Septal Splints Research Articles

Prophylactic antibiotics in septoplasty with intranasal septal splints: A comparative analysis.

Postoperative antibiotic therapy is a common practice following septoplasty with intra-septal splints placement (ISS), even though there is a lack of evidence to support it. We sought to investigate the role of antibiotic therapy in septal surgeries with the placement of ISS. A retrospective comparative study was conducted using the electronic charts of adult patients who underwent septoplasty with the placement of ISS with or without turbinate reduction. Nasal cultures were taken routinely during surgery as part of the department's protocol for monitoring infectious diseases. The ISS were also routinely examined for the presence of bacteria after their removal on the eighth day following surgery. A large otolaryngology department in a tertiary medical center. Adult patients who underwent septoplasty in our institution. We analyzed all post-operative infections to search for risk factors in the cohort. Post-operative infection rates following septoplasty with ISS were low at 6%, which is consistent with previously published rates. Infection rates were significantly higher in patients who were not treated with antibiotics (OR = 8.2, 95%CI: 1.63-41.1; p = .01, φ = 0.04). Diabetes was associated with an increased risk of postoperative infection regardless of prophylactic antibiotic therapy (OR = 5.2, 95%CI: 1.15-23.5; p = .032, φ = .04). The detection of Klebsiella pneumonia before surgery was associated with an increased rate of postoperative infection (OR = 16.6, 95%CI: 3.02-91.54; p = .001, φ = 0.12). Patients undergoing septoplasty with the placement of ISS are at increased risk of gram-negative bacterial colonisation, and development of postoperative nasal infection. A single preoperative dose of IV antibiotic therapy should be considered a potential prophylactic option for septoplasty with ISS.

Silicone septal splint for recurrent epistaxis in HHT patients: experience of a national referral centre.

To report our experience in the use of silicone septal splint for recurrent severe epistaxis in hereditary haemorrhagic telangiectasia patients (HHT). This is a descriptive analysis carried out at the Otorhinolaryngology Department of Fondazione IRCCS Policlinico San Matteo in Pavia, a reference centre for the treatment and diagnosis of HHT. We retrospectively evaluated HHT patients who underwent silicone septal splint positioning after the endoscopic surgical treatment of epistaxis from 2000 to 2022. Of the 506 patients surgically treated in the period of analysis, 74 patients underwent silicone septal splint positioning and 37 were post-operatively interviewed. With a mean of 2.4 previous surgical treatments and a mean epistaxis severity of 7.38, the majority of patients presented with septal perforation (71.6%). On average, patients maintained the splint in place for 54.5 months, with a good tolerability and a significant reduction in epistaxis severity, need for blood transfusion and improvement of haemoglobin levels. In HHT patients with recurrent severe epistaxis and with septal perforation, the placement of septal splints offers a useful additional strategy in the management of nosebleeds.

A comparative study on the effects of intranasal silicone splints and silastic sheets on breathing post septal surgeries

Background: Septoplasty is a surgical procedure to straighten the bone and cartilage dividing the space between your two nostrils (septum). If septoplasty is performed alone or as a part of a rhinoplasty procedure, internal nasal splints are generally used. Objective: To compare silicone nasal septal splints with integral airways and silastic sheets after septal surgery in terms of patient breathing (with the splint in place). Patients and Methods: This study involved 50 patients who underwent septal surgery in terms of septoplasty or septo-rhinoplasty due to nasal septal deviation. They were allocated into two groups. Group A comprised 25 patients who underwent septal surgery and were packed with silicone nasal septal splints. Group B comprised 25 patients who underwent septal surgery and were packed with silastic sheets. They were removed on the seventh postoperative day. Clinical efficacy was compared using visual assessment and patients' subjective breathing status. Results: The patients in both groups A and B had similar mean ages: 27.8 years (range, 18-51 years) and 25.84 years (range, 18-48 years) in Group A and Group B, respectively. The study included 58% males and 42% females. The tyspe of surgery were septoplasty and septorhinoplasty in 38% and 62%, respectively. Breathing status was significantly lower in Group A than in Group B at the 7th postoperative day (p<0.004). Conclusion: Intranasal septal splints with silastic sheets result in less nasal obstruction while in place; thus, they can be used as an effective alternative to silicone nasal splints with integral airways after septal surgery. Keywords: Septal surgery, silicone splint, silastic sheet

A comparative study on the effects of intranasal silicone splints and silastic sheets on breathing post septal surgeries

