Comparison of suture and nasal packing in rabbit noses

Intranasal Synechiae as Complications of Rhinosurgical Treatment-A Review of Current Knowledge

Intranasal adhesions (synechiae) develop as a result of improper healing of the nasal mucosa. Their incidence ranges from 6.8% to 36% of rhinosurgical procedures. The aim of this study was to review the available publications and monographs dealing with intranasal adhesions-both in the context of formation and risk factors. The study used a review of the literature to determine the articles and studies available in the following medical databases: MEDLINE (National Library of Medicine's), PubMed, and Google Scholar. The following search terms were used: synechiae nasal + synechial nasal + intranasal adhesions + nasal adhesions. The time criterion of available materials was not applied. Available filters in the search engines were used to narrow down the search results. Artificial intelligence was not applied. The review indicated that the risk of intranasal adhesions correlates with the type of surgery, the surgical technique, the dressing materials, and wound care in the postoperative period. Every case requires an individualized approach. Nasal septum separators, (self-)dissolving dressings and (in selected cases) Mitomycin C were investigated thoroughly. Further studies are required which may result in a universal classification system for intranasal adhesions.

Application Effect of Modified Through and Through Suture in Anterior Chondrectomy of Auricular Pseudocyst

Objective

To introduce a novel method of modified through and through suture with collagen sutures in conjunction with anterior chondrectomy of auricular pseudocyst and assess its therapeutic efficacy.

Subjects and Methods

The study comprised 87 patients with unilateral auricular pseudocyst, treated in our department from December 2019 to November 2021. Following anterior chondrectomy of the cyst, modified through and through suture was performed using collagen sutures. Evaluation of successful resolution of the problem, assessment of complications, recurrence, and ultimate ear cosmesis was undertaken with a minimum of 6 months follow-up.

Results

There were 83 males and 4 females, ages ranged from 26-78 years old, with a median age of 41 years. The right and left ears were affected in, 52 and 35 patients, respectively. Local skin color deepening was found in 15 patients within 3 months, which returned to normal within 5 months. During the follow-up, such complications as anaphylaxis, hematocele in the surgical cavity, incision infection, and deformity were not observed in any patients. All patients were cured with a single operation without relapse.

Conclusion

The modified through and through suture with collagen sutures in conjunction with anterior chondrectomy of an auricular pseudocyst is characterized by a straightforward, single-stage operation, with no relapses, few complications, restoration of normal ear cosmesis, and high patient acceptance.

Surgical repair of nasal septal perforations: A systematic review and meta-analysis

BACKGROUND

A wide variety of techniques for the surgical repair of nasal septal perforations (NSPs) have been described. Surgical management of NSPs can be broadly divided into open versus endonasal approaches, with additional variables involving unilateral or bilateral flaps, use of grafts, and placement of splints. The objective of this study was to compare surgical approaches and their outcomes.

METHODS

PubMed, EMBASE, and CINAHL Plus databases were examined for patients undergoing NSP repair. English-language studies reporting surgical management of patients with the primary diagnosis of NSP were included. Outcome measures of interest included perforation size, surgical approach characteristics, and success rate defined as complete closure assessed by surgeon postoperatively. The quality of articles was assessed with the methodological index for nonrandomized studies (MINORS) criteria. A random-effects model was used to calculate pooled proportions for the different outcomes.

RESULTS

The electronic database search yielded 1076 abstracts for review. A total of 64 articles met the inclusion criteria, with 1591 patients: 1127 (71%) underwent an endonasal approach and 464 (29%) an open approach. The median (range) MINORS score was 10 (5-12) out of 16 points. Overall, 91% of patients had total closure (95% confidence interval [CI], 0.89-0.93, p < 0.01), with moderate heterogeneity between studies (I²  = 42.03%). There was no difference in closure success between open and endonasal approaches. Use of bilateral versus unilateral flaps, interposition grafts, and intranasal splints and packing were not associated with differences in outcomes.

CONCLUSION

Nasal septal perforation surgical repair success rates are comparable regardless of technique.

A clinical and histopathological comparison of saline, adrenaline and 2-mercaptoethanesulfonate (MESNA) in mucoperichondrial elevation: which is superior?

Objective

To determine whether submucosal mesna (2-mercaptoethane sodium sulfonate) infiltration is superior to normal saline or adrenaline + lidocaine in mucoperichondrial hydrodissection.

Methods

Twenty-one rabbits were administered adrenaline + lidocaine, saline or mesