Edema, Rhinoplasty
Conditions
Keywords
Photobiomodulation, Low-Level Laser Therapy, Postoperative, Inflammation
Brief summary
This single-centre, randomized, double-blind, sham-controlled clinical trial evaluates whether preoperative photobiomodulation (PBM) with red and infrared light can reduce early postoperative periorbital edema in patients undergoing primary open rhinoplasty with osteotomies. Sixty participants will be randomly assigned to receive active PBM or sham PBM one hour before surgery. The primary outcome is periorbital edema on postoperative day 3 measured using a validated ordinal clinical scale with standardized photographic documentation. Secondary outcomes include ecchymosis, postoperative pain, analgesic consumption, nasal tip skin thickness, and patient-reported functional and aesthetic outcomes. Participants will be followed for up to 12 months after surgery.
Detailed description
This is a single-centre, randomized, double-blind, sham-controlled clinical trial designed to investigate the effectiveness of preoperative photobiomodulation (PBM) using red (660 nm) and infrared (808 nm) light-emitting diodes in patients undergoing primary open rhinoplasty with piezo-assisted osteotomies. The study hypothesis is that prophylactic PBM applied one hour before surgery can modulate the early inflammatory response and reduce the intensity of postoperative periorbital edema. Participants will be randomly allocated in a 1:1 ratio to active PBM or sham PBM. Allocation concealment will be ensured using a computer-generated randomization sequence and sealed assignment procedures. Both participants and outcome assessors will be blinded to group allocation. The intervention will be delivered preoperatively by trained personnel following a standardized operating protocol, with predefined anatomical application points and device parameter verification before each session. The sham procedure will follow identical steps, with the device inactive, in order to preserve masking. All participants will undergo standardized surgical technique and perioperative care according to institutional protocols. Concomitant medications and perioperative management will be recorded to allow assessment of potential confounding effects. The primary endpoint is assessed early in the postoperative period using a validated ordinal clinical scale applied by a calibrated blinded assessor, with standardized photographic documentation obtained under controlled conditions. Digital image analysis will be used as a complementary objective method to support clinical grading. Additional postoperative clinical and patient-reported measures are collected longitudinally to characterize recovery trajectory and treatment response. Follow-up visits are scheduled at predefined postoperative time points extending to 12 months. Outcome assessors are trained and calibrated prior to study initiation to ensure inter-rater consistency. Data collection follows standardized case report forms and predefined operational definitions. Statistical analysis will follow a modified intention-to-treat approach including all randomized participants with at least one postoperative assessment. The primary comparison between groups will use nonparametric methods appropriate for ordinal outcomes. Secondary analyses will be conducted according to data distribution and measurement scale. A two-sided significance level of 0.05 will be adopted. No interim analyses are planned. Safety monitoring will be conducted throughout the study period, and any adverse events will be documented and reported in accordance with ethical and regulatory requirements.
Interventions
The photobiomodulation device used in this study will be the ECCO Reability (Ecco Fibras, Campinas, SP, Brazil), which is approved for clinical use by the Brazilian Health Regulatory Agency (ANVISA) under registration number 80323310001. The equipment is also certified by INMETRO, ensuring adherence to nationally established safety and performance standards.
In the sham group, the photobiomodulation procedure will be simulated with the device turned off. To preserve blinding, the equipment will be positioned as in the active treatment and its operational sound will be reproduced during the simulation, ensuring that the intervention remains indistinguishable from the actual PBM application.