Background: Septoplasty is a surgical procedure to straighten the bone and cartilage dividing the space between your two nostrils (septum). If septoplasty is performed alone or as a part of a rhinoplasty procedure, internal nasal splints are generally used.
 Objective: To compare silicone nasal septal splints with integral airways and silastic sheets after septal surgery in terms of patient breathing (with the splint in place).
 Patients and Methods: This study involved 50 patients who underwent septal surgery in terms of septoplasty or septo-rhinoplasty due to nasal septal deviation. They were allocated into two groups. Group A comprised 25 patients who underwent septal surgery and were packed with silicone nasal septal splints. Group B comprised 25 patients who underwent septal surgery and were packed with silastic sheets. They were removed on the seventh postoperative day. Clinical efficacy was compared using visual assessment and patients' subjective breathing status.
 Results: The patients in both groups A and B had similar mean ages: 27.8 years (range, 18-51 years) and 25.84 years (range, 18-48 years) in Group A and Group B, respectively. The study included 58% males and 42% females. The tyspe of surgery were septoplasty and septorhinoplasty in 38% and 62%, respectively. Breathing status was significantly lower in Group A than in Group B at the 7th postoperative day (p<0.004).
 Conclusion: Intranasal septal splints with silastic sheets result in less nasal obstruction while in place; thus, they can be used as an effective alternative to silicone nasal splints with integral airways after septal surgery.

Nasal Septal Perforation Closure by "Sandwich Grafts": Technique, Initial Results.

Nasal septal perforation closure represents a considerable surgical challenge. Many techniques rely on the implantation of foreign materials that pose a persisting threat of infection. The authors have identified a reliable technique closing septal perforations by an autologous "sandwich graft." It is layered around a piece of auricular cartilage, covered with temporal fascia, thus emulating the physiological layers of the nasal septum. Finally, the prepared graft is then sewn into the perforation in an underlay technique and kept in place by septal splints for 4 weeks. The technique is easily feasible and strives to reconstruct the nasal as physiological as possible. The data obtained from a case series of 11 patients highlights the efficacy of the technique.

Comparison of Efficacy of Nasal Septal Splints with Clip versus Nasal Packing after Septoplasty

Introduction It has always been a concern of ENT surgeon to prevent post operative complications like nasal bleeding, septal hematoma and septal abscess after septoplasty. Traditionally nasal packing has been done to avoid these complications. Although the nasal pack itself has been a concern for several reasons, packing apart from causing breathing distress, has resulted in epiphora, dysphagia, sleep disturbance, post-operative pain, headache, septal infection, septal abscess and even toxic shock syndrome. Materials and Methods This study has compared the efficacy of a newly designed septal splint with clip with nasal packs. This study was done on 60 patients, nasal packing was done in 30 patients and septal splints with clip were applied in 30 patients. Results Post-operative pain, epiphora, dysphagia, dryness of mouth and sleep disturbance was found to be significantly less in patients with septal splints with clip as compared to those with nasal packing. Conclusion Septal splints with clip is more efficacious alternative to nasal packing in patients undergoing septoplasty.

Use of Nasal Septal Splint with Clip in Septoplasty: A Retrospective Study

Use of Nasal Septal Splint with Clip in Septoplasty: A Retrospective Study

Intranasal Septal Splints: Prophylactic Antibiotics and Nasal Microbiology.

Intranasal septal splints are often used in nasal septal surgeries. Routine use of postoperative antibiotics is an accepted practice, although data regarding its efficacy in preventing postsurgical complications are limited. This study aimed to examine bacterial colonization on septal splints following prophylactic antibiotic therapy and the association with postoperative infections. Fifty-five patients underwent septoplasty by a single surgeon between March 2015 and April 2016. All had intranasal septal splints and were given antibiotic prophylaxis for 7 days until removal of splints. Nasal cultures were taken before surgery, and septal splints were examined for bacterial colonization following their removal. Thirty-six patients (65%) had positive nasal culture prior to surgery. The most common isolates were Staphylococcus aureus (30%) and Enterobacteriaceae species (66%). All these patients had postoperative bacterial colonization on septal splints. In 15 patients with negative preoperative cultures, bacteria were isolated postoperatively. An increased resistance profile was documented postoperatively in 9 patients (16%), including two with multidrug resistance. In two of these patients preoperative wild-type strains acquired antibiotic resistance postoperatively. No adverse drug reactions to antibiotics were reported. Increased bacterial growth and emergence of resistant strains were observed on intranasal septal splints despite prophylactic antibiotic treatment. Nonetheless, this did not translate into clinical infection. Thus, considering antibiotics overuse and increasing bacterial resistance, further research is needed to determine the role of antibiotic prophylaxis in the setting of intranasal splints.

Mitomycin-C in Post-endoscopic Septoplasty Synechiae: Does it Really Helps?

Endoscopic septoplasty has advantage of magnified image and access to posterior part of the septum. Synechiae formation is a common complication of this procedure. The incidence of adhesions rises particularly in cases of submucosal flap tears which is sometimes unavoidable during spurectomy. Various procedures like septal splints, nasal packings have been tried to reduce the incidence of adhesions. Recently mitomycin-C is being tried to decrease post operative adhesions after Functional Endoscopic Sinus Surgery, endoscopic Dacrocystorhinostomy, with varying degree of success. Mitomycin-C has got anti fibroblastic activity, which inhibits the fibroblasts without hampering epithelization. Eighty (80) Patients undergoing septoplasty and spurectomy were observed for any submucosal flap tear, and those developing flap tear were included in the study. The patients were divided into 2 groups of 40 each. In group-1 topical mitomycin (0.4mg/ml) was applied at the raw area for 5min, similarly normal saline was applied in group-2 (control).The aim of study was to evaluate the role of mitomycin-C in preventing post operative adhesions in Endoscopic septoplasty. Adhesion rate was calculated at 1month, and compared using Chi square test. P value < 0.05 was considered significant. The adhesion rate at 1month was 17.5% in group-1 and 45% in group-2 (P = 0.008). Incidence of adhesion decreased significantly in mitomycin-C treated group. Mitomycin-C can routinely be used in septoplasty to prevent post op adhesions, particularly in cases of submucosal flap tears/concurrent turbinate reduction procedures.

Effects of Silicone Nasal Septal Splints and a Polyvinyl Alcohol Sponge After Septoplasty on Postoperative Pain and Pain During Pack Removal

Effects of Silicone Nasal Septal Splints and a Polyvinyl Alcohol Sponge After Septoplasty on Postoperative Pain and Pain During Pack Removal

Rare case of choanal atresia in a 54-years-old female

Introduction: Choanal atresia is a rare disorder presenting with complete separation between the nasal cavity and the nasopharynx. There are two types of this abnormal blockage of the nasal airway – congenital and acquired. Material and Methods: This paper presents the case of a 54-years-old woman administered to the clinics for septoplasty. During the preoperative diagnostic process via CT scan and endoscope examination a coincidental finding was diagnosed – unilateral congenital choanal atresia. The medical history of the patient revealed difficult nasal breathing which is absent in the right nasal airway, also frequent rhinosinusitis, moreover orthodontic problems with her dentition and malocclusion; regarding her post-birth period she was on feeding tube and with oxygen mask in a neonatal clinic for several months; no facial traumas reported during the rest of her life. Results: Septoplasty was managed and endoscopic assisted fenestration in the choanal regional was performed viatransseptal access. Seven days postoperatively before the removal of the septal splints a CT scan was performed for evaluation of the surgical treatment and three months later – endoscopy which displayed well-formed without postoperative stenosis neochoana. Conclusion: The congenital choanal atresia is a rare abnormality which determines the insufficient clinical experience with this disorder. It is possible that many cases could have been missed or misdiagnosed because of the low incidence of the condition. The conducted literature review reveals that the case report we are presenting is one of the oldest patients diagnosed with unilateral, congenital, bony choanal atresia.

Comparison of Early-period Results of Nasal Splint and Merocel Nasal Packs in Septoplasty.

Several types of nasal packs are used postoperatively in septoplasty. In this study, we compared two commonly used nasal packing materials, the intranasal septal splint with airway and Merocel tampon, in terms of pain, bleeding, nasal obstruction, eating difficulties, discomfort in sleep, and pain and bleeding during removal of packing in the early period. The study group included 60 patients undergoing septoplasty. Patients were divided into two groups (n=30 in each group). An intranasal splint with airway was used for the patients in the first group after septoplasty, while Merocel nasal packing was used for the second group. Patients were investigated in terms of seven different factors - pain, bleeding while the tampon was in place, nasal obstruction, eating difficulties, night sleep, pain during removal of the nasal packing, and bleeding after removal of packing. There was no statistically significant difference between the groups in terms of pain 24 hours after operation (p=0.05), while visual analog scale (VAS) scores for nasal obstruction, night sleep, eating difficulties, and pain during packing removal were lower in the nasal splint group with a statistically significant difference (p<0.05). There was no statistically significant difference between the groups in terms of postoperative bleeding (p=0.23). Significantly less bleeding occurred during removal of the packing in the nasal splint group (p<0.05). Our study indicates that the nasal splint was more comfortable and effective in terms of causing lesser bleeding and pain during removal of packing.

