The impact of osteotomies in rhinoplasty on systemic inflammation and early postoperative quality of life

Objective: This study aimed to evaluate and compare systemic inflammation, periorbital edema, ecchymosis, and quality of life in the early postoperative period among patients undergoing rhinoplasty with conventional osteotomy, piezosurgery osteotomy, or without osteotomy. Materials and Methods: A total of 175 patients were prospectively included in this study. Based on the osteotomy method, patients were divided into three groups: Group 1 (n = 80), conventional osteotomy; Group 2 (n = 63), piezosurgery osteotomy; and Group 3 (n = 32), no osteotomy. Preoperative and postoperative day 1 blood samples were analyzed for neutrophil-to-lymphocyte ratio (NLR), lymphocyte-to-monocyte ratio (LMR), platelet-to-lymphocyte ratio (PLR), systemic immune inflammation index (SII), and systemic inflammatory marker (SIM) to assess inflammatory activity. Hemoglobin (Hb), CRP, ESR, and albumin levels were also recorded. On postoperative day 1, edema and ecchymosis were scored, and the quality of recovery (QoR-15) questionnaire was administered. Groups were compared based on blood parameters, edema, ecchymosis, and QoR-15 scores. Findings: Regarding blood parameters, the increase in NLR and decrease in Hb levels were significant in Groups 1 and 2 compared to Group 3. The increase in SII values was significantly higher in Group 2 compared to Group 3. No significant differences were found between Groups 1 and 2 for these parameters. Edema and ecchymosis were significantly lower in Group 3. Ecchymosis was significantly lower in Group 2 compared to Group 1, while no significant difference in edema was observed between these two groups. QoR-15 scores, evaluated across five domains (physical comfort, pain, physical independence, psychological support, and emotional state), were significantly higher in Group 3 compared to Groups 1 and 2. No significant differences were observed in quality-of-life scores between Groups 1 and 2. Conclusion: While there was a significant difference in ecchymosis between conventional osteotomy and piezosurgery, this difference did not translate into significant changes in inflammation or quality of life. The no-osteotomy group demonstrated superior outcomes in inflammation, edema, ecchymosis, and QoR-15 scores compared to the osteotomy groups. Based on our findings, the increase in inflammation is primarily attributable to the osteotomy itself rather than the technique used.