Comparison of the degree of algogenicity of rhinoplasty, septoplasty and rhinoseptoplasty

Introduction. One of the most challenging objectives in facial reconstructive surgery is the repair of external nasal defects. Difficulties may arise with simultaneous septo- and rhinoplasty, as there is a need to restore and preserve the structures of the nasal cavity. To date, very few studies exist that have focused on the evaluation of pain after surgical intervention on the nasal structures, which prompted us to investigate this issue.

The purpose of the study. The purpose of this study was to assess the severity of acute pain after septoplasty, rhinoplasty, and rhinoseptoplasty.

Material and methods. A total of 98 patients, 19 men and 79 women, aged from 18 to 45 years, were examined and operated on. The open rhinoplasty group (group 1) included 6 men and 27 women, the open rhinoseptoplasty group (group 2) – 7 men and 26 women, and the septoplasty group (group 3) included 6 men and 26 women. After performing rhinoplasty, septoplasty, or rhinoseptoplasty, the severity of pain was assessed using a visual analogue scale (VAS), a digital rating scale (DRS) and facial pain scale (FPS 3, 6, 24, 48 hours after the completion of surgical intervention).

Results. According to the VAS pain assessment, pain intensity in group 1 reached the maximum one hour after rhinoplasty and declined subsequently: at 3, 6 (p<0.001), 24 (p<0.05), and 48 (p<0.001) hours post-surgery. In groups 2 and 3, pain intensity was highest at the 3rd hour postoperatively (p<0.001) compared to the 1st hour postoperatively. According to the DRS, the intensity of pain in group 1 decreased 3 hours after rhinoplasty compared with the assessment at 1 hour after surgery, and continued to decrease at 3rd, 6th (p<0.001), 24th (p<0.01) and 48th hours (p<0.001). In group 2, 3 hours after the surgical manipulation, the intensity of pain increased significantly compared with the previous period of assessment (p<0.05), which was also found in the group of patients after rhinoseptoplasty (p<0.05) at similar timepoints. Assessing the severity of the pain syndrome according to FPS we found that the pain was insignificant in group 1 and did not cross the threshold. In group 2 and 3 patients, the pain significantly increased after 3 hours (p<0.001) compared with the 1st hour after the intervention but decreased thereafter.

Conclusion. Based on the acute postoperative pain assessment, this study confirms that septoplasty is a more traumatic intervention compared with rhinoplasty, and surgical operations in the external nose area and on the nasal septum result in increased stress reactions in the early postoperative period compared with rhinoplasty and septoplasty.

Key words: septoplasty, rhinoplasty, pain, trigeminal nerve

Conflicts of interest. The authors have no conflicts of interest to declare.

Funding. There was no funding for this study