Reverse Trendelenburg Positioning in Open Rhinoplasty: A Systematic Review of Clinical outcomes

Rhinoplasty, a frequently performed facial plastic surgery procedure, often associated with challenges such as intraoperative bleeding and postoperative periorbital odema and/or ecchymosis, which can prolong recovery and reduce patient satisfaction. This systematic review investigates the impact of intraoperative patient positioning, in reverse Trendelenburg positioning (RTP), on bleeding and postoperative outcomes in open rhinoplasty. The included studies comprised of randomized and observational studies comparing reverse Trendelenburg position (RTP) with varying degrees of head elevation, and reporting outcomes such as blood loss, surgical field visibility, and postoperative odema or ecchymosis. Three studies met the inclusion criteria, proving that reverse Trendelenburg position (RTP) at angles between 10° and 20° being effective in reducing intraoperative bleeding and enhancing clarity of the surgical field compared to supine or lesser degrees of elevation. The largest trial demonstrated a decrease in bleeding with increasing tilt, with no significant advantage beyond 15°. Reverse Trendelenburg position (RTP) has also been shown to decrease postoperative periorbital odema and ecchymosis, especially at 20°, with these effects lasting through the first week following surgery. Surgeon satisfaction improved with Reverse Trendelenburg position (RTP), while operative time and physiological parameters remained stable, the later proving its safety. This review is the first to comprehensively assess the role of reverse Trendelenburg position (RTP) in open rhinoplasty and supports its adoption as a straightforward, safe, and effective technique to reduce bleeding and postoperative complications. Due to its simplicity and proven benefits, the reverse Trendelenburg position (RTP) at about 10° to 20° should be considered a valuable addition to rhinoplasty practice for optimizing surgical conditions and enhancing recovery. Level of evidence: Level II