Effect of nasal packing and haemostatic septal suture on mucociliary activity after septoplasty: an assessment by rhinoscintigraphy

Submucosal Trans-Septal Suturing Technique After a Septal Extension Graft with Porous High-Density Polyethylene: A Technical Report

BACKGROUND

Porous high-density polyethylene (pHDPE) is an alternative material for a septal extension graft (SEG) in oriental rhinoplasty when autologous cartilage is limited. Although nasal packing (NP) and trans-septal suturing (TSS) techniques are routine procedures to obviate the dead space after septoplasty, they are associated with certain discomforts and complications.

OBJECTIVE

To investigate the application of a submucosal trans-septal suturing (STSS) technique after SEG with pHDPE.

METHODS

A prospective study was conducted on 60 female participants who underwent SEG with pHDPE. The participants were randomly divided into the NP group and STSS group. The extra surgical duration of NP and STSS, pain, nasal obstruction, and sleeping disturbance as well as postoperative complications were recorded and compared between groups.

RESULTS

No significant difference was found between group NP and group STSS in terms of mean age. The mean extra surgical duration of group STSS was significantly longer than group NP. There were significant higher pains of group NP at 24 hours and 48 hours postoperatively, compared with group STSS. The NP group also experienced significantly more nasal obstruction and sleep disturbance within 48h postoperatively compared to the STSS group. There was one infection in each group, minor bleeding in two NP patients, and one STSS patient. There was no major bleeding, hematoma, graft exposure, or septal perforation in both groups.

CONCLUSION

Although STSS needs a longer extra surgical duration than NP, it significantly improves the patient's postoperative comfort with a faster return to normal respiration compared to NP.

LEVEL OF EVIDENCE I

This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Trans-septal Suturing Versus Merocel Nasal Packing: A Post Septoplasty Comparison

It has been observed that nasal packing following septoplasty contributes to co-morbidities like post-operative pain, bleeding and increased duration of hospital stay. Trans-septal suturing has been suggested as a safe and effective alternative with a view to obviate the need for nasal packing and the hence avoid the discomfort associated with it. To compare the outcome of trans-septal suturing technique with merocel nasal packing after septoplasty. This was a prospective comparative study done on 60 patients who underwent septoplasty. The patients were divided randomly into 2 groups, while Group A comprised of patients undergoing Post-operative nasal packing with poly vinyl alcohol sponge (also commercially called Merocel), Group B included patients who underwent nasal septal suturing after surgery. The postoperative pain, hemorrhage and duration of hospital stay were the main parameters that were assessed and a comparison was drawn between the post-operative outcome of two techniques. Post-operative global pain score was 62.18 ± 4.75 in the group A (patients with nasal packing) and 24.73 ± 4.29 (patients with trans-septal suturing) in group B ('p'value was < 0.0001). Post-operative bleeding was noticed in 19 patients (out of 30) in group A, and in 2 patients of group B ('p'value was < 0.0001). 27 out of 30 patients of Group A were discharged on day 2 whereas 24 out of 30 patients of Group B required only 1 day of hospital stay after the surgery ('p' value was < 0.0001). Trans-septal suturing technique reduces the duration of hospital stay, causes lesser post-operative bleeding and pain and is a relatively less painful technique than merocel nasal packing.

Is postoperative nasal packing after septoplasty safe? A systematic review and meta-analysis of randomized controlled studies

OBJECTIVES

To systemically review and compare post-septoplasty complications between total nasal packing and other techniques.

METHODOLOGY

We searched electronic databases (PubMed, Scopus, and Cochrane Library) and additional sources. The most recent search was on November 30th, 2020. Randomized controlled trials (RCTs) comparing adverse events after post-septoplasty nasal packing versus other techniques were included. The outcomes were adverse events, including respiratory distress, oxygen desaturation, pain severity, bleeding, hematoma, sleep disturbance, infection, crusting, epiphora, dysphagia, perforation, adhesion, and residual septal deviation.

RESULTS

There were 47 studies (4,087 participants) in this systematic review. Nasal packing was more likely to cause adverse events than other techniques. There were significant increases in respiratory distress, pain, sleep disturbance, crusting, epiphora, dysphagia, and adhesion. There were no statistically significant differences in oxygen desaturation, bleeding, hematoma, infection, perforation, and residual septal deviation. Subgroup analysis found that trans-septal suture was less likely to cause post-operative complications compared with total nasal packing.

