Nasal packing and transseptal suturing techniques: surgical and anaesthetic perspectives

Abstract

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.

Clinical Practice Guideline: Improving Nasal Form and Function after Rhinoplasty

“…Even for septoplasty procedures, the evidence suggests that packing is not only unnecessary but can lead to discomfort, pain, and anxiety, thereby diminishing patient satisfaction. 116 More severe potential risks include toxic shock syndrome, 108,109 pack-related sleep apnea, 117 and challenges with postoperative CPAP delivery.…”

Prophylactic versus postoperative antibiotics in septoplasty

“…4 There is a distinction between the normal flora of the nasal vestibule and those of the nasal cavity concerning potential infectious pathogens (PIPs), in particular, Staphylococcus aureus. 5,6 So far, only a few microbiological studies have been undertaken to differentiate the micro-organisms of the vestibule and cavity, although divergent bacterial colonization can be anticipated because Background and objective: Septoplasty is one of the most common procedures worldwide in otolaryngology clinics. The use of antibiotics in Septoplasty is a common practice among most otolaryngologists.…”

The comparison of trans-septal suture, Merocel nasal packing and septal splint following septoplasty combined with inferior turbinate surgery

“…[1,3] Nasal packing may lead to complications such as mucosal injury, loss of ciliary function, worsening of breathing due to sleep disorders, displacement and aspiration of the packing material, allergy, toxic shock syndrome, postoperative infections and eustachian tube dysfunction. [1,3,4] In addition, nasal pack application following nasal surgery requires hospitalization until the pack is removed and causes more pain compared to that caused by surgery postoperatively and during the process of pack removal.…”

“…[4] Therefore, nasal packing--commonly used after septoplasty and inferior turbinate surgeries and even considered one of the basic steps of surgery--has increasingly been replaced by the use of nasal splints and suture techniques. Clinical studies have demonstrated that nasal septal splints and trans-septal suturing after septoplasty caused less postoperative pain but similar results in the prevention of postoperative complications compared to packing.…”

“…Clinical studies have demonstrated that nasal septal splints and trans-septal suturing after septoplasty caused less postoperative pain but similar results in the prevention of postoperative complications compared to packing. [3][4][5][6] Other researchers have suggested that they are superior to packing in the prevention of nasal synechiae and postoperative hemorrhage. [7,8] Numerous studies have compared the effects of sutures, splints and packing on postoperative complications following septoplasty.…”