Nasal Packing Research Articles

Incidence and Management of Delayed Epistaxis Following Endoscopic Skull Base Surgery

Objective:Among other complications of endoscopic skull base surgery, delayed epistaxis has not been given much importance. This report presents postoperative delayed nosebleed cases in a large number of patients who underwent an endoscopic endonasal transsphenoidal approach to the sellar region for resection of lesions.Methods:Three hundred and sixty three patients who were reached to the sellar region by endoscopic endonasal transsphenoidal route and operated was included in the study. Retrospective chart reviewing of these patients was performed. The correlation between the duration of nosebleeds, bleeding location, treatment methods and comorbidities of the patients were evaluated.Results:Ten patients (3.6%) reported delayed epistaxis in the postoperative period and were referred to the otolaryngology department. Postoperative epistaxis occurred between days 7th and 33th (mean 16.5) days. The treatment consisted of chemical silver nitrate cauterization in two patients, return to the operating room in three patients, nasal packing in five patients.Conclusion:Delayed postoperative epistaxis often has no obvious etiology, and intervention requires teamworking. Well-coordinated teamworking of the neurosurgeon with other specialities such as neuroradiology and otorhinolaryngology is needed to achieve better results.

ANTERIOR NASAL PACKING POST SUBMUCOUS RESECTION (SMR): A COMPARISON BETWEEN REMOVAL ON 1ST VERSUS 2ND POST OPERATIVE DAY

Objective: To evaluate the effect of removal of nasal packs after sub mucous resection (SMR) on the first postoperative day versus second post operative day in terms of bleeding control and prevention of septal hematoma formation.
 Study Design: Comparative cross sectional study.
 Place and Duration of Study: ENT department, Combined Military Hospital Jhelum Pakistan, from Oct 2017 toOct 2018.
 Methodology: Total 100 patients of both genders, ages from 16 to 35 years with a deviated nasal septum wereincluded. Written informed consent was taken and hospital ethical committee approval was obtained. Patientswere randomly divided into two groups of 50 patients each by simple random sampling. Patients in both groupsunderwent submucous resection. Patients in whom sub mucous resection was combined with other procedureslike rhinoplasty, turbinectomy, polypectomy were excluded. In group A the nasal packs were removed on thefirst post operative day. In group B the nasal packs were removed on the second post operative day. Nasal packing in all patients was done with vaseline gauze rolls. The groups were compared for bleeding at the time of nasal pack removal and septal hematoma formation in the follow up period.
 Results: There was no statistically significant difference between the two groups in terms of bleeding (p-value0.40) and septal hematoma formation (p-value 0.49).
 Conclusion: After sub mucous resection, removal of nasal packs on 1st versus 2nd post operative day is notassociated with any significant difference in bleeding and septal hematoma formation.

The Use of Tranexamic Acid to Reduce the Need for Nasal Packing in Epistaxis (NoPAC): Randomized Controlled Trial

Epistaxis is a common emergency department (ED) presentation and, if simple first aid measures fail, can lead to a need for anterior nasal packing. Tranexamic acid is an agent that contributes to blood clot stability. The aim of this study is to investigate the effectiveness of topical intranasal tranexamic acid in adult patients presenting to the ED with persistent epistaxis, and whether it reduces the need for anterior nasal packing. From May 5, 2017, to March 31, 2019, a double-blind, placebo-controlled, multicenter, 1:1, randomized controlled trial was conducted across 26 EDs in the United Kingdom. Participants with spontaneous epistaxis, persisting after simple first aid and the application of a topical vasoconstrictor, were randomly allocated to receive topical tranexamic acid or placebo. The primary outcome was the need for anterior nasal packing of any kind during the index ED attendance. Secondary outcome measures included hospital admission, need for blood transfusion, recurrent epistaxis, and any thrombotic events requiring any hospital reattendance within 1 week. The study sample consisted of 496 participants with spontaneous epistaxis, persisting after simple first aid and application of a topical vasoconstrictor. In total, 211 participants (42.5%) received anterior nasal packing during the index ED attendance, including 111 of 254 (43.7%) in the tranexamic acid group versus 100 of 242 (41.3%) in the placebo group. The difference was not statistically significant (odds ratio 1.107; 95% confidence interval 0.769 to 1.594; P=.59). Furthermore, there were no statistically significant differences between tranexamic acid and placebo for any of the secondary outcome measures. In patients presenting to an ED with atraumatic epistaxis that is uncontrolled with simple first aid measures, topical tranexamic acid applied in the bleeding nostril on a cotton wool dental roll is no more effective than placebo at controlling bleeding and reducing the need for anterior nasal packing.

