4 Complications and Risks
The principal risk of a rhinoplasty is the presence of a significant new or residual nasal deformity after the operation ( Fig. 4.1 ). This is due to the fact that the definitive result of a rhinoplasty cannot be accurately predicted. When should the definitive result be assessed? At several months, 1 year, or 10 years after the operation?
Healing is a dynamic process that proceeds at different rates in different individuals and may be associated with varying reactions. Moreover, this process involves a variety of tissues such as the skin, subcutaneous tissue, fascia, superficial musculoaponeurotic system (SMAS), nerves, vessels, bone, cartilage, perichondrium, and periosteum. The surgeon should traumatize these tissues as little and as briefly as possible to promote uncomplicated healing. Complications may arise from the individual tissue types or from surgical materials such as sutures, implants, and grafts. 1
Atraumatic surgery should cause very little swelling. The degree of eyelid hematoma depends on skin and connective-tissue type and on the individual propensity for hematoma formation. Possible early complications include hematoma, local infection, and skin necrosis. Later complications may consist of atrophic skin changes, sensory disturbances, granulomas, or cyst formation. 2 , 3 Orbital complications may have a traumatic or inflammatory cause. Rhinoplasty may cause injury to the lacrimal ducts or orbital contents. 4 Vascular and intracranial complications are rare but have been described. 5 , 6 Cerebrospinal fluid rhinorrhea, cerebritis, brain injury, carotid–cavernous fistula, and septic cavernous sinus thrombosis with subdural empyema have all been reported after rhinoplasties. 4 , 7 Devitalization and discoloration of the anterior teeth may result from osteotomies or surgical manipulations around the nasal floor or piriform aperture. 8 It has also been shown that rhinosurgery may evoke a nasocardiac reflex leading to intraoperative bradycardia or even asystole. 9
References
1. Stoll W. Complications following implantation or transplantation in rhinoplasty. Facial Plast Surg 1997;13(1):45–50 2. Kotzur A, Gubisch W. Mucous cyst—a postrhinoplasty complication: outcome and prevention. Plast Reconstr Surg 1997;100(2):520–524 3. Meyer R. Secondary Rhinoplasty. New York, NY: Springer; 1988 4. Rettinger G. Risiken und Komplikationen der Rhinoplastik. Laryngorhinootologie 2007;86:40–54 5. Casaubon JN, Dion MA, Larbrisseau A. Septic cavernous sinus thrombosis after rhinoplasty: case report. Plast Reconstr Surg 1977;59(1):119–123 6. Marshall DR, Slattery PG. Intracranial complications of rhinoplasty. Br J Plast Surg 1983;36(3):342–344 7. Pothula VB, Reddy KT, Nixon TE. Carotico-cavernous fistula following septorhinoplasty. J Laryngol Otol 1999;113(9):844–846 8. Bergmeyer JM. Death of a tooth after rhinoplasty. Plast Reconstr Surg 1994;93(7):1529 9. Russo C, Corbanese U, Della Mora E. Nasocardiac reflex evoking during rhinoseptoplasty. Description of a clinical case [in Italian]. Minerva Anestesiol 1992;58(1-2):63–64
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