Tumescent steroid infiltration to reduce postoperative swelling after craniofacial surgery

Br J Plast Surg. 2001 Oct;54(7):565-9. doi: 10.1054/bjps.2001.3664.


Steroids are often administered to paediatric craniomaxillofacial patients perioperatively to reduce postoperative facial swelling, although there is little evidence of their efficacy. Preoperative tumescent infiltration using 7 ml x kg(-1) of a solution consisting of 0.1 mg x ml(-1) triamcinolone acetate, 0.0125% bupivacaine, 0.025% lignocaine, 3 units x ml(-1) hyaluronidase and 1:1000000 adrenaline in Hartmann's solution was evaluated from a retrospective case controlled study of patients undergoing standard fronto-orbital remodelling for simple craniosynostosis (n = 20). Eye closure (i.e. inability to open the eyes) was used as a marker for severe facial swelling. Patients receiving the tumescent infiltration demonstrated significantly less eye closure (P < 0.005), implying that the tumescent infiltration had a significant effect on facial swelling. The avoidance of eye closure allowed more effective monitoring for neurological and ophthalmological complications, which is a significant clinical benefit. The infiltration solution has the advantage of a lower corticosteroid dose than previously reported dexamethasone-based perioperative regimens, thereby minimising any unwanted metabolic effects. The technique is advocated for the reduction of postoperative facial swelling in craniomaxillofacial surgical patients.

MeSH terms

  • Anesthetics, Local / therapeutic use
  • Anti-Inflammatory Agents / therapeutic use*
  • Blepharitis / drug therapy*
  • Blepharitis / etiology
  • Case-Control Studies
  • Craniosynostoses / surgery*
  • Drug Therapy, Combination
  • Edema / prevention & control*
  • Epinephrine / therapeutic use
  • Humans
  • Hyaluronoglucosaminidase / therapeutic use
  • Infant
  • Injections, Subcutaneous
  • Length of Stay
  • Pain, Postoperative / etiology
  • Postoperative Complications / prevention & control*
  • Premedication*
  • Preoperative Care / methods
  • Retrospective Studies
  • Treatment Outcome
  • Triamcinolone / therapeutic use*


  • Anesthetics, Local
  • Anti-Inflammatory Agents
  • Triamcinolone
  • Hyaluronoglucosaminidase
  • Epinephrine