What is the risk and complication in rhinoplasty?

Posted by Delhi Aesthetic Clinic on January 17th, 2020

Rhinoplasty comes with high risks, mainly as its aesthetic result can be limitedly predicted. Here are its major risks and complications.

Risks and complications

Functional disturbances

Rhinoplasty treats deformities like tension and twisted noses due to breathing trouble. Hence, after primary rhinoplasty, 10% of the patients, and after revision rhinoplasty, 70% of the patients complain about new or remaining breathing troubles. Valve disturbances if your upper lateral cartilages are separated from your septum, can be corrected by acoustic rhinometry. Deep osteotomies might narrow your airways at your piriform aperture. Semi-circular scars and alar collapse may occur from severe alar cartilage resections. But rhinoplasty usually doesn’t deteriorate breathing functions. A loss of sensitivity due to surgical scars might feel like a blocked nasal airway. Post-surgery hyposmia due to mucosa swelling is temporary. Anosmia is rarely permanent. 

Implants and transplants

Common risks for nasal transplants and implants with below 1% of probability include infection, resorption, distortion, and extrusion. The risks for distortion and resorption are minimal in the long run with the right procedure. Resorption of any autogenous cartilage is still problematic based on the conditions of your recipient site. The extent being unpredictable, and overcorrection is difficult. You can expect resorption with diced cartilage rather than solid cartilage due to its large surface. Chondrocytes can be supported if the cartilage is warped with autogenous fascia lata. If unrequired growth of cartilage occurs, resection of perichondrium is needed in ear cartilage transplantations. Injectable fillers can cure minor impressions post-surgery. 

Complications of soft tissue and skin

Severe complications include local infections, abnormal swelling, skin necrosis, and hematomas. Consequences might be numbness, pain, fibrosis, rubeosis, and atrophy. Granulomas and subcutaneous cysts might develop. Post-surgery minor normal effects include periorbital hematomas and restricted swelling. Percutaneous osteotomy can reduce swelling, but scars are visible in 6% cases. Subcutaneous giant emphysemas happen rarely. Subconjunctival ecchymosis occurs mainly in the temporal area in 20% cases but is reabsorbed within 2 weeks. Subcutaneous vessels become visible by skin atrophy. Decollement in a deep plane can reduce them. Common subcutaneous mucosal cysts are due to the dislocation of the mucosa. These are corrected with external skin incision, endoscopy or open rhinoplasty.

Lipogranulomas occur from the dislocation of ointment into your subcutaneous plane from nasal packings. For prevention, ointment must be avoided for packings, and vestibular incisions must be sewed close.  

Numbness frequently happens in specific areas post-surgery as reported, involving the inferior part of your columella and your nasal tip. Damage to these nerves is unavoidable while decollement. Sensitivity usually returns within a year.

Postoperative pain may happen from open-roof-syndrome (contact between skin and mucosa) and is diagnosed by the interposition of cartilage. Damage to your infraorbital nerve rarely happens else is pre-existing.

Infections, rare and systemic complications

Infections occur below 1% of all interventions. Abscess near the medial canthus doubted for a sequestrum from your lateral osteotomy must be removed. Infections are more probable on combining sinus surgery with rhinoplasty while purulent sinusitis is present. Streptococcus bacteria might cause crucial complications by invading your osteotomies. Bacteremia after septoplasty happens rarely. But streptococcus-exotoxin may lead to TSS (toxic-shock-syndrome) rooting from nasal packings. 

Orbital complications may be infectious or traumatic. Swelling may restrict lacrimal drainage. Intubation of your lacrimal system can treat severe purulent dacryocystitis from the laceration of your lacrimal sac. An enophthalmos rarely develops months following aesthetic rhinoplasty. A silent-sinus-syndrome might happen from permanent negative pressure due to occlusion of your maxillary ostium. The contraction of your maxillary sinus cavity may displace your orbital content. Streptococci may lead to an orbital or necrotizing periorbital infection. Periorbital infection and usual postoperative swelling must be differentiated. Systemic application of penicillin can treat lid necrosis and orbital cellulitis in situations of pathologic blood parameters, fever, and pain. Postoperative blindness mainly happens from occlusion of your central retinal artery that might be due to intranasal injection of local anesthetics. 

Acute endocranial and vascular complications aren’t rare. These include encephalitis, rhinoliquorrhea, aneurysm, arteriovenous deformities, brain damage with pneumocephalus and sinus cavernous thrombosis with subdural empyema and septicemia. Naso-cardiac reflex may cause heart attacks. Dental complications like discoloration and devitalization may happen due to an atypical course of nerves and vessels to your upper incisors.