Septoplasty without packing or splints: Our experience
Main Article Content
Keywords
septoplasty, nasal packing, nasal splints, quilting sutures, continuous trans-septal sutures
Abstract
Background: Septoplasty is a common surgical procedure performed in otorhinolaryngology departments to correct nasal septum deviation. Traditionally, nasal packing or splints used to stabilize the septal mucosal flaps and promote adhesion. However, these can cause complications such as nasal obstruction until removal, dry mouth, watering of eyes, severe pain during pack removal, headache, difficulty swallowing, and hypoxia. Methods: This prospective longitudinal observational study conducted on 50 patients undergoing septoplasty for nasal obstruction without the use of nasal packing or splints. This study included 50 patients who presented to the ENT department with nasal obstruction over one year (October 2021 to October 2022). The septal mucosa was sutured using 4-0 poly glycolic with an initial few quilting sutures, followed by continuous sutures to approximate the flaps and prevent septal hematoma. Patients monitored on the day of surgery and during follow-ups for bleeding or hematoma. The severity of nasal obstruction assessed using the NOSE score preoperatively, then reassessed at one week and one month postoperatively. Follow-up examinations evaluated the nasal cavities for synechiae, hematoma, septal perforation, or residual deviation. Results: Among the 50 patients, 36 were male and 14 were female. The youngest patient was 15 years old, and the oldest was 57 years old. Minor bleeding occurred in two patients within a few hours postoperatively in the recovery room. These patients treated with intravenous tranexamic acid (500 mg) without requiring nasal packing. No complications occurred in the remaining patients, and no long-term complications were observed in any case. Conclusion: Septoplasty was performed using multiple continuous trans-septal sutures after initial quilting sutures for stabilizing the corrected septum with absorbable 4-0 Vicryl suturing material, without nasal packing or splints, is an effective method for preventing hematoma and synechiae. This technique also avoids the discomfort and complications associated with foreign material inside the nasal cavity. Thus, septoplasty can be safely performed as a daycare procedure.
References
2. Erkan E, Yilmaz I. Pack-free septoplasty: functional outcomes and complications. Ear Nose BogazIhtis Derg. 2015;25(5):275–8.
3. Adriaan F, Olphen V. The septum. In: Gleeson M, et al., editors. Scott-Brown’s otorhinolaryngology. Head and Neck Surgery; Seventh Edition. London, UK: Hodder Arnold. 2008, p. 1850.
4. Ferguson BJ. Surgical correction of nasal obstruction.LOperative international journal of surgery & surgical techniques. 2008; DOI:10.1016/B978-1-4160-2445-3.50007-8;
5. Ramakrishnan JB. Septoplasty and turbinate surgery. In: Scholes MA, Ramakrishnan VR, editors. ENT SECRETS. 4th ed. India: Elsevier; 2016. p. 185.
6. Elsahy N. Basic septoplasty and turbinate reduction. . 1st ed. Philadelphia, United States: Saunders; 2000. p. 48.
7. Varghese GM. Septoplasty without packing, splints or clip-our experience. Int J Surg Surgical Tech. 2017;1(2):000109.
8. Valentine R, et al. Advances in biomaterials and nasal packing. In: Sindwani R, editor. Otolaryngological clinics of North America. 42(5
9. Varghese GM. Otolaryngology head and neck surgery. Philadelphia, United States: Saunders Elsevier. p. 1133.
10. Michael SG, Witsell DL, Smith TL, Yueh B, et al. Development and validation of the nasal obstruction symptom evaluation (NOSE) scale 1. Otolaryngology—Head and Neck Surgery. 2004;130(2): 157–63.
11. Tang S, Kicker A. Should intranasal splints be used after nasal septal surgery? The Laryngoscope 2012;122(8):1647–8.
12. Erkhan G, Ergin TN, Bilezikçi B. Comparison of suture and nasal packing in rabbit noses. The Laryngoscope. 2004;114(4):639–45.
13. Karatas A, Pehlivanoglub F, Salviza M, Kuvatb N, Cebi IT, et al. The effects of the time of intranasal splinting on bacterial colonization, postoperative complications, and patient discomfort after septoplasty operations. Brazilian Journal of Otorhinolaryngol. 2016;82:654–61.
14. Cukurova I, Cetinkaya EA, Mercan GC, Demirhan E, Gumussoy M, et al. Retrospective analysis of 697 septoplasty surgery cases: packing versus transseptal suturing method. Acta Otorhinolaryngological Italica. 2012;32(2):111–4.
15. PérezJuan PD, Falcón C, Barreiro SB, Bocanegra MS, Mario PB, Barrero V, et al. Transeptal suturing-a cost-efficient alternative for nasal packing in septal surgery. Brazilian Journal of Otorhinolaryngology. 2016;82(3):310–3.
16. Sashikanth J, Yu VM, Catalanom P. Endo‐nasal surgeries without nasal packing or splints‐a retrospective review of postoperative bleeding complications in 300 patients. The Laryngoscope. 2011;121(S5):s362.
17. Sarfaraz MB, Gill M, Sommer DD, Psaltis A, Schlosser R, et al. Is nasal packing necessary after septoplasty? A meta‐analysis. International Forum of Allergy & Rhinology. 2013;3(5):418–24.
18. Melih C, Acer A, Horasanli E, Atnunbag A, Salihoglu M, et al. Comparison of totally occlusive nasal pack, internal nasal splint, and transseptal suture technique after septoplasty in terms of immediate respiratory distress related to anesthesia and surgical complications. Acta Otolaryngologica. 2014;134(4):390–4.
19. Ehab Z, Bajin MD, Aytemir K, Yilmaz T. The effects on cardiac functions and arterial blood gases of totally occluding nasal packs and nasal packs with airway. The Laryngoscope. 2010;120(11):2325–30.
20. Christos G, Obholzer R, Martinez DP, Sandhu G Day-case septoplasty and unexpected re-admissions at a dedicated day-case unit: a 4-year audit. The Annals of The Royal College of Surgeons of England. 2006;88(2):202–6.
21. Basha SI, Kaluskar GD. Routine nasal packing following nasal surgery—Is it necessary? Indian Journal of Otolaryngology and Head & Neck Surgery. 2005;57(1):69–71.
22. Muhammad H, Iqbal K. Septoplasty without nasal packing. Gomal Journal of Medical Sciences. 2010;8(2).
23. Al-shehri MAS. Assessment of complications of nasal packing after septoplasty. The Medical Journal of Cairo University. 2011;79(2).
24. Rajashri SM, Patil B, Mohite A. Comparison of septoplasty with and without nasal packing and review of literature. Indian Journal of Otolaryngology and Head & Neck Surgery. 2013;65(2):406–8.
25. Naik K. A novel way of trans-septal splint suturing without nasal packing for septoplasty. Indian J Otolaryngol Head Neck Surg. 2015;67(1):48–50
26. Korkut AY. A randomised prospective trial of trans-septal suturing using a novel device versus nasal packing for septoplasty. Rhinology. 2010;48(2):179.
27. Bijan N, Peyvandi AA, Naghibzadeh G. Does post septoplasty nasal packing reduce complications? Acta Medica Iranica. 2011;49(1):9–12.
28. Erkan E, Güvenç IA, Hızal E, Yılmaz I. Effects of nasal pack use on surgical success in septoplasty. Kulak Burun BogazIhtis Derg. 2014;24(4):206–10.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.