Razi Journal of Medical Sciences

fa کاربرد لیزر PDL (Pulsed Dye Laser) در کاهش اکیموزیس پس از جراحی سپتورینوپلاستی The Role of Pulsed Dye Laser Treatment in Reducing Ecchymosis After Septorhinoplasty جراحی گوش و حلق و بینی ENT Surgery مروري review article <div style="text-align: justify;">سپتورینوپلاستی یک فرایند جراحی دقیق است که به هدف ارتقای شکل و عملکرد بینی انجام می‌شود. یکی از مشکلات معمول پس از این فرایند توسعه اکیموزیس پس از جراحی است که منجر به طولانی شدن بهبود و نارضایتی بیمار می‌شود. در سال‌های اخیر، نقش درمان با Pulsed Dye Laser (PDL) در کاهش اکیموزیس پس از سپتورینوپلاستی توجه قابل توجهی به خود جلب کرده است. در بعضی مطالعات انجام شده درمان با لیزر در دوره پس از جراحی نتایج قابل قبولی در کاهش شدت و مدت زمان اکیموزیس ارائه داده است. به نظر می‌رسد استفاده از لیزر از طریق رویکرد هدفمند و غیر تهاجمی خود، به طور موثر در رفع خونریزی کمک کرده و فرآیند بهبود طبیعی را شتاب ‌دهد که این امر احتمالا حاصل از افزایش جریان خون و دفع لنف، در کاهش التهاب و افزایش نسج‌زایی می‌باشد و در نتیجه فرایند بهبودی را برای بیمارانی که سپتورینوپلاستی انجام می‌دهند شتاب می‌دهد. در این مطالعه مروری سعی شده است مقالاتی که در سال‌های اخیر در این حوزه انجام شده مورد بررسی قرار گرفته و نتایج حاصل از آن ارایه گردد تا بتواند در تصمیم گیری در مورد استفاده از PDL پس از جراحی سپتورینوپلاستی کمک نماید.</div> <div style="text-align: justify;">Background & Aims: Septorhinoplasty surgery is a common and popular procedure in Iran, known for its significant impact on improving the quality of life, self-confidence, and overall life satisfaction of patients. This surgical technique is well-established and precise, aiming to enhance both the aesthetic and functional aspects of the nose. However, a common challenge associated with septorhinoplasty is the development of ecchymosis, a condition characterized by swelling and bruising, which can be severe and, in some cases, even fatal. Recent years have witnessed a growing interest in the potential of PDL (Pulsed Dye Laser) treatment to mitigate ecchymosis following septorhinoplasty. Several studies have explored the efficacy of laser therapy in reducing the severity and duration of ecchymosis in the postoperative period. PDL treatment, with its targeted and non-invasive approach, has shown promise in effectively reducing bleeding and accelerating the natural healing process. This positive outcome is likely attributed to its ability to increase blood flow, promote lymph drainage, reduce inflammation, and enhance tissue generation. The non-invasive nature of this approach provides a favorable alternative to traditional methods, reducing the risk of further damage to delicate nasal tissues and ultimately facilitating a smoother recovery for patients. This review aims to examine recent articles in this field to present the results, ultimately aiding in informed decision-making regarding the use of PDL laser therapy after septorhinoplasty. Methods: The process of investigating the role of PDL laser in reducing ecchymosis after septorhinoplasty commenced with a thorough research methodology. Keywords including "laser," "ecchymosis," and "septorhinoplasty" were employed to search various academic databases, including Pubmed, Google Scholar, and the Cochrane Library, for relevant studies. Specific filters were applied to refine the search, including parameters related to publication date, study design, and subject relevance. Priority was given to peer-reviewed articles, clinical trials, systematic reviews, and comprehensive meta-analyses published within the past decade to ensure that the review encompassed current and relevant research. Additionally, the selection criteria focused on studies that specifically investigated the application of PDL laser therapy to reduce ecchymosis following septorhinoplasty. The selected articles underwent meticulous evaluation, considering methodology, sample size, study design, and the results of laser treatment in managing ecchymosis. Particular attention was given to the quality of evidence, statistical significance, and the identification of any potential limitations or biases within the studies. Subsequently, a detailed analysis of key findings was conducted, emphasizing the mechanisms of action, efficacy, and potential challenges associated with the utilization of laser therapy to reduce ecchymosis after septorhinoplasty. Results: In the study conducted by Alegre-Sánchez et al., involving 34 patients aged between 28 and 79 years, ecchymosis resulting from various causes, including trauma, surgery, and cosmetic procedures, was investigated. The study aimed to assess the effectiveness of PDL laser treatment with varying parameters. The findings indicated that shorter pulses (0.5 ms) and higher fluences (8 j/cm2) were more effective in treating ecchymosis, particularly in cases of severe ecchymosis. Older, milder, and deeper ecchymoses exhibited a lower response rate. DeFatta et al. conducted a study to explore the effectiveness of PDL laser (6 j/cm2, 6 ms) in reducing ecchymosis following cosmetic procedures in 20 patients. Their research revealed a 63% improvement in ecchymosis within 48 to 72 hours of laser treatment. Moreover, the rate of healing was higher when laser therapy was administered between days 5 and 10 after the onset of ecchymosis. Two other studies reported that the rate and speed of recovery from ecchymosis following PDL laser treatment were significantly higher than in control groups. Conclusion: Septorhinoplasty is widely recognized as an effective cosmetic procedure both in Iran and across the globe. Consequently, significant efforts have been devoted to addressing the challenges associated with this surgery in recent years. Among these challenges, ecchymosis stands out as a worrisome complication during the early postoperative phase. The application of lasers in this context generally contributes to a faster resolution of ecchymosis, providing a smoother path to recovery for patients. This positive outcome is attributed to the reduction of inflammation, improved blood circulation, and increased lymph drainage. The capability of laser therapy to expedite the resolution of bruising and promote rapid healing significantly enhances patient satisfaction and overall surgical outcomes. Recent studies have demonstrated the effectiveness of low-level laser therapy in various medical conditions, ranging from diabetic foot to androgenic alopecia, post-chemotherapy mucositis, wound healing, and inflammation. Harsant et al. explored the effects of low-level laser therapy in facial plastic surgery, highlighting its impact on flap survival, wound healing, alopecia, and potential effects on skin aging. They recommended further comprehensive data in this field and considered the use of laser therapy as an adjuvant treatment. Moreover, Alegre Sanchez et al. and Fata et al. indicated the potential of low-level laser therapy in reducing ecchymosis. However, it's important to note that none of these studies were case-control studies. In another meta-analysis, Enwemeka et al. emphasized the highly effective role of laser phototherapy in tissue repair and pain reduction, positively impacting all three stages of tissue repair. The potential effects of low-level laser therapy, as discussed in previous articles, encompass several key mechanisms: Reducing Edema and Inflammation, Restoring Damaged Tissue, Collagen Synthesis, Increasing Elasticity, Reducing Pain, Increasing Tissue Perfusion and Neovascularization, Increasing Cell Proliferation, and Especially Fibroblasts. An accepted theory regarding the biological mechanism of photomodulation suggests that it involves the absorption of light by chromophores. These mechanisms, especially the recovery of damaged tissue and neovascularization, can effectively reduce edema and ecchymosis following rhinoplasty. In a study conducted by Saedi et al., the Visual Analog Scale (VAS) scores in the laser-treated group were reported as better than those in the control group. However, it's worth noting that this difference was not statistically significant. Possible explanations for this inconsistency could include patients experiencing post-surgery stress or focusing on all parts of their face rather than just the area around the eyes. Additionally, if patients do not report a significant difference after laser surgery, the treatment may not fully serve its intended purpose. This discrepancy may also account for the differences in perceptions between the researchers and the patients involved. Nevertheless, the findings of this study demonstrated a positive effect of low-power laser therapy on ecchymosis that persisted for up to one month. While the precise results may vary across different studies, there is a general consensus that the use of laser therapy is effective in reducing ecchymosis following surgery. Patients who undergo septorhinoplasty and receive laser treatment post-surgery tend to experience a swifter healing process. Moreover, certain studies have highlighted the benefits of laser treatment, such as the reduction of side effects and increased patient comfort compared to traditional treatment methods. The available data strongly support the notion that laser therapy plays a pivotal role in the management of ecchymosis following surgeries, including septorhinoplasty. However, it's important to acknowledge a limitation of this treatment method, namely its cost, which may pose a barrier to its widespread adoption. Despite the positive results observed in this study, the extensive use of PDL in reducing ecchymosis after surgery necessitates longer-term follow-up and further studies with larger sample sizes and diverse intervention types to comprehensively evaluate its benefits and cost-effectiveness. </div> اکیموزیس, لیزر PDL, سپتورینوپلاستی Ecchymosis, Pulsed Dye Laser, Septorhinoplasty 1 7 http://rjms.iums.ac.ir/browse.php?a_code=A-10-7845-1&slc_lang=fa&sid=1 Reihaneh Heidari ریحانه حیدری 3900319475328460090002 3900319475328460090002 No Otorhinolaryngology Research Center, Department of Otorhinolaryngology-Head and Neck Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran مرکز تحقیقات گوش و حلق و بینی، بیمارستان ولیعصر، دانشگاه علوم پزشکی تهران، تهران، ایران Behrooz Amirzargar بهروز امیرزرگر 3900319475328460090003 3900319475328460090003 No Otorhinolaryngology Research Center, Department of Otorhinolaryngology-Head and Neck Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran مرکز تحقیقات گوش و حلق و بینی، بیمارستان ولیعصر، دانشگاه علوم پزشکی تهران، تهران، ایران Abbas Dehghani عباس دهقانی 3900319475328460090004 3900319475328460090004 No Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran دپارتمان پوست، بیمارستان رسول اکرم، دانشگاه علوم پزشکی ایران، تهران، ایران Babak Saedi بابک ساعدی 3900319475328460090005 3900319475328460090005 No Otorhinolaryngology Research Center, Department of Otorhinolaryngology-Head and Neck Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran مرکز تحقیقات گوش و حلق و بینی، بیمارستان ولیعصر، دانشگاه علوم پزشکی تهران، تهران، ایران Azadeh Goodarzi آزاده گودرزی azadeh_goodarzi1984@yahoo.com 3900319475328460090006 3900319475328460090006 Yes Department of Dermatology, Rasool Akram Medical Complex Clinical Research Development Center (RCRDC), School of Medicine, Iran University of Medical Sciences, Tehran, Iran دپارتمان پوست، بیمارستان رسول اکرم، دانشگاه علوم پزشکی ایران، تهران، ایران