The Effects of Vibration and Pressure Treatments in the Early Postoperative Period of Rhinoplasty

Background The early postoperative period can be distressing for the patients undergoing rhinoplasty since edema and ecchymosis are common complications. Objectives To analyze the effects of the vibration and pressure treatments in the early postoperative period of rhinoplasty. Methods Sixty patients, who had undergone rhinoplasty, were randomized into 3 groups: group 1 (control group, n = 20) received classic nasal casting, group 2 (n = 20) received nasal cast with an elastic bandage to hold it on the face, and group 3 (n = 20) received vibration treatment in addition to that in group 2 following the rhinoplasty. They were evaluated preoperatively and postoperatively at 3 and 7 days in a prospective study. The postoperative edema and ecchymosis were scored by 2 independent surgeons. The postoperative pain was measured using the visual analog scale, and the necessity of anti-inflammatory medication (and the dose needed) and the cast comfort was questioned. The sebaceous activity of the nose skin was examined. A preoperative and postoperative seventh day sonographic study was performed to evaluate the tissue edema objectively. Results The pressure treatment decreased the edema and ecchymosis significantly compared with the control group. The vibration treatment minimized edema, ecchymosis, sebaceous activity of the nose skin, pain score, and the need for anti-inflammatory medication, and increased the cast comfort significantly compared with the other groups (P < 0.0001). Conclusions Rapid regression of edema and ecchymosis may be achieved using the vibrating nasal cast technique that may minimize patient discomfort, pain, and sebaceous activity following rhinoplasty. Level of Evidence: 1

R457 – Paranasal Aerosol Delivery of Budesonide Using PARI VibrENT

Problem Nasal sprays containing inhaled corticosteroids are widely used for the treatment of chronic, allergic and acute sinusitis. However, nasal sprays deposit mainly on the nasal valve and on the anterior portion of the nose, and are rapidly cleared from there. Clinical efficacy data are equivocal which might be caused by the inability of nasal sprays to reach into the posterior regions of the nose. Hence, a drug delivery system such as the PARI VibrENT designed to target the deep nose and the paranasal cavities via a pulsating aerosol may offer substantial benefits. Methods Nebulization efficiency was investigated by a novel cast deposition model of the upper airway including paranasal sinuses developed by PARI GmbH (Munich, Germany). 0.5 mL of a captisol enabled budesonide inhalation solution (CBIS, 480 μg Budesonide/ml) was completely aerosolized into each nostril. Consequently, in total 1 ml or 480 μg of Budesonide were administered in about 3 minutes. Sinus deposition was measured by extracting the deposited drug with a defined volume of solvent and assayed by HPLC. Results The mean values are as follows: the mean paranasal deposition was 15.9% of the initially charged budesonide amount. Only about 2% of the initial budesonide charge remained in the nebulizer, whereas 57.7% deposited in the nasal cavity, 15.2 % were expelled and 90.8 % of the drug was recovered. Deposition in the single sinus cavities ranged from 0.1% up to 7% depending significantly on sinus volume (p<0.01) and ostium diameter (p<0.01). Conclusion Relevant drug amounts could be delivered by the VibrENT into the nose and paranasal cavities of the nasal cast. Sinus deposition depends on its anatomy and was highest with ostium diameters from 1.5 to 3 mm. Significance Significant sinus deposition of abudesonide solution may be attainable through the use of the VibrENT nebulizer system. Clinical studies are warranted.