CONCLUSION

Nasal packing after septoplasty was more likely to cause adverse events, including respiratory distress, pain, sleep disturbance, crusting, epiphora, dysphagia, and adhesion. Furthermore, there were no benefits of nasal packing in preventing bleeding, hematoma, and residual septal deviation when compared with other techniques. Routine nasal packing after septoplasty should be avoided. Trans-septal suture should be considered instead.

Efficacy of nasal septal splints for preventing complications after septoplasty: A meta-analysis

BACKGROUND

The efficacy of nasal septal splints, which are used as alternatives to nasal packs for preventing complications such as synechia and maintaining septal stability after septoplasty, remains controversial. The present meta-analysis assessed the efficacy and safety of nasal septal splints used after septoplasty.

METHODS

PubMed and Google Scholar databases were systematically searched until June 20, 2019. Randomized controlled trials or cohort or case-control studies comparing patients who received nasal septal splints with those who did not receive splints after septoplasty were included. Primary outcomes included postoperative pain, infection, bleeding, hematoma formation, synechia, and perforation. Random effects models were used to calculate risk differences and risk ratios with 95% confidence intervals (CIs).

RESULTS

Thirty-three eligible studies were included. The estimated rate of synechia was significantly lower in the splint group (0.037, 95% CI 0.024-0.056) than in the no splint group (0.087, 95% CI 0.055-0.135; P = 0.003), while visual analog scale scores for pain and the estimated rates of infection, bleeding, hematoma, and perforation were comparable between groups.

CONCLUSIONS

These findings suggest that the use of nasal septal splints as alternatives or in addition to nasal packing prevent synechia after septoplasty without increasing other complications, including pain, thus adding to evidence supporting the use of septal splints, particularly in cases where postoperative synechia is expected.

A Comparative Study Between Septal Quilting Sutures Without Nasal Packing and Only Nasal Packing Post-septal Correction

Septal correction is the commonest surgery by rhinologists worldwide. We aimed at studying the comfort level of the patient with standard postoperative nasal packing with Merocel and placing quilting sutures in septum leaving the nose unpacked in the postoperative period. We conducted the study in the tertiary care centre enrolling 82 patients in a quasi-randomised method of odd and even numbers placing them in the nasal packing group and the quilting group respectively. We used analogue scoring method for subjective assessment of comfort level in the postoperative period and the surgeon objectively assessed the patient on follow up. The results were tabulated and analysed. Postoperative pain, headache and sleep disturbance was significantly more in the nasal packing group. We found that the crusting is commonly seen in patients in the nasal packing group. Quilting the nasal septum and leaving the nasal cavity unpacked increases the comfort level of the patient in the postoperative period. The resultant pain, headache and sleep disturbance caused by nasal packing can be significantly avoided by using quilting the septum without nasal packing. We also observed that by avoiding nasal packing postoperatively, the patients were more comfortable and compliant with the treatment regimen and follow-up.

Application of high expansion degradable cotton in nasal bleeding model of dog

BACKGROUND

The discomfort and complications have always been problems for nasal packing materials. This study provided a new nasal packing material called high expansion degradable cotton (HEDC).

METHODS

Nasal endoscopic surgery was used to establish a dog model of nasal bleeding, and wound surfaces were filled with Merocel, Nasopore and HEDC, respectively. Intraoperative and postoperative bleeding of 24 h was calculated. We evaluate the absorbability score, adhesion score, infection sore and nasal mucosal epithelium in postoperative 3, 7, 14 and 28 days. HE staining and electron microscopy were used to evaluate the recovery of nasal mucosa.

RESULTS

There was no significant difference in nasal bleeding between HEDC, Merocel and Nasopore. Nasal endoscopic examination revealed HEDC absorbability of score, adhesion score, infection score were significantly lower than Merocel and Nasopore. The epithelialization time of HEDC was significantly shorter than that of Merocel and Nasopore. HE staining showed that HEDC and Nasopore could significantly reduce scar hyperplasia on the wound surface. The results of electron microscopy suggested that HEDC could protect the edge cilia of the wound.

CONCLUSION

HEDC could be used as new choice for hemostasis after nasal endoscopic surgery, which could reduce nasal epithelialization time, and protect wound edge cilia.

Evaluation of the effect of inferior turbinate outfracture on nasolacrimal transit time by saccharin test

AIM

To evaluate the effect of inferior turbinate outfracture on nasolacrimal transit time by saccharin test.

