Nasal Septal Clips: An Alternative to Nasal Packing After Septal Surgery?

Abstract

Surgeons have debated since decades on the efficacy or inefficacy of nasal packing yet it is considered routine after septal surgery. Various types of septal splints have been tried as an alternative to nasal packs but most of them need to be sutured around the septum which requires a meticulous approach and expertise. Our aim is to assess and compare the immediate post-operative morbidity and the eventual outcome of septal surgery while using glove finger packs with that of septal clips with splints. This comparative study was done at MCV Memorial ENT Trust Hospital on 80 patients who were diagnosed to have DNS and underwent septal surgery. Patients were divided into two groups. Group A (n = 40) constituted of patients who had glove finger packs and Group B (n = 40) constituted of patients who had septal clips. In the immediate postoperative period patients were assessed for pain, headache, dysphagia, epiphora, dryness of mouth and post-operative bleed. On the first post-operative night, patients were assessed for oxygen saturation. Patients underwent tympanometry just before pack/splint removal and on reviews if the same was abnormal. Post-operative complications like septal perforation and synechiae were noted for both groups and compared. We found that the incidence of pain and various other signs and symptoms was significantly higher in Group A. The difference in the complication rates among the two groups was not statistically significant. We observed that nasal packing is a cause for significant morbidity and discomfort in the immediate post-operative period and does not give any added advantage over septal clips used in our study as far as the final outcome is concerned. Nasal septal clips with splints are a useful alternative to existing techniques of flap approximation after septal surgery. The method is not expensive and needs no special expertise.

A comparative study between nasal clips and anterior nasal packing in septoplasty/submucosal resection patients at VIMS Bellary, Karnataka

“…Similar observations were made in study done by Udgir et al and Veluswamy et al 9,10 The postoperative complaints can be attributed to the effect of complete block of nasal cavity and pressure of the ANP on Lateral wall of the nose. Dysphagia attributed to Toynbee phenomenon, was significantly high in packed patients.…”

“…In a study conducted by Udgir et al 52% were males & 48% were females, with mean age of males and females being 27.8 & 25.1 years respectively. 9 69% were males and 31 % were females in a study done by Veluswamy et al 10 The observed mean age in study conducted by Ardehali et al was 24.6 years.…”

“…12 Similarly Veluswamy et al observed less pain perception in NSC group compared to ANP group in VAS Scale as shown in Table 9. 10 This statistically significant and lesser pain and bleeding during pack removal with NSC compared to ANP proves it to be a better packing method.…”

Quantification of biofilm formation on silicone intranasal splints: An in vitro study

“…In this study, all investigated strains of two common nasal colonizers, S. aureus and M. catarrhalis, had the ability to produce biofilm on intranasal splints with different capacities (Table I). Postoperative nasal packing may be performed by various types of packing materials including Vaseline gauze, bismuth iodoform paraffin paste, Merocel nasal packs, SS, and others [7,21]. Dag et al [5] investigated biofilm formation capacity of two different nasal materials [Merocel packs (made of polyvinyl acetal) and SS] and showed that biofilm formation on Merocel is significantly higher than on SS, mainly due to the different texture and surface properties of these materials.…”

“…A survey carried out among the Members of the US Rhinology Society showed that 66% of ENT doctors used antibiotics as a routine practice in postoperative period of septoplasties, and the most common reason for prophylactic use is the prevention of postoperative infections [25]. Amoxicillinclavulanic acid is the most frequently administered antibiotic prior to septoplasty with nasal packing [5,6,21]. Although all strains tested in this study were sensitive to this drug, microbiology methods typically determine the susceptibility of planktonic and not sessile form of bacteria (i.e., bacteria in a biofilm).…”