A Clinical Decision Analysis for Use of Antibiotic Prophylaxis for Nonabsorbable Nasal Packing.

Nonabsorbable nasal packing is often placed for the treatment of epistaxis or after sinonasal or skull base surgery. Antibiotics are often prescribed to prevent toxic shock syndrome (TSS), a rare, potentially fatal occurrence. However, the risk of TSS must be balanced against the major risk of antibiotic use, specifically Clostridium difficile colitis (CDC). The purpose of this study is to evaluate in terms of cost-effectiveness whether antibiotics should be prescribed when nasal packing is placed. A clinical decision analysis was performed using a Markov model to evaluate whether antibiotics should be given. Patients with nonabsorbable nasal packing placed. Utility scores, probabilities, and costs were obtained from the literature. We assess the cost-effectiveness of antibiotic use when the risk of community-acquired CDC is balanced against the risk of TSS from nasal packing. Sensitivity analysis was performed for assumptions used in the model. The incremental cost-effectiveness ratio for antibiotic use was 334,493 US dollars (USD)/quality-adjusted life year (QALY). Probabilistic sensitivity analysis showed that not prescribing antibiotics was cost-effective in 98.0% of iterations at a willingness to pay of 50,000 USD/QALY. Sensitivity analysis showed that when the risk of CDC from antibiotics was greater than 910/100,000 or when the incidence of TSS after nasal packing was less than 49/100,000 cases, the decision to withhold antibiotics was cost-effective. Routine antibiotic prophylaxis in the setting of nasal packing is not cost-effective and should be reconsidered. Even if antibiotics are assumed to prevent TSS, the risk of complications from antibiotic use is of greater consequence. 3a.

The Effects of Using Bioglue in Nasal Septal Surgery.

Nasal septal surgery is one of the most common surgical procedure performed by otolaryngologists. Nasal packs are used for bleeding control, prevention of septal hematoma, replacement of mucoperichondrial flaps, and stabilization of the septum after nasal septal surgery. The aim of this study was to investigate the effects of albumin-glutaraldehyde-based tissue adhesive (Bioglue), which can be used as an alternative to nasal pack on the nasal septum after experimental nasal septum surgery. A total of 16 female Wistar albino rats were randomly separated into the study group (n = 10) and the control group (n = 6). After raising the mucoperichondrial flap on one side of the septum, Bioglue was used to fix the mucoperichondrial flap over the septal cartilage ın the study group and nasal packs (Merocel) were used for fixation in the control group. The rats were sacrificed at 2 and 4 weeks after septoplasty. All the tissue samples were evaluated under light microscope by the same pathologist in respect of foreign-body reaction, degree of inflammation, granulation tissue, fibrosis, cartilage damage, and cilia and goblet cell damage. In the control group, the Merocel packs were removed after 2 days and the groups were compared in terms of hematoma. No hematoma was observed in any group. Septal perforation was determined in all the study group participants and loss of cilia and goblet cells and foreign-body reaction were found in 8 samples of the study group participants and in none of the control group. The results of this study show that Bioglue caused segmental cartilage injury; therefore, it may not suitable for use following septal surgery.

Outcome of treatment for severe epistaxis: nasal packing and endoscopic sphenopalatine artery ligation

Background: Severe epistaxis is a frequent emergency condition encountered by otolaryngologists and is often treated with nasal packing. In the event of failure surgical treatment is considered. We aimed to evaluate the efficacy of Nasal Packing (NP) and Endoscopic Sphenopalatine Artery Ligation (ESPAL) as treatment of severe epistaxis in terms of failures and recurrences including risk factors. Methodology: Retrospective descriptive study of patients with epistaxis treated with NP, admitted to an ENT department from 2011-2017. If initial treatment with NP failed, patients were considered for ESPAL. Results: An analysis of 511 patients was performed. All patients were treated with NP at the time of admission, and 14% of pa- tients were treated with ESPAL due to failure of NP. The majority of patients was only admitted once. Twelve percent were readmit- ted within 30 days, 7% were readmitted >30 days later. Treatment failure after ESPAL was 7.9%. No significant difference in the risk of readmission was found between patients treated with NP alone and patients treated with ESPAL. Conclusion: The majority of epistaxis patients were effectively treated with NP alone. We found good effect of ESPAL although no significant differences in risk of readmission NP vs. ESPAL were identified.

Management of ENT emergencies during the coronavirus disease 2019 pandemic.

Coronavirus disease 2019 imposed dramatic changes on ENT service delivery. Pre-pandemic, such changes would have been considered potentially unsafe. This study outlines the impact of lockdown on the incidence and management of ENT emergencies at a large UK centre. After modification of pre-pandemic guidelines, ENT emergency referrals data during the UK lockdown were prospectively captured. A comparative analysis was performed with retrospective data from a corresponding period in 2019. An overall reduction (p < 0.001) in emergency referrals (n = 119) and admissions (n = 18) occurred during the lockdown period compared to the 2019 period (432 referrals and 290 admissions). Specifically, there were reduced admission rates for epistaxis (p < 0.0001) and tonsillar infection (p < 0.005) in the lockdown period. During lockdown, 90 per cent of patients requiring non-dissolvable nasal packing were managed as out-patients. Coronavirus disease 2019 compelled modifications to pre-pandemic ENT guidelines. The enforced changes to emergency care appear to be safe and successfully adopted. Arguably, the measures have both economic and patient-related implications post-coronavirus disease 2019 and during future similar pandemics and lockdowns.

Comparison of Intubating Conditions using “Spray-as-You-Go” Technique versus Transtracheal Instillation of Lignocaine for Airway Topical Anesthesia during Awake Nasal Fiberoptic Intubation

Introduction: Awake fiberoptic intubation (AFOI) is the gold standard for the management of recognized difficult airway. Good airway anesthesia along with sedation is necessary to ensure patient comfort. Aim: The aim of the study was to evaluate topical lignocaine administered by “spray-as-you-go” versus transtracheal injection technique on intubating conditions during AFOI. Patients and Methods: After obtaining written informed consent, 36 patients were randomly allocated to one of two groups: Group T – transtracheal technique and Group S – Spray-as-you-go technique. All patients were sedated with intravenous dexmedetomidine infusion titrated to a Ramsay Sedation Score of 2–3 during AFOI. All patients received oral gargle and nasal packing with lignocaine 2%. Patients in Group T received 2 mL lignocaine 2% intratracheally just prior to beginning fiberscopy. Patients in Group S received 2 mL lignocaine 2% spray over the vocal cords and another 2 mL below the vocal cords during fiberscopy. Tracheal intubation was then performed. Primary outcome measure was a composite score of patient comfort. Secondary measures were intubation and fiberscopy time, adverse effects, and postoperative patient evaluation. Results: The demographic data were comparable. A composite score of <10 was considered optimal, 10–15 as acceptable, and >15 unacceptable. Significantly more patients in Group T had optimal composite score compared to Group S. There were no differences between the two groups as regards postintubation score, ease of intubation, and postoperative survey. Conclusion: During awake nasal fiberoptic intubation, in comparison with spray-as-you-go technique, the transtracheal instillation of lignocaine improves patient tolerance and comfort during tracheal intubation and provides better patient satisfaction.

Endoscopic Sphenopalatine Artery Cauterization in Refractory Hypertensive Epistaxis.

Epistaxis is a commonly occurring phenomenon which is defined as "bleeding from inside the nose" and often presents as an emergency. The management of epistaxis involves many factors with regard to the treatment and ultimate control of the condition. Each patient presenting with epistaxis should be well assessed clinically and managed accordingly. Endoscopic sphenopalatine artery cauterization is a safe, simple and effective procedure in the management of refractory epistaxis. Moreover, in view of minimal morbidity, higher success rate, shorter hospital stays and higher patient satisfaction, our current practice is to consider this treatment option in the management of cases not responding to conservative treatment modalities. A total of 11 patients (8 males and 3 females) underwent sphenopalatine artery cauterization during the study period. All patients were hypertensive and were refractory to treatment with general measures, anterior nasal packing and Foley catheter. The mean age of the study population was 58.36 and the range was 39-70years. The epistaxis was rapidly controlled in all patients without any intraoperative or postoperative complications. The follow up period was 60-90days. Strict control of hypertension was done throughout the follow up period. None of the patients developed epistaxis in the follow up period. The sphenopalatine artery cauterization technique using nasal endoscope was safe, simple, fast and effective with low rates of morbidity and complications for the management of refractory epistaxis. It was concluded that endoscopic sphenopalatine artery cauterization should be considered as an immediate second line treatment where conservative measures fail and it is proved to be of low morbidity and cost effective.

Is Nasal Packing Necessary After Endoscopic Dacryocystorhinostomy Without Stent and Mucosal Flaps Preservation?

This study aimed to evaluate the effect of nasal packing on the surgical success and postoperative complications of endoscopic dacryocystorhinostomy (EnDCR) without using stents and mucosal flaps. The retrospective study comprised of 75 eyes of 65 consecutive patients undergoing EnDCR with the biting and removing technique. The patients were assigned to 2 groups depending on whether the biodegradable synthetic polyurethane foam was used or not (the packing group, 34 eyes; the nonpacking group, 41 eyes). At least 6 months after the EnDCR, the postoperative outcomes including anatomical and functional successes, and the postoperative complications such as synechia, granuloma, and bleeding were compared between the packing and nonpacking groups. Synechia was lower in the packing group (23.5% versus 24.4%) but it was not statistically significant (P = 0.93). There were also no significant differences in the granuloma and bleeding complications between the 2 groups (respectively, P = 0.72, P = 0.08). The success rates of anatomical and functional reached 88% in the packing group compared with 82.9%, and 75.6% in the nonpacking group (respectively, P = 0.74, P = 0.76). The present study findings suggest that both groups have no superiorities over each other in the surgical outcomes after the EnDCR. However, further randomized studies are recommended before the generalization can be made.

Dissolvable intranasal haemostatic agents for acute epistaxis: A systematic review and meta-analysis.

Nasal packing is the mainstay of epistaxis management; however, packs cause patient discomfort and can lead to hospital admission. Absorbable haemostats provide clotting factors or act as a substrate to stimulate clotting and represent a potential treatment alternative. A systematic review was performed to evaluate the efficacy of topical haemostats in the management of epistaxis. A systematic literature search of 7 databases was performed. Only eligible randomised controlled trials (RCTs) and observational studies were included. The primary outcome was short-term haemostatic success (<7days). Secondary outcomes included long-term haemostatic control (no rebleeding 7-30days), patient discomfort and adverse effects. Meta-analysis was performed where possible. Of 2249 records identified, 12 were included in the qualitative synthesis and 4 RCTs were included in meta-analysis. The following haemostats were reported: gelatin-thrombin matrix (n=8), aerosolised/gel tranexamic acid (n=1), cellulose agents (n=2) and fibrin sealants (n=1). Studies involving tranexamic acid on removable delivery devices (eg, pledgets) were excluded. There was heterogeneity in outcome measures and inclusion criteria (coagulopathies/anticoagulants were excluded in 3 RCTs and 2 observational studies). The short-term haemostatic success varied between studies (13.9% to 100%). No significant post-procedural complications were reported. The meta-analysis favoured absorbable haemostatic agent versus packing (risk ratio 1.20; 95% confidence interval 1.05 to 1.37; P=.007). The risk of bias across all studies was moderate to high. The evidence suggests haemostatic agents are effective at managing acute epistaxis when compared with nasal packing. More data are required before recommendations can be made regarding management in patients on anticoagulants.

Analyse des Risikoprofils stationärer Epistaxis-Patienten

Epistaxis is a disease well known to general practitioners and ENT specialists in the outpatient sector as well as in hospitals. The aim of this study was to analyze data of patients that were treated as inpatients at the ENT university hospital Freiburg between 2014-2018. This retrospective study analyzes data of admitted patients with epistaxis regarding age, medication, bleeding site, underlying health conditions, radiological imaging and treatment. Risk factors for longer inpatient length of stay and readmission were identified. Median length of stay was 3.5 days. 55 % of the patients suffered from posterior epistaxis. 72.3 % of patients were treated with anticoagulants at the time of admission. The most prevalent medical conditions were hypertension (66 %) and arrhythmia due to atrial fibrillation (36.1 %). 63.5 % of the patients were treated by nasal packing. 97 patients (14.6 %) had to be treated surgically. Surgical treatment, transfusion, posterior epistaxis and anticoagulant treatment were risk factors for longer length of inpatient stay. Preexisting hypertension, posterior bleeding and single anticoagulant treatment increased the risk of readmission. Determination and consideration of risk factors allow identification of patients at risk of longer inpatient length of stay and readmission. Adequate management accounting for risk profiles of patients could help reduce morbidity.