Subjective patient satisfaction after nasal septumplasty

Septal surgery (SP) is one of the most frequently performed operations in Germany and thus represents ahigh cost burden for the health system. However, sufficient data on postoperative patient satisfaction and objective indication criteria for surgery are still lacking. This study aimed to determine postoperative patient satisfaction and possible factors influencing the subjective success of SP, in order to optimize preoperative indication establishment. Atotal of 600questionnaires were sent by mail, resulting in inclusion of 238patients (60female, 178male) who had received SP. The questionnaires were retrospectively evaluated using validated questionnaires (NOSE-D, SNOT-20-GAV) as well as aself-designed questionnaire regarding patients' subjective satisfaction after SP. Clinical data were collected from the electronic patient record. Follow-up was between 2 and 11years. The main symptom for SP was difficult nasal breathing in 89% (212 of 238) of patients. In total, 68% (161) were satisfied with the outcome of surgery and 73% (172) of the patients would opt for SP again. The scores of the visual analog scales for nasal breathing, smell, nasal secretion, physical performance, use of nose drops, and headache were statistically significantly improved postoperatively. Additionally, the analysis of Nose-D and SNOT-20-GAV questionnaires presented asignificant improvement in scores. Surprisingly, patients with aprolonged duration of septal splints were more satisfied. Previous nasal surgery had no significant influence. SP leads to ahigh degree of patient satisfaction, if the indication for surgery is correct. The main complaint of patients should be "difficult" nasal breathing. SP leads to asignificant improvement in preoperative symptoms.

Is nonabsorbable nasal packing after septoplasty essential? A meta-analysis.

Septoplasty is one of the most frequently performed rhinologic surgeries. Complications include nasal bleeding, pain, headache, septal hematoma, synechia, infection, residual septal deviation, and septal perforation. In this study, we aimed to compare complication rates among patients according to packing method. We performed a literature search using PubMed, Embase, and the Cochrane Library through August 2016. Our systematic review followed Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Random effect models were used to calculate risk differences and risk ratio with 95% confidence intervals (CIs). Cases referred to the nonpacking group included patients treated with transseptal sutures or septal splints. Cases referred to as the packing group included patients treated with nonabsorbable packing such as Merocel or gauze. Our search included 20 randomized controlled trials (RCTs) with a total of 1,321 subjects in the nonpacking group and 1,247 subjects in the packing group. There were no significant differences between packing methods regarding bleeding, hematoma, perforation, infection, and residual septal deviation. The risk differences of postoperative pain, headache, and postoperative synechia were -0.50 [95% CI: -0.93 to -0.07, P = .02], -0.42 [95% CI: -0.66 to -0.19, P = .0004], and -0.03 [95% CI: -0.06 to -0.01, P = .01], respectively. Nonabsorbable nasal packing is no more effective than treatments without packing after septoplasty. Septal splints and transseptal sutures reduce postoperative pain, headache, and synechia. 1B Laryngoscope, 127:1026-1031, 2017.

Nasal septum configuration as a basis for novel septal splints.

The objective is to use anatomical determinations of nasal septum shape and surface area in adults as a design basis for silastic septal splints of universal size and fit and offering maximum possible surface coverage. The objective is also to devise a method of securing the septal splints, so that surface pressure on septal mucosa is distributed as evenly as possible while not interfering with capillary perfusion. Nasal septum area was determined in 21 Caucasian body donors, and nasal septum thickness was measured in 20 CT scans. Septal splints of universal size and shape were prepared from silastic sheeting. The holding force of various neodymium-iron-boron (NdFeB) magnets, and the surface pressure exerted by magnet-containing septal splints was calculated. These septal splints of novel design offer a satisfactory fit in routine clinical practice. The splints can be securely attached with built-in NdFeB magnets, and surface pressure can be distributed evenly across the nasal septum while not interfering with mucosal tissue perfusion. With their simple intranasal insertion, these magnet-containing septal splints of universal size and optimised shape offer maximum possible septum coverage following septoplasty/septorhinoplasty. The absence of interference with septal tissue perfusion means that they are likely to be associated with fewer postoperative complications and better outcomes.

Evaluation of the application of rhino-septal splints in endoscopic transsphenoidal skull base surgery.

