Original contributionThe impact of different nasal packings on postoperative complications☆,☆☆,★
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)
- et al.
Packing in endonasal surgery
Am J Otolaryngol
(2001) - et al.
Use of nasal packs and intranasal septal splints following septoplasty
Int J Oral Maxillofac Surg
(2009) - et al.
Comparison of nasal packs with transseptal suturing after nasal septal surgery
Am J Otolaryngol
(2013) - et al.
Nasal splinting using silicone plates without gauze packing following septoplasty combined with inferior turbinate surgery
Auris Nasus Larynx
(2012) - et al.
Nasal adhesions
J Laryngol Otol
(1987) - et al.
Intranasal adhesions formation following surgery for chronic nasal obstruction
Clin Otholaryngol
(1988) - et al.
Packing and stents in endonasal surgery
Rhinology
(2000) - et al.
Evaluation of stents following septoplasty
Aesthetic Plast Surg
(1995) - et al.
Randomized controlled trial comparing Merocel and RapidRhino packing in the management of anterior epistaxis
Clin Otolaryngol
(2005) - et al.
A prospective randomized controlled trial comparing the use of Merocel nasal tampons and BIPP in the control of acute epistaxis
Clin Otolaryngol Allied Sci
(1995)
Cited by (22)
The impact of nasal adhesions on airflow and mucosal cooling – A computational fluid dynamics analysis
2021, Respiratory Physiology and NeurobiologyCitation Excerpt :The adhesions are most commonly found at the internal nasal valve following septoplasty or the middle meatus following endoscopic sinus surgery but can occur at other locations (Chandra et al., 2009). The reported incidence of adhesions following septoplasty with submucous turbinate surgery estimates 0–19.7% occurrence (Naghibzadeh et al., 2011; Deniz et al., 2014; Chen and Huang, 2019; Joshi et al., 2019). Patients who develop nasal adhesions after surgery often complain of persistent nasal airway obstruction (Young et al., 1997; Stewart et al., 2004; Joe Jacob et al., 2011; Derin et al., 2016).
Efficacy of nasal septal splints for preventing complications after septoplasty: A meta-analysis
2021, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryCitation Excerpt :The full-text of the remaining 65 articles was assessed for eligibility, and 32 were excluded for the following reasons: different intervention (n = 11), irrelevant outcome (n = 8), insufficient information (n = 7), and nonoriginal articles (n = 6). Eventually, 33 articles [3,10–41] were included in the meta-analysis (Fig. 1. and Table 1).
A novel surgical technique: Crushed septal cartilage graft application in endonasal septoplasty
2019, Auris Nasus LarynxCitation Excerpt :We presented a novel septoplasty technique to decrease and remove the complications of nasal septal surgery. Among the indicators of the efficacy of a septoplasty technique can be counted the improvement of symptoms, which can be seen by the NOSE score, postoperative endoscopic findings, and decreasing associated complications [9–15]. In a study, in order to evaluate the success of the method, the preoperative and the postoperative NOSE scores obtained in the 2nd and the 6th month were compared.
Do we really need to coat the novel silicone intranasal splints with antibiotics?
2016, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryCitation Excerpt :Following endonasal surgery, various nasal packing materials are being used to control epistaxis, prevent synechia and haematoma formation and support the skeleton of the nose [1,2].
Effect of nasal packs in septoplasty
2015, American Journal of Otolaryngology - Head and Neck Medicine and SurgeryProphylactic antibiotics in septoplasty with intranasal septal splints: A comparative analysis
2024, Clinical Otolaryngology
- ☆
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.