MATERIALS AND METHODS

Twenty patients who underwent septoplasty + unilateral radiofrequency ablation and outfracture of inferior turbinate were enrolled into study. They had no complaints about their eyes and denied previous ocular surgery. Their nasolacrimal saccharin transit times (NSTTs) were estimated preoperatively and postoperatively in the 1st and 2nd months. The non-fractured side eye was measured only once preoperatively. The fractured-side eye was measured three times. These times were compared statistically.

RESULTS

There were 8 men and 12 women. Mean age was 29.04. Killian incision was used in 14 and hemitransfixion incision was used in 6 patients. Median NSTT was 484, 461, 490 and 446 s for the non-fracture side, preoperatively and postoperatively in the 1st and 2nd months, respectively. There was no statistically significant difference between the two eyes preoperatively, and in the fractured side preoperatively and postoperatively in the 2nd month. There were significant differences between median NSTT in postoperative 1st month and median NSTT in the preoperative measure, and between postoperative 1st and 2nd months (p < 0.05). Median NSST in the 1st month was longer than the others.

CONCLUSION

Outfracture of inferior turbinate had no permanent effect on NSTT 2 months after surgery in patients that had a healthy nasolacrimal system.

The influence of standardized dry ivy leaf extract on the proportion of nasal secretion after post-septoplasty nasal packing removal

Introduction

After post-septoplasty nasal packing removal, a certain proportion of nasal secretion occurs, leading to local and sometimes systemic infections.

Objective

The aim was to determine if standardized dry ivy leaf extract application after nasal packing removal influences the reduction of nasal secretion and diminish the occurrence of local infections.

Methods

The study included 70 post-septoplasty patients (divided into two equal groups) whose nasal packing was removed on the third day after the procedure. Group I was treated with standardized dry ivy leaf extract syrup along with regular nasal irrigation for the five days after the nasal packing removal whereas the Group II had only nasal lavage. On the sixth day after nasal packing removal, the quantity of nasal secretion was determined using a visual analog scale and nasal endoscopic examination.

Results

The group treated with standardized dry ivy leaf extract syrup had significantly lesser nasal secretion both by subjective patients’ assessment (p < 0.001) and by nasal endoscopic examination (p = 0.003). The post-surgical follow up examination on the sixth day after nasal packing removal showed no development of local infection in the Group I, while in the Group II a local infection was evident in five patients (14.29%) and antibiotic therapy was required.

Conclusion

The use of the standardized dry ivy leaf extract after nasal packing removal significantly lowers the proportion of nasal secretion.

Nasal silicone splints and quilting sutures using a septum stitch device following septoplasty: a prospective comparative study

PURPOSE

Although nasal splints and trans-septal sutures are preferred for septal closure following septoplasty, quilting sutures, also known as continuous mattress sutures, are technically challenging and thus time consuming. Recently, the utility of a novel stitch device was demonstrated for quilting sutures; however, whether it contributes to the technical solution and time management of septal sutures remains unclear. This study aims to quantify the time and cost of septal closure following septoplasty by comparing nasal splints with quilting sutures using the septum stitch device.

METHODS

We prospectively examined 23 patients who underwent septoplasty and assigned them to the following two groups: group 1, underwent the quilting suture for septal closure following septoplasty; group 2 underwent the nasal silicone splint method. We recorded the total operation time and surgical time for septal closure. Furthermore, we evaluated postoperative symptoms with Visual Analogue Scale (VAS) scores and compared the complication rate.

RESULTS

We observed no significant difference in the average of total operating time (P = 0.641) and the surgical time for septal closure (P = 0.886). Among postoperative symptoms, only nasal bleeding was significantly worse in group 1 on postoperative day 1 (P = 0.023). In addition, the occurrence of postoperative complications was insignificant between both groups.

CONCLUSIONS

The septum stitch facilitated safe and easy quilting suturing without significant increase of operation time.

The Effect of Dexpanthenol-Vitamin A (Nazalnem) on Silastic Splints After Nasal Septal Surgery

OBJECTIVE

To investigate the effect of dexpanthenol-vitamin A (Nazalnem) ointment applied to the surface of silastic splints with an airway immediately after nasal septal surgery on postoperative complaints and nasal mucosa function.

