The effect of topical tranexamic acid application on postoperativeperiorbital ecchymosis and edema in rhinoplasty

Introduction and Aim: Periorbital ecchymosis and edema after rhinoplasty are among the most common comorbid conditions in all surgical techniques. Tranexamic acid (TA) is an antifibrinolytic agent and reduces the amount of bleeding by preventing the dissolution of the fibrin clot. Systemic application of TA is used to reduce periorbital edema and ecchymosis after rhinoplasty. However, there is no study in the literature investigating the effectiveness of topical application of TA in preventing and treating ecchymosis and edema after rhinoplasty. The aim of our study is to examine the effectiveness of topical TA application in overcoming these comorbid conditions, which are common and do not have a standard treatment. Materials and Methods: This study was designed as a prospective, randomized, double- blind and controlled clinical study in which patients who were planned to undergo open technical rhinoplasty operation between June - September 2021, in Baskent University Department of Otorhinolaryngology. Fifty patients over the age of 18 were included in the study. The patients were divided into two groups: those who were applied topical TA and those who were not (control). In the TA group, the TA-soaked surgical pads were kept in the surgical field for 5 minutes immediately after the osteotomy in the intraoperative period. In the control group, isotonic saline soaked surgical pads were kept in the same way. Photographs of the patients were taken on the 1st, 3rd and 7th postoperative days, and the patients were evaluated by two surgeons in terms of periorbital ecchymosis and edema. Mann-Whitney U test was used to compare the groups. Results: When the patients were evaluated in terms of periorbital edema, it was found that the edema that developed in the patients who applied TA was significantly less than the control group on the postoperative 1st day. There was no difference between the two groups on postoperative 3rd and 7th days. When the patients were evaluated in terms of periorbital ecchymosis, it was found that the ecchymosis developed in patients who applied TA was significantly less than the control group on all days. Conclusion: Topical TA application reduces the development of periorbital ecchymosis both in the early and late periods. It reduces the development of periorbital edema in the early period.