Introduction
With advancements in medicine and research, more techniques and procedures allow patients to choose from a wide range of options. One specialty that has attained popularity is plastic or cosmetic surgery. The promising fact that people can correct flaws that were acquired by birth or due to an unfortunate injury is the main reason for its popularity. One of the most common plastic surgeries done on the face is rhinoplasty. It is done to correct the shape or function of the nose.
What Is Rhinoplasty?
Rhinoplasty, popularly known as a nose job, is a plastic surgery procedure performed on a patient's nose to correct appearance, improve functionality, or both. The primary reasons why people opt for rhinoplasty are:
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To enhance the shape of the nose.
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To change the size of the nose.
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To change the appearance of the nose tip.
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Airway blockage due to underlying causes.
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To correct congenital disabilities.
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Nose injury.
Based on the needs of the patient and the case presentation, rhinoplasty comes in four types. They are:
Open Rhinoplasty
An incision is made across the columella separating the nostrils to reshape the nose.
Closed Rhinoplasty
This type of rhinoplasty is usually preferred in cases where aesthetics are the primary concern because the incision is not visible.
Filler Rhinoplasty
Filler rhinoplasty is used to fill a dent or smoothen the nose tip. This is the least invasive kind of rhinoplasty.
Secondary Rhinoplasty
It is also called revision rhinoplasty and is used to correct an already reshaped nose.
As a cosmetic procedure, rhinoplasty comes with a set of complications. Some common risks and complications are:
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A blocked nose or breathing difficulty is a common complication associated with rhinoplasty. The loss of mucosal sensation is the main reason behind this. However, in most cases, the difficulty disappears once healing sets in.
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Postoperative swelling.
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Atrophy, numbness, or cysts due to displaced mucosa.
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Infections as a complication are rare. But if it happens, the situation can be life-threatening, leading to toxic shock syndrome.
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Necrosis of the eyelids by infections is also an associated risk.
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One of the most common problems after surgery is deformities, which may need to be fixed with a second surgery.
How Has COVID-19 Affected Rhinoplasty Surgery?
The COVID-19 era was a dark time for every living being. However, it has had a lasting impact on the healthcare industry, especially plastic surgery. The reasons why COVID-19 hit this particular industry hard are:
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COVID-19 infection being spread primarily through aerosols, it was initially believed to be risky to perform any medical procedure. The health sector had overworked and overburdened at the time and needed help balancing non-essential surgeries like rhinoplasty. So these elective procedures were put on hold so that healthcare workers could focus on the life-threatening conditions.
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Since the virus is believed to live at the back of the nose, there was initially a fear of transmission. Putting the patient and surgeon at risk for a cosmetic procedure seemed trivial.
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COVID-19 was a dangerous period for patients to reach a hospital as there was a risk of exposure. Many patients opted out of surgery due to the uncertainty that prevailed.
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Early results of a study coordinated by the University of Birmingham indicated that the outcome of a COVID-19 infection caught immediately before or after surgery could be worse.
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Apart from the surgeon and patient, there are several other staff members whose presence is necessary for the smooth conduct of the surgery. They are also at risk of exposure.
What Are the Practice and Safety Considerations to Minimize Transmission?
After years of battling this virus and waiting for the pandemic to disappear, healthcare professionals are learning to live with the virus by taking specific measures to ensure staff and patients are at minimum risk of exposure. The risk of transmission is higher in cases involving the oral and nasal passages, which makes rhinoplasty one of the high-risk procedures. There are a set of precautions and safety measures that are followed by surgeons worldwide during the preoperative, intraoperative, and postoperative periods. This set of safety protocols can minimize the risk of exposure to a certain extent.
Three types of people are at risk during a rhinoplasty procedure:
Patient
They are at the highest risk of transmission due to their proximity to healthcare workers and other patients. In addition, lack of hygiene and unsterilized settings can contribute to increased risk, which can be avoided by maintaining proper social distancing, maintaining hand hygiene, and wearing masks when possible.
Surgeon
They are exposed to aerosols from patients during the examination. Infection can be prevented if proper hygiene measures are incorporated into practice.
Other Staff Members
Apart from surgeons and patients, several frontline workers risk their lives coming to work every day, including nurses, attendants, receptionists, janitors, etc.
The safety protocols can be divided into four groups. They are:
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Preoperative protocols.
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Intraoperative protocols.
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Postoperative protocols.
What Are the Preoperative Safety Measures for Rhinoplasty?
- Preoperative assessment.
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Most cases should be assessed through teleconsultations.
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If the case necessitates a physical examination, ensure that the patient completes two questionnaires: the COVID-19 symptom questionnaire and the high-risk exposure questionnaire.
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None or a limited number of visitors or bystanders.
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Social distancing at all times.
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Wearing masks should be mandatory.
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No provision for waiting rooms to prevent interaction.
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Preoperative screening.
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RT-PCR testing for COVID-19 two days before the surgery.
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Temperature check.
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Distributing questionnaires the day before surgery.
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Application of 2% PVP-I (Povidone-Iodine) nasal spray and 15 seconds of 2% PVP-I (Povidone-Iodine) mouth gargling.
Intraoperative Safety Measures for Rhinoplasty
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Allow fewer personnel during intubation and induction, as these stages are at the highest risk for transmission.
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N95 masks and personal protective equipment are to be worn by doctors.
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Insertion of a 2% PVP-I (Povidone-Iodine) nasal pledget and throat mask (should be kept in place till the end of the procedure).
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The patient’s face is prepped with 10% PVP-I (Povidone-Iodine) for 30 to 60 seconds and then rubbed off with saline.
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Tegaderm dressing to cover the oral cavity and endotracheal tube.
Postoperative Safety Measures for Rhinoplasty
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As in intubation, the number of personnel present during extubation should be minimum.
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Anterior neck manipulation should be limited to avoid coughing from irritation.
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Recovery areas should be individual and isolated, not wards.
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Patients are advised to socially isolate themselves and follow safety protocols for at least four weeks.
Conclusion
The pandemic era is a tough time for everyone and even more challenging for some. Even though rhinoplasty is a blessing to many, it should be kept in mind that nothing is more important than health. Therefore, overall health should be prioritized, and all precautions and safety measures should be strictly followed during the procedure.