MATERIALS AND METHODS

The study enrolled 60 patients undergoing nasal septoplasty surgery. Group 1 (n = 30) received silastic splints with ointment containing dexpanthenol-vitamin A (Nazalnem), and Group 2 (n = 30), the control group, received silastic splints with vaseline. Of these patients, 2 patients from the Group 1 and 9 from the Group 2 were excluded.A thin layer of ointment was applied to the flat side of a silastic splint with an airway. The splints were removed on the second postoperative day. Patients were evaluated preoperatively and 1 and 2 weeks postoperatively using a visual analog scale and the Sino-Nasal Outcome test (SNOT-22). Mucociliary clearance (MCC) tests were performed at the same times.

RESULTS

Visual analog scale for nasal crusting, nasal congestion, and foul odor was better in Group 1 than in Group 2 both at 1 week and at 2 weeks postoperatively (P < 0.05).The SNOT scores were significantly lower in Group 1 than in Group 2 at 1 week (P < 0.01), but did not differ at 2 weeks postoperatively (P > 0.05).Postoperatively, the MCC were insignificant between the groups and within the groups at 1 and 2 weeks (P > 0.05).

CONCLUSION

Although Dexpanthenol-Vitamin A ointment had no direct effect on wound healing, it had significant effects on crusting, obstruction, and foul smell. However, silastic splints with dexpanthenol did not improve the MCC of the nose.

Comparison on effectiveness of trans-septal suturing versus nasal packing after septoplasty: a systematic review and meta-analysis

This systematic review applied meta-analytic procedures to evaluate the curative effect of trans-septal suturing versus nasal packing after septoplasty. Computerized search of the published literature in PubMed, EMBASE, CENTRAL, Cochrane Database of Systematic Reviews, WANFANG, CNKI databases. Randomized trials investigating trans-septal suturing versus nasal packing following septoplasty in patients with deviated nasal septum. Adhesion, septal hematoma, bleeding, septal perforation, infection, pain, headache, or residual septal deviation per randomized patients. 19 randomized controlled trials of 1845 subjects were included. Meta-analysis showed that postoperative pain, headache, and adhesion were significantly lower in trans-septal suturing group. Nasal packing and trans-septal suturing technique appear to be equivalent with regard to postoperative bleeding, hematoma, septal perforation, infection, and residual septal deviation. Trans-septal suturing technology is not only associated with less patient pain, headache, and lower occurrence rate of adhesion after septoplasty but it also relates to higher patient satisfaction and an improved quality of life. The suturing technology can be used as a substitute for traditional nasal packing of the first-line treatment. More well-designed studies are needed to confirm the effect of trans-septal suturing following septoplasty.

Nasal Septal Chain Suture: A New Suturing Technique

As a new technique for suturing the nasal septum, the nasal septal chain suture has been described in this study, and compared with nasal packing and the quilting suture technique in terms of patient comfort after septoplasty. A total of 75 patients were evaluated in 3 groups: Merocel nasal packing group, absorbable quilting suture group, and nonabsorbable nasal septal chain suture group. The symptoms of these patients were evaluated using the nasal obstruction symptom evaluation (NOSE) scale and rhinomanometry measurements. The NOSE scale values were significantly higher on the postoperative 1st and 3rd days in the nasal packing group (P < 0.001 and P < 0.001, respectively). The nasal resistance was significantly lower (P = 0.011) and the nasal airflow significantly higher (P < 0.001) in the suture groups on the postoperative 3rd day. The use of nasal packing was found to shorten the surgery duration significantly (P < 0.001), while there was no difference between the 2 suture groups (P = 1.000). There was significantly severe pain during the removal of the nasal packing when compared to the nasal septal chain suture removal (P < 0.001), but there was no difference in the bleeding (P = 0.460). Overall, nasal septal sutures significantly improve patient comfort during the postoperative period, when compared to nasal packing, with an earlier return to nasal respiration. The nasal septal chain suture that has been described in this study for the first time can be an alternative to nasal packing and the nasal septal suture techniques currently in use, since both absorbable and nonabsorbable materials can be used, it is easy to remove, and there is no pain during the suture removal.

Is nonabsorbable nasal packing after septoplasty essential? A meta-analysis

OBJECTIVES

Septoplasty is one of the most frequently performed rhinologic surgeries. Complications include nasal bleeding, pain, headache, septal hematoma, synechia, infection, residual septal deviation, and septal perforation. In this study, we aimed to compare complication rates among patients according to packing method.