Perioperative Management of Nasal Septal Perforation: A Case Series and Review.

Nasal septal perforation is a prevalent pathology, and its successful treatment remains a significant challenge. Surgical closure is complex, and there are a plethora of accounts of various surgical techniques within the existing literature. Much less has been written about perioperative considerations, which are arguably just as important. This article therefore focuses predominantly on the pre and postoperative management of patients with septal perforation. By drawing both on the existing literature and a series of 64 cases managed over several years by our department, this review aims to consolidate guidance on patient selection, timing of surgical intervention, postoperative splinting, use of antibiotics, and patient advice. It is clear that the size of the perforation (relative to the size of the septum), health of surrounding mucosa, and the systemic health and age of the patient remain essential considerations in patient selection and operative timing. Internal and external splints are widely used to good effect, but the role of nasal packing is less clear-cut. This article suggests packing, but with an increasing preference for NasoPore over BIPP (bismuth iodoform paraffin paste). Use of prophylactic antibiotics remains controversial. The complete closure rate for the series presented here was 81.3%, with an average perforation diameter of 15.1 mm (range: of 6-32 mm), and that for perforations with a diameter below 22 mm was 97.9%.

Polyurethane Versus Chitosan-Based Polymers Nasal Packs After Functional Endoscopic Sinus Surgery: A Prospective Randomized Double-Blinded Study.

Different packing materials are applied to the nose at the end of surgery to maintain drainage and sinus ventilation of the paranasal sinuses and avoid some complications such as bleeding, infection, crustations, adhesions in the middle meatus and lateralization of the middle turbinate. The study aims to compare the clinical outcomes of two absorbable packing materials, the synthetic polyurethane, and the naturally occurring Chitosan-based polymers (CBP) nasal packs, after functional endoscopic sinus surgery. Fifty patients with bilateral chronic rhinosinusitis with nasal polypi were operated with 100 surgical cavities. At the end of the surgery, one side was randomly packed with synthetic polyurethane and the opposite side with CBP nasal pack. Measure their outcomes at week 1, 2, 4, 8 and 12 as the presence of remnants materials in the middle meatus, crustations, adhesions, bleeding, granulations, infection, and general satisfaction of patients. CBP nasal pack shows a statistically significant advantage only in the first two weeks as regard remnants material, crusting and bleeding. All over the 12 weeks, there was no statistically significant difference between the two types of packs as regard granulations, adhesions and infection. In the first month, eight patients of the CBP group experienced bad smell and two patients had watery rhinorrhea as adverse reaction without a statistically significant difference. Patients were generally satisfied without a statistically significant difference between the two types of packs. Synthetic polyurethane and Chitosan-based polymers nasal packs are safe and efficient regarding; the mucosal healing, bleeding control, and the overall satisfaction of patients. The CBP showed a higher statistically significant advantage in the first two weeks only regarding the amount of the retained material, crusting as well as bleeding. Patients packed with CBP experienced fish-like smelly odor and watery rhinorrhea but there is no statistically significant difference.

CSF Rhinorrhoea After Endonasal Intervention to the Skull Base (CRANIAL) - Part 1: Multicenter Pilot Study

BackgroundCRANIAL (CSF Rhinorrhoea After Endonasal Intervention to the Skull Base) is a prospective multicenter observational study seeking to determine 1) the scope of skull base repair methods used and 2) corresponding rates of postoperative cerebrospinal fluid (CSF) rhinorrhea in the endonasal transsphenoidal approach (TSA) and the expanded endonasal approach (EEA) for skull base tumors. We sought to pilot the project, assessing the feasibility and acceptability by gathering preliminary data.MethodsA prospective observational cohort study was piloted at 12 tertiary neurosurgical units in the United Kingdom. Feedback regarding project positives and challenges were qualitatively analyzed.ResultsA total of 187 cases were included: 159 TSA (85%) and 28 EEA (15%). The most common diseases included pituitary adenomas (n = 142/187), craniopharyngiomas (n = 13/187). and skull base meningiomas (n = 4/187). The most common skull base repair techniques used were tissue glues (n = 132/187, most commonly Tisseel), grafts (n = 94/187, most commonly fat autograft or Spongostan) and vascularized flaps (n = 51/187, most commonly nasoseptal). These repairs were most frequently supported by nasal packs (n = 125/187) and lumbar drains (n = 20/187). Biochemically confirmed CSF rhinorrhea occurred in 6/159 patients undergoing TSA (3.8%) and 2/28 patients undergoing EEA (7.1%). Four patients undergoing TSA (2.5%) and 2 patients undergoing EEA (7.1%) required operative management for CSF rhinorrhea (CSF diversion or direct repair). Qualitative feedback was largely positive (themes included user-friendly and efficient data collection and strong support from senior team members), demonstrating acceptability.ConclusionsOur pilot experience highlights the acceptability and feasibility of CRANIAL. There is a precedent for multicenter dissemination of this project, to establish a benchmark of contemporary practice in skull base neurosurgery, particularly with respect to patients undergoing EEA.