All participants will undergo primary open rhinoplasty performed using piezo-assisted osteotomies, following standardized surgical protocols. Subperiosteal dissection will be carried out along the lateral nasal walls, with supraperiosteal dissection in the medial region of the bony nasal dorsum. The configuration of osteotomies will be selected according to individual anatomical and surgical requirements. All procedures will be performed by experienced otolaryngologists. All participants will also receive standardized perioperative medical care, identical in both groups. No medication will be administered preoperatively. Intraoperatively, dexamethasone 4 mg and tranexamic acid 1 g will be administered intravenously. Postoperative in-hospital care will include hydrocortisone 200 mg IV, tranexamic acid 250 mg IV, dipyrone 1 g IV, and cefazolin 1 g IV every 8 hours, with ketorolac 10 mg sublingual as needed. After discharge, patients will receive cefuroxime axetil 500 mg orally every 12
Sponsors
Study design
Masking description
Only the researcher responsible for administering the treatments, who will open the randomization envelopes, will be aware of the participants' group allocation. Group identification will be disclosed only after statistical analysis, ensuring blinding of all other individuals involved in the study. The researcher responsible for data collection, including the assessment of edema and all secondary outcomes, as well as the statistician, will remain blinded to group assignments. Additionally, participants will not be informed of the intervention received. To ensure blinding, the device will remain turned off for the control group, and its use will be simulated by the healthcare professional responsible for administering the photobiomodulation (PBM). The device sound will also be reproduced to simulate activation, ensuring that participants are unaware of differences between interventions.
Intervention model description
randomized, controlled, single centre, double-blind clinical trial
Eligibility
Inclusion criteria
* individuals 18-60 years of age; * ASA I or II; no comorbidities (no pre-existing diseases); * indication for rhinoplasty; * regardless of gender identity.
Exclusion criteria
* use of anticoagulant, * anti-inflammatory, or corticosteroid medications; * indication for closed rhinoplasty; * procedures not performed using the Piezo device (Schuster SW Surgery II); * intraoperative complications (e.g., haemorrhage or technical difficulties); * prior nasal filler with hyaluronic acid; * use of vitamin A derivatives (oral isotretinoin or topical retinoic acid) within 30 days before surgery; * or known allergy to any mandatory intra- or postoperative medication.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Periorbital Edema on postoperative day 3 | Postoperative day 3 | Periorbital edema on postoperative day 3 will be assessed using the Hoffmann Clinical Ordinal Scale for Periorbital Edema (score range 0 to 4), based on the extent of eyelid involvement. In this scale, higher scores indicate more severe edema and therefore a worse outcome. Assessments will be performed by a blinded and calibrated evaluator. Standardized photographic documentation will be obtained and analyzed using ImageJ software as a complementary objective measurement. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Periorbital Edema Time Course | 7, 30, 60, and 90 days; 6 and 12 months postoperatively | Periorbital edema assessed using the Hoffmann clinical scale (0-4), based on eyelid involvement, evaluated by a blinded and calibrated assessor, with standardized photographic documentation and complementary ImageJ analysis. |
| Periorbital Ecchymosis | 3, 7, 30, 60, and 90 days; 6 and 12 months postoperatively | Periorbital ecchymosis assessed using the Hoffmann clinical ordinal scale (0-4), based on the extent and intensity of periorbital discoloration, evaluated by a trained assessor blinded to group allocation. |
| Nasal Tip Skin Thickness | Preoperative baseline; 3, 7, 30, 60, and 90 days; 6 and 12 months postoperatively | Skin thickness will be assessed through physical examination of the nasal tip using a standardized protocol. The evaluations will be conducted by a trained clinician during scheduled follow-up visits. |
| Postoperative Pain (VAS) | 3 and 7 days postoperatively | Postoperative pain will be assessed using the Visual Analog Scale (VAS), a validated tool commonly used in rhinoplasty research. A 10 cm horizontal ruler will be used, with endpoints labeled "0" (no pain) and "10" (worst imaginable pain),. All participants will use the same standardized ruler. |
| Patient-Reported Functional and Aesthetic Outcomes (SCHNOS) | Preoperative baseline; 30 and 90 days; 6 and 12 months postoperatively | Functional and aesthetic outcomes assessed using the Standardized Cosmesis and Health Nasal Outcomes Survey (SCHNOS), validated for Brazilian Portuguese. |
| Analgesic Consumption | 3, 7, 30, 60, and 90 days; 6 and 12 months postoperatively | Total amount of analgesic medication ingested by each participant, recorded as an indirect indicator of postoperative pain control and functional recovery. |
Countries
Brazil
Contacts
University of Nove de Julho