 1b level of evidence supporting the use of dexamethasone during rhinoplasty to reduce the amount of intraoperative blood loss, edema and ecchymosis as compared to normal saline. The meta-analysis reveals beneficial effects for dexamethasone interventions by demonstrating medium to large effect reduction of the amount of intraoperative blood loss (Hedge's g: - 0.69), mean edema score (- 1.09) and mean ecchymosis score (- 1.03) as compared to placebo groups using normal saline. Conclusion The current systematic review and meta-analysis recommend the administration of dexamethasone with rhinoplasty. The review reports beneficial effects of dexamethasone's administration as compared to normal saline for reducing the amount of intraoperative blood loss, postoperative edema and ecchymosis. Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266.