Simplified management of epistaxis.

Primary care, urgent care, and emergency department providers periodically treat epistaxis, either as recurrent nosebleed or an acute persistent episode. Silver nitrate application to the decongested and anesthetized nasal mucosa addresses the former in most cases. The plethora of commercial nasal packing devices testifies to the discomfort, technical difficulty, and frustration associated with traditional gauze-packing methods. Inflatable anterior nasal balloon packs reliably control most nosebleeds. Addition of a Foley catheter nasopharyngeal balloon pack manages most posterior epistaxis. Cautery and the two packing techniques mentioned above should treat most cases not requiring otolaryngology consultation or interventional radiology. Appropriate anesthetic and analgesics lessen the unpleasantness for both the patient and the provider. Topical moisturizing facilitates mucosal healing. Oxymetazoline 0.05% nasal spray provides the patient means to address rebleeding after discharge from treatment.

Comparación entre una sutura transfixiante y el taponamiento nasal en la septoplastia y turbinoplastia

IntroductionThere is a lack of consensus regarding the need for nasal packing after a septoplasty. The use of nasal packing has been proposed to reduce bleeding, synechiae and haematomas. Despite these advantages evidence is scant to support postoperative packing. Furthermore, packing is not an innocuous procedure and can cause complications. ObjectiveThe purpose of this study was to investigate the efficacy of quilting sutures compared with sponge nasal packing on haemostasis, haematomas and wound healing following septoplasty. Material and methodsSeventy-six patients with nasal septum deviation requiring septoplasty and turbinoplasy with radiofrequency were included. Following surgery, fifty patients were selected randomly for septoplasty with one quilting suture. And twenty-six patients had sponge nasal packing. Haemostatic properties, formation of haematomas, formation of synechiae, the patients’ pain and bleeding on removal of the packing were evaluated. ResultsBoth techniques were equally effective in the control of postoperative bleeding, haematoma and synechiae formation following septoplasty. Sponge packing was associated with significant pain and bleeding on removal. ConclusionThe use of quilting sutures like sponge packing is efficient in controlling bleeding, synechiae and haematomas after septoplasty and turbinoplasty.

Modern views of rehabilitation after septoplasty

To evaluate the effect of nasal spray Polydexa with phenylephrine on the postoperative period and bacterial contamination in the nasal cavity after septoplasty and inferior turbinectomy. There were 40 people observed, who underwent septoplasty and inferior turbinectomy followed by nasal packing. After removing the tampons from the nasal cavity, the growth of coagulase-negative staphylococci was most often observed in 50%, Enterococcus faecalis - 22.5%, Staphylococcus aureus - 20.0%. In patients who received intranasally Polydexa with phenylephrine drug in the postoperative period, we observed decrease in inflammation in the nasal cavity, an improvement in the quality of life, as well as a significant (p<0.05) decrease in bacterial growth (both in the presence of flora and in intensity growth of microorganisms). The absence of intranasal antibacterial drugs in the scheme of postoperative management of patients contributes to the growth of pathogenic flora, in particular S. aureus.

Endonasal trans sphenoidal endoscopic excision of pituitary adenoma with and without sellar floor reconstruction and nasal packing. A comparative study

Endonasal trans sphenoidal endoscopic excision of pituitary adenoma with and without sellar floor reconstruction and nasal packing. A comparative study

Video ile Bilgilendirme Yapılmasının Postoperatif Tampon Çıkarılma Anksiyetesine Etkisi

Video ile Bilgilendirme Yapılmasının Postoperatif Tampon Çıkarılma Anksiyetesine Etkisi