Routine Nasal Packing Research Articles

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

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

Septorhinoplasty with and without Nasal Packing:A Comparative Study from North of Iran

Septorhinoplasty are the most common nose surgical procedures widely used the world over. The main aim of this study was comparing the results of septorhinoplasty with and without nasal packing. This case control interventional study was conducted on patients who underwent septorhinoplasty in an ENT university hospital in north of Iran. Two separate groups, with or without nasal tampon (each group consisted of 35 patients) were includedin the study. Open surgical approach for repairment was executed for all and nasal packing (ie. tetracycline impregnated mesh, that was removed after 48 hours) for 35 patients inserted postoperatively.Patients were studied in three time periodsfor pain (using Visual Analogue Scale) and other postoperative signs and symptoms and convenience and overall satisfaction. No significant difference for postoperative bleeding, ecchymosis, hematoma and rhinorrhea was founded between the groups (pE�?0.05), but there was a significant difference in short-term outcomes in terms of convenience (p=0.006), edema two days after surgery (p= 0.001), right side and left side edema (p=0.002). The overall satisfaction was significantly higher in patients without nasal packing (p= 0.002). In assessment of the pain rate one week after surgery, there was no significant difference in various age and sex groups (pE�?0.05). Based on our 8indings routine nasal packing is not working well in septo-rhinoplasty cases and it is recommended to be avoided in these patients.

Routine nasal packing versus no nasal packing following functional endoscopic sinus surgery

Reason for withdrawal from publication Withdrawn from Issue 9, 2016. Authors unable to complete the review.

Assessing Patient Reported Outcomes after Septorhinoplasty with and without Nasal Packing Using the Glasgow Benefit Inventory

Introduction : Patient-reported outcomes are an invaluable tool to guide clinical decision-making. Nasal packing is a traumatic, painful event for patients, which could negatively impact patient-reported outcomes. We aimed to evaluate if avoiding postoperative nasal packing in septorhinoplasty and rhinoplasty affects patient-reported outcomes. Methods : All septorhinoplasty and rhinoplastyoperations performed over 5 years were identified. The case notes were reviewed to obtain patient demographics, operative details and any post-operative complications. The Glasgow Benefit Inventory (GBI) was administered via telephone to measure patient-reported outcomes. Results : 167 patients were identified. In 11 the case notes were unavailable. Of the 156 patients remaining, 126 completed the GBI questionnaire (who had undergone 132 operations). No significant difference in GBI scores was found with or without the use of nasal packing. Conclusion : This study suggests that routine nasal packing can be avoided in the majority of patients, but can be used with confidence that patient-reported outcome is not being compromised.

Avoiding routine nasal packing post septorhinoplasty does not jeopardise patient reported outcomes

Avoiding routine nasal packing post septorhinoplasty does not jeopardise patient reported outcomes

Effect of polyvinyl acetal sponge nasal packing on post-operative care of nasal polyposis patients: a randomised, controlled, partly blinded study

To compare the effects of routine nasal packing with polyvinyl acetal sponge (Merocel) versus no packing, after endoscopic sinus surgery for nasal polyposis. This clinical, randomised, controlled trial was performed in an academic tertiary referral centre between 2008 and 2011. Sixty patients with resistant nasal polyposis underwent endoscopic sinus surgery, and were then randomly divided into two groups: packed and non-packed. The amount of bleeding and pain in each group during pack removal was documented. There was no significant difference between the two groups in the outcome of surgery and complications. One patient in each group needed extra packing. In the packed group, the mean ± standard deviation pain score on pack removal was 61 ± 3 (using a visual analogue scale in which 0 = no pain and 100 = worst pain imaginable). This study found no significant difference between polyvinyl acetal packed and non-packed groups, following endoscopic sinus surgery for nasal polyposis. This confirms the findings of similar studies, and supports the reconsideration of routine post-operative packing in selected cases.

Use of CMC foam sinus dressing in FESS

Aim is to determine the efficacy and pain level associated with the use of dissolvable carboxymethyl cellulose (CMC) foam dressing in functional endoscopic sinus surgery (FESS) in adult patients. In the present prospective study, 60 patients with bilateral chronic rhinosinusitis were included. All patients underwent bilateral FESS. Thirty patients had both nasal cavities packed with dissolvable CMC foam (CMCF) and another 30 patients had their nasal cavities packed with routine nasal packing (RNP) in latex glove fingers. The haemostatic effect of the CMCF was assessed during the recovery period, and pain levels were recorded by the patients on a visual analogue scale 24 h after surgery. The prevalence of postoperative middle meatal synechia formation was assessed 1, 2, 4 and 8 weeks after the operation. Four (13.3%) of the patients packed with CMCF had primary postoperative bleeding during the recovery period and required additional dressing. Bleeding appeared in two (6.7%) patients packed with RNP. The mean level of pain was 0.962 (range 0-4) for patients packed with CMCF but was 5.5 (range 3-9) for patients packed with RNP. Four (6.7%) of 26 CMCF patients and 10 (35.7%) of 28 RNP patients developed a synechia in the middle meatus. We found that dissolvable CMC foam dressing is associated with very low levels of localised pain and with low levels of postoperative bleeding and synechia formation.

Endoscopic intraoperative control of epistaxis in nasal surgery

Objective : Epistaxis represents a dangerous post-operative complication of nasal surgery. The advances of endoscopic procedures have also brought along the possibility of a surgical solution of nasal bleeding. These procedures include endoscopic cautery of the bleeding points, and more difficult techniques of endoscopic ligation of the sphenopalatine artery or the anterior ethmoidal artery. These surgical methods permit avoiding nasal packing, a very annoying procedure for the patient. This study aims to evaluate the advantages of this approach at the end of a nasal surgery to prevent routine nasal packing. Method : 133 subjects were operated on by the same surgeon in the Otorhinolaringology Department of University of Foggia (Italy) from March 2006 to March 2007. 17 (12.8%) patients were submitted to septoplasty, 42 (31.5%) to turbinoplasty (in 22 accompanied by septoplasty) and 74 (55.6%) to endoscopic sinus surgery (ESS) for nasal polyposis or nasal tumors. Results : Only 16 cases (12%) underwent nasal packing, while in the remaining 117 (88%) endoscopic control of bleeding permitted avoiding packing. In 53 (39.8%) patients only an endoscopic cauterization of bleeding points was performed; in 29 (21.8%) cases a sphenopalatine artery ligation was necessary. Only 2 subjects (1.5%) underwent anterior ethmoidal artery ligation. In the remaining 34 (25.5%) patients no procedure was necessary, due to the apparently scarce bleeding in the endoscopic vision at the end of surgery. In this group of non-packed patients, only 8 (6.8%) needed a post-operative tamponade while in the group of packed patients, 2 (12.5%) cases had a re-bleeding and a revisional surgery was necessary. Conclusion : Intra-operative precautional packing is therefore not justified during nasal surgery because of the small percentage of post-operative epistaxis. Intra-operative control of bleeding allowed nasal packing to be avoided in a large percentage of cases.

Porównanie opatrunków rozpuszczalnych zastosowanych w czynnościowych endoskopowych operacjach zatok przynosowych

Nasal packing is commonly practiced in postoperative care after nose and sinus surgery, not only for haemostasis but also as internal stabilisation and synechia formation control. The aim of our study was to compare the pain level, adhessions and haemostatic properties of Stammberger sinus dressing (SSD) with Dissolvable Sinu-Knit (DSK) and routine nasal packing in latex gloves finger (RNP) after FESS in adult patients. 45 patients with bilateral chronic rhinosinusitis (CRS) (totally 90 sides) were recruited into our trial. All patients underwent bilateral FESS without septoplasty. Following completion of surgery, every single nasal cavity side was packed with one of the studied dressing chosen randomly. In 41 sides nasal cavities were packed with Stammberger Sinus Dressing (SSD) in 26 sides packed with Dissolvable Sinu-Knit and 23 sides were filled with routine nasal packing in latex gloves finger (RNP). Haemostatic effect was assessed during the recovery period, pain level was recorded by the patients on a visual analogue scale 24 hours after surgery. Tendency to postoperative middle meatal synechia formations was assessed during control visits in the 1, 2, 4 and 8 week postoperatively. Three (7.3%) of sides packed with SSD and four (15.3%) packed with DSK had primary postoperative bleeding that required additional packing. Finally 3D patients were packed with RNP. In patients packed with RNP bleeding didn't appear. Mean pain level for SSD was 0.85 (range from 0 to 3) and for DSK 2.1 (range 0 to 5) whereas for RNP was 5.6 (range from 2 to 9). Five (13.1%) of thirty-eight sides with SSD and five (22.7%) of twenty-two sides with DSK had synechia in middle meatus whereas eight (26.6%) of total thirty sides packed with RNP had synechia at any one of the control visits. We found that Rapid Rhino Stammberger Sinus Dressing and Dissolvable Sinu-Knit are associated with very low local pain level and with a good effect in postoperative bleeding and synechia formation control.

Routine nasal packing follwoing nasal surgery—Is it necessary?

The practice of routine nasal packing after nasal surgery is usually customary and not evidence based. Post operative complications, while uncoumon, are sometimes pack related. A retrospective analysis of 110 patients who underwent a variety of nasal operations was performed to determine the incidence of complications when nasal packs were not routinely inserted 9 cases (8.2%) [6 out of these were revision surgeries] needed nasal packing for haemostasis at the end of surgery. 4 cases (3.6%) required to be packed in the immediate post operative period. One patient who required nasal packing developed a unilateral adhesion. No patient developed septal hematoma. The need for routine nasal packing is not supported. Packing should be indicated where there continuous bleeding at.

A case against nasal packing.

Nasal packing is included in most technical descriptions of septal and rhinoplasty surgery with little accompanying discussion of its indications and possible pitfalls. We believe that routine nasal packing is not an innocuous step. There are certain specific indications for its use but these are uncommon. We suggest that exclusion of packing is a wiser alternative in routine procedures. Over 800 cases of nasal surgery have been reviewed with fewer than 9% requiring packing. The indications for such packing are described as are the alternatives. Problems and complications attendant with its routine use are explored.