The endoscopic transnasal route for the surgical removal of tumors in the sellar region is frequently associated with nasal complications such as synechiae or impaired nasal breathing. In this study, we investigated the impact of septal splints on avoiding surgery-related co-morbidities. 49 patients in whom endoscopic transnasal, transsphenoidal surgery for sellar tumors was performed between 2012 and 2014 were studied. In 30 of these, nasal septal splints were applied at the end of surgery to both sides of the septum and left in situ for 10days (group 1), 19 patients received no splints (group 2). A standardized postsurgical follow-up investigation with endoscopic nasal examination, rhinomanometry and olfactory testing was performed on average 2months postoperatively. Patients' subjective nose-related discomfort at follow-up was assessed descriptively using a set of standardized self-rating statements on nasal problems. Synechias occurred less likely with nasal septal splints (n=15; 50%) than without (n=16; 84.2%). Moreover, multiple synechiae were predominantly observed in the group without septal splints (n=10 vs. n=2). Rhinomanometry showed improved flow-V150-inspiration scores when splints were used (with significant differences between groups for the left nostril: p=0.039 and p=0.022, resp.). In accordance, impaired nasal breathing after surgery was reported more frequently by 76.9% of patients without splints, but only 56% of patients with splints. Our results provide support for the application of nasal septal splints when operating endoscopically on tumors in the sellar region to reduce postoperative synechias and to improve nasal breathing.

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

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

Autologous composite grafts from the cavum conchae for reconstruction of multilayer nasal defects

Autologous transplants comprising skin and cartilage, so-called composite grafts (cgs), are an important reconstructive tool for multilayered defects of the nose. Acg from the auricular cavum conchae needs to fulfill both functional and esthetic demands. This article illustrates the indications for and requirements of cgs, and also investigates graft healing and functional-aesthetic results. The current publication is a review article; the original data were published with the award of the2014 APKO prize under the title "The auricle's cavum conchae composite graft in nasal reconstruction". At the ENT department of Ulm University Medical School, multilayered defects of different nasal esthetic subunits are reconstructed with cgs. Based on these experiences, the authors report on long-term functional and esthetic results in the areas of the donor and recipient sites. Auricular cgs are versatile and reliable autologous transplants. The ease of harvesting, minimal donor site morbidity, and stable convex shape of these grafts render them ideal for reconstruction of multilayered nasal defects. Septal splints and custom-made prosthesis promote healing and prevent stenotic scarring.

The value of intranasal splints after partial inferior turbinectomy.

To assess the value of using the intranasal septal splint after partial inferior turbinectomy (PIT) surgery. Prospective, randomized comparative study. The study was conducted over a period of 2years from January 2012 to January 2014 at Minia University hospital, Minia, Egypt. A total of 100 patients underwent bilateral PIT. They were randomly divided into 2 groups. Group A included 50 patients had PIT with intranasal splints and group B included 50 patients had PIT without splints. A comparison was made between the 2 groups regarding the postoperative pain, degree of nasal obstruction and the degree of tissue healing and adhesions formation at 2 time points (2 and 4weeks postoperatively). At 2weeks postoperatively: visual analogue score (VAS) for the pain was 5 in group A versus 2.1 in group B (P=0.01), VAS for nasal obstruction was 6 in group A versus 5 in group B (P=0.328), 70% of patients had good healing in group A versus 24% in group B (P=0.02). At 4weeks postoperatively: VAS for the pain was 1.5 in group A versus 1.8 in group B (P=0.423), VAS for nasal obstruction was 7 in group A versus 6 in group B (P=0.353), 80% of patients had good healing in group A versus 54% in group B (P=0.03). The use intranasal septal splints after PIT without septal surgery can cause increased postoperative pain in the short term follow-up period with significant evidence of decreasing rates of intranasal adhesions.

The impact of different nasal packings on postoperative complications

ObjectiveThe objective of this study was to find out if there is any association between the use of nasal packings and nasal synechia formation, septal perforation, postoperative infection and epistaxis in patients who underwent septoplasty and concha reduction operations. MethodsThis retrospective study was conducted at a tertiary referral center. One hundred thirty patients were randomly selected among patients who underwent endonasal surgery in Namık Kemal University Hospital between January 1st 2012 and August 1st 2013. Retrospective analysis of these patients' files, including operative reports and follow-up notes, was done. The postoperative findings of patients who had septal splints and Merocel nasal packings were compared and analyzed for statistical significance. ResultsThe results of the study showed a statistically significant difference in the frequency of synechia formation between two groups (p<0.05). The frequency of synechia formation was found to be higher in the Merocel packing group. However, no statistically significant difference was found between groups in terms of postoperative infection, septal perforation, and epistaxis (p>0.05). ConclusionOur findings suggest that intranasal splints are superior to Merocel nasal packings in terms of preventing nasal synechia formation. Insertion of a septal splint after nasal surgery should be preferred to avoid this complication. On the other hand, other factors should be sought in the etiology of postoperative infection, septal perforation, and epistaxis.