Elsevier

American Journal of Otolaryngology

Volume 35, Issue 5, September–October 2014, Pages 554-557
American Journal of Otolaryngology

Original contribution
The impact of different nasal packings on postoperative complications,☆☆,

https://doi.org/10.1016/j.amjoto.2014.04.001Get rights and content

Abstract

Objective

The objective of this study was to find out if there is any association between the use of nasal packings and nasal synechia formation, septal perforation, postoperative infection and epistaxis in patients who underwent septoplasty and concha reduction operations.

Methods

This retrospective study was conducted at a tertiary referral center. One hundred thirty patients were randomly selected among patients who underwent endonasal surgery in Namık Kemal University Hospital between January 1st 2012 and August 1st 2013. Retrospective analysis of these patients' files, including operative reports and follow-up notes, was done. The postoperative findings of patients who had septal splints and Merocel nasal packings were compared and analyzed for statistical significance.

Results

The results of the study showed a statistically significant difference in the frequency of synechia formation between two groups (p < 0.05). The frequency of synechia formation was found to be higher in the Merocel packing group. However, no statistically significant difference was found between groups in terms of postoperative infection, septal perforation, and epistaxis (p > 0.05).

Conclusion

Our findings suggest that intranasal splints are superior to Merocel nasal packings in terms of preventing nasal synechia formation. Insertion of a septal splint after nasal surgery should be preferred to avoid this complication. On the other hand, other factors should be sought in the etiology of postoperative infection, septal perforation, and epistaxis.

Introduction

Septoplasty and reduction of the inferior turbinates are the most commonly used surgical interventions to enhance nasal airway compromised secondary to septal deviations or spurs and turbinate hypertrophy. Following these operations nasal packing materials are used in an attempt to prevent synechia and hematoma formation, support septal flap apposition and reduce the dead space between the subperichondrial flaps [1], [2]. However, various complications, such as nasal synechia formation, septal perforation, postoperative infection and epistaxis were reported to be associated with the use of nasal packings [3], [4].

Nasal splints and Merocel nasal packings are used following endonasal surgical interventions. The literature review showed that use of nasal splints is favored by some authors [5], [6] whereas use of Merocel nasal packing is advocated by others [7], [8]. It was even suggested by some authors that use of any nasal packing material was associated with the above-mentioned complications and they should be replaced by trans-septal suturing techniques [9], [10], [11], [12].

The main objective of our study was to find out if there is any association between the use of nasal packings and nasal synechia formation, septal perforation, postoperative infection and epistaxis. This topic is quite interesting for otolaryngologists because septoplasty and concha reduction are day-in/day-out procedures in ENT surgery. A careful reflection of the use of well-known medical products is just as important as the investigation of new material. For this purpose, we retrospectively investigated the complication rates associated with the use of septal splints and Merocel nasal packings in our patients and discussed our findings under the scope of literature.

Section snippets

Materials and methods

This investigation was done with the permission of Namık Kemal University Ethics Committee. Following endonasal surgery, septal splints or Merocel nasal packings are routinely used in our department. One hundred thirty patients, randomly selected among patients who underwent septoplasty and inferior turbinate reduction with radiofrequency in Namık Kemal University Hospital between January 1st 2012 and August 1st 2013, were enrolled in this study. Operative reports and follow-up notes of

Results

The review of patient files showed that of 130 patients, 61 were female and 69 were male. The number of patients who received septal splint was found to be 59 (45.38%). The number of patients who received Merocel nasal packing was found to be 71 (54.61%). The mean ages for septal splint group and Merocel packing group were 36.61 ± 11.2, and 37.1 ± 10.3, respectively, ranging from 18 to 61. The two groups were similar in demographic parameters.

Postoperative nasal synechia was found to occur in 14 of

Discussion

Following endonasal surgery various nasal packing materials are used to control bleeding, prevent hematoma formation and support septal flap apposition [3]. Despite their advantages, nasal packings have certain drawbacks including obligatory mouth breathing, headache, dysphagia, risk of aspiration, airway obstruction, eustachian tube blockage, a considerable degree of pain during pack removal and foreign body reaction. In addition, complications including infection, synechia, septal perforation

Conclusion

Our findings suggest that intranasal splints are superior to Merocel nasal packings in terms of preventing nasal synechia formation. Although statistically insignificant, rates of infection, epistaxis and septal perforation were found to be lower in the splint group. We suggest use of septal splints following endonasal surgery to prevent or reduce these complications. On the other hand, other factors also should be sought in the etiology of postoperative infection, septal perforation, and

Conflict of interest

None.

Financial disclosure

None.

Acknowledgments

We thank Namik Kemal University Ethics Committee for giving permission to our study.

References (21)

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None of the authors have any conflict of interest, financial or otherwise.

☆☆

This manuscript is original and it, or any part of it, has not been previously published or is under consideration for publication elsewhere.

Each of the authors has contributed to, read and approved this manuscript.

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