METHODS

We performed a literature search using PubMed, Embase, and the Cochrane Library through August 2016. Our systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Random effect models were used to calculate risk differences and risk ratio with 95% confidence intervals (CIs). Cases referred to the nonpacking group included patients treated with transseptal sutures or septal splints. Cases referred to as the packing group included patients treated with nonabsorbable packing such as Merocel or gauze.

RESULTS

Our search included 20 randomized controlled trials (RCTs) with a total of 1,321 subjects in the nonpacking group and 1,247 subjects in the packing group. There were no significant differences between packing methods regarding bleeding, hematoma, perforation, infection, and residual septal deviation. The risk differences of postoperative pain, headache, and postoperative synechia were -0.50 [95% CI: -0.93 to -0.07, P = .02], -0.42 [95% CI: -0.66 to -0.19, P = .0004], and -0.03 [95% CI: -0.06 to -0.01, P = .01], respectively.

CONCLUSIONS

Nonabsorbable nasal packing is no more effective than treatments without packing after septoplasty. Septal splints and transseptal sutures reduce postoperative pain, headache, and synechia.

LEVEL OF EVIDENCE

1B Laryngoscope, 127:1026-1031, 2017.

The effect of duration of merocel in glove finger with tetracaine solution on septoplasty morbidity

OBJECTIVE

We aimed to decrease the postseptoplasty morbidities depending on nasal packing by using Merocel within glove finger moistened with tetracaine 0.25% solution.

STUDY DESIGN

The study was designed as a randomized prospective study.

SETTING

A university hospital in Turkey.

SUBJECTS AND METHODS

Our study consisted of 80 patients who underwent septoplasty. The Merocel nasal tampon within glove finger was inserted after surgery in the study group and removed after 24 or 48 hours. Merocel was moistened with tetracaine 0.25% solution after insertion into the nasal cavity and just before removal. The morbidities and normal breathing time were recorded and compared with those of the control group.

RESULTS

The postseptoplasty morbidities were significantly decreased in the study group compared with those in the control group. The morbidities were also improved after removal of tampons after 24 hours compared with 48 hours. However, the normal breathing time was prolonged when the nasal tampons were removed after 24 hours.

CONCLUSIONS

The glove finger provides comfortable removal of nasal packing. The Merocel tampons might be safely removed just after 24 hours postoperatively without any complication.

The effect of the duration of merocel in a glove finger on postoperative morbidity

We examined the effects of the duration of keeping a Merocel nasal packing in the nose and the application technique (packing applied either directly or inside a glove finger) on postoperative morbidity and complications. The study included 129 patients (67 males and 62 females; age range 18 to 56 years) undergoing nasal septoplasty without turbinate intervention. The patients were randomly assigned into 4 groups. In group 1 and group 2, Merocel was directly applied in the nasal cavity for 24 hours and 48 hours, respectively; in group 3 and group 4, Merocel was kept in the nasal cavity in a powder-free glove finger for 24 hours and for 48 hours, respectively. Pain and discomfort scores were evaluated by a visual analog scale. The time taken between removal of the tampon and when the patients began to breathe comfortably was called the nasal obstruction time. The differences in mean discomfort score between the groups were not statistically significant (P > 0.05), while the mean pain scores were statistically higher in groups 1 and 2 than in groups 3 and 4 (P < 0.05). The nasal obstruction time was statistically shorter in groups 2 and 4 than in groups 1 and 3 (P < 0.05). Therefore, keeping Merocel inside a glove finger in place for 48 hours notably reduces the pain occurring during the removal of the nasal tampon. It also reduces nasal obstruction time and prevents synechia, leakage, bleeding, and septal hematoma, without compromising patient comfort.

Assessment of mucosal changes associated with nasal splint in a rabbit model

INTRODUCTION

There is no consensus on duration of the nasal splint after nasal septum surgeries. The pressure of nasal splint on the mucosa may cause tissue necrosis and nasal septum perforation.

OBJECTIVES

To investigate the histopathological changes of the nasal mucosa caused by nasal splints in a rabbit model.

METHODS

No splint was used in group A. Bilateral silicone nasal splints were placed for five, ten, and 15 days in groups B, C, and D, respectively. Biopsy of the nasal mucosa was performed after removal of splint. Histopathologic evaluations were performed. The severity and depth of the inflammation were scored.

RESULTS

Group A had a normal histological appearance. Comparison of the results of groups B, C, and D with group A demonstrated statistically significant differences with regards to the severity of histopathological findings. There was no statistically significant difference between groups B and C. There were statistically significant differences between the groups B and D, and also between groups C and D.

CONCLUSIONS

Longer duration of nasal splint had a higher risk for septal perforation. Therefore, removal of the splint as soon as possible may be helpful for preventing potential perforations.

The impact of unilateral concha bullosa on mucociliary activity: an assessment by rhinoscintigraphy

BACKGROUND

In this study, we aimed to compare the differences of nasal mucociliary clearance rate (NMCR) by rhinoscintigraphic examination between the nasal cavities of patients with unilateral concha bullosa (CB).

METHODS

The study group consisted of 43 patients (18 men and 25 women), with unilateral CB ranging in age from 20 to 58 years (mean age, 33.5 ± 9.51 years). The nasal mucociliary clearance was described as the velocity (mm/min) of nasal mucociliary transport of the technetium 99m-macroaggragated albumin droplet. Rhinoscintigraphy was performed on each nasal cavity with 2-day intervals in the patients. The mucociliary clearance rates obtained in the unaffected side were accepted as control values.

RESULTS

The average values for mucociliary clearance rate were 2.29 ± 0.42 mm/min in the CB side of the nasal cavity, and 3.19 ± 0.52 mm/min in the other side of the nasal cavity. Mucociliary transport took a longer time in the CB side of the nasal cavity than in the other side of the nasal cavity, which was found to be statistically significant (p < 0.001).

CONCLUSION

Our study showed that unilateral CB might impair NMCR in the ipsilateral side of the nasal cavity. Thus surgical intervention to reduce the middle concha volume may result in a better mucociliary clearance with possibly a less chance of development of chronic sinus diseases and nasal pathologies. Obviously, it is of utmost importance that new studies be planned with larger patient series to better understand nasal mucociliary transport mechanism and CB relationships.

Postoperative management in the prevention of complications after septoplasty: a systematic review

OBJECTIVES/HYPOTHESIS

The purpose of this article is to assess the relative rates of septal hematomas, synechiae, and septal perforations associated with methods commonly used to manage the nasal septum after septoplasty. As a secondary objective, we assessed the relative contribution of each method of septal management with respect to pain and patient discomfort.

STUDY DESIGN

Systematic review.

METHODS

A systematic literature search was performed for all relevant English randomized controlled, cohort, or case-control trials. Inclusion criteria included any study that assessed postoperative septal hematoma, perforation, or synechiae formation and reported on these outcomes regardless of method of septoplasty. Two authors independently extracted study information and analyzed all included articles for bias.

RESULTS

A total of 279 studies were identified, with 17 meeting the inclusion criteria. The majority of the studies had a high risk of bias that prevented the performance of a meta-analysis. Eight studies provided data on postoperative pain associated with different techniques, and quilting sutures were found to be significantly less painful than both nasal packing and septal splints.

CONCLUSIONS

Due to the low level of evidence and the high bias of the studies, the results of this systematic review fail to demonstrate a clear benefit among any of the postseptoplasty treatment techniques. However, the results do demonstrate that septal sutures are associated with less postoperative pain versus the other methods of septal management in this review.

The evaluation of nasal mucociliary activity after septoplasty and external septorhinoplasty

The aim of this study was to evaluate the nasal mucociliary activity after septoplasty (SP) and external septorhinoplasty (eSRP). Twenty patients who had SP operation (group 1) and 15 patients who had eSRP operation (group 2) were enrolled in the study. On each case, mucociliary clearance (MCC) measurement was performed by saccharine test before surgery, and on the first and third months of postoperative period. Saccharine clearance time (SCT) of 28 healthy volunteers were measured to establish control values. The mean SCT in control group was 8.79 ± 2.63 min, in group 1 patients before surgery was 14.03 ± 1.68 min, in group 2 patients before surgery was 14.34 ± 1.70 min. The preoperative SCT values of the group 1 and group 2 were significantly higher than healthy controls (p < 0.05). While there were statistically significant differences between preoperative and postoperative third month SCT values of group 1 patients, and postoperative first month and postoperative third month SCT values of group 1 patients (p < 0.05), there was no statistically significant difference between preoperative and postoperative first and third months SCT values of group 2 patients. Nasal septal deviation impairs the nasal mucociliary activity. Septoplasty operation positively affects the MCC mechanism. On the other hand, we observed no significant effect of eSRP operation on mucociliary activity on the first and third months of postoperative period as compared with preoperative.

Nasal septal packing: which one?

The aim of this study was to investigate the effects of four different types of nasal packs on pain, nasal fullness and postoperative bleeding following septoplasty. Prospective randomised double blind study was conducted. The study group included 119 patients who underwent endonasal septoplasty under general anaesthesia. Four types of nasal packing materials were utilized: (1) Merocel standard 8-cm nasal dressing without airway, (2) Doyle Combo splint (DCS), (3) Merocel in a glove finger and (4) Vaseline gauze. All packs were removed at the 48th hour (±3 h) after the surgery. Three different variables were investigated following the surgical procedure: (1) pain, (2) nasal fullness and (3) bleeding after removal of the nasal packing material. DCS produced the greatest pain at the first and sixth postoperative hours. At the first postoperative day, the greatest pain score was reported for Merocel in the glove finger and the least for Merocel. The pain scores during the removal of the nasal packings were highest for Merocel and lowest for Merocel in the glove finger. DCS had the lowest nasal fullness score. Bleeding ratio was highest for Merocel, followed by Vaseline gauze, DCS and Merocel in the glove finger. Many different commercially available packing materials are presently used, each with inherent advantages and disadvantages. We evaluated the pain, nasal fullness and bleeding potential of four nasal packing materials and determined that Merocel had the highest pain potential during removal and the highest rate of bleeding following removal.

Nasal splinting using silicone plates without gauze packing following septoplasty combined with inferior turbinate surgery

OBJECTIVE

Nasal packing after septoplasty is uncomfortable and painful for patients. The aim of this study was to determine the efficacy of nasal splinting using silicone plates to prevent complications and decrease the pain after septoplasty compared with the conventional gauze packing.

MATERIALS AND METHODS

Thirty-five adult patients who had undergone septoplasty were included in this study. The patients were allocated into two groups: Group S, silicone plates were used (13 males, 2 females); and Group G, gauze packing smeared with an antibiotic ointment was used (19 males, 1 female). We evaluated and compared the postoperative pain, pain due to postoperative cleaning, nasal bleeding, postnasal drip, body temperature, effect on stay in the hospital, effect on food intake and sleep disturbance using visual analogue scale (VAS) scores.

RESULTS

The postoperative pain score in Group S was significantly lower than in Group G on days 1 and 2 after the septoplasty. And the pain due to postoperative cleaning score was significantly lower than in Group G on days 2 and 3 after operation. No statistically significant differences were found between the two groups in regard to nasal bleeding, postnasal drip, body temperature, effect on stay in the hospital, effect on food intake or sleep disturbance. Objective evaluation performed at 4 weeks postoperatively revealed that nasal crusting occurred at a significantly higher incidence in Group G compared with Group S.

CONCLUSION

The use of silicone plates in lieu of conventional gauze packing decreased post-septoplasty nasal pain and pain due to postoperative cleaning of the nasal cavity. We conclude that nasal splinting using silicone plates after septoplasty is an effective method for managing pain and preventing complications.

Nasal packing and transseptal suturing techniques: surgical and anaesthetic perspectives

The objective of this study is to compare the nasal packing and the transseptal suturing techniques regarding the extubation difficulty evaluation scores, follow-up times in post-anaesthesia care unit (PACU), pain scores, and postoperative complications. Two hundred patients who underwent septoplasty from January 2009 to October 2009 were randomly assigned either to have nasal packs (n: 100) or transeptal sutures (n: 100). In the transseptal suture group, extubation was easier and PACU follow-up times were shorter, when compared to the nasal packing group (p < 0.001). Patients with nasal packing had significantly higher pain scores (p < 0.001). Minor bleeding was significantly higher in the transseptal group with seven cases, compared to the nasal packing group without any bleeding cases (p = 0.014). There were two patients who had postoperative major bleeding, and two patients who had septal hematoma in the transseptal suture group. One patient with nasal packing had postoperative infection. Septal perforation was not seen in any of the cases. While patients in both groups experienced postoperative crusting, patients in the transseptal suture group also complained about foreign body sensation. Extubation was more comfortable; post-anaesthesia monitorization duration was shorter, and postoperative pain was less, but minor bleeding was seen more with transseptal sutures. There was no significant difference in terms of major bleeding, hematoma, infection or perforation. Foreign body sensation was the main cause of postoperative discomfort in the transseptal suture group. Transseptal suturing might be a significantly comfortable, cost-effective and reliable alternative to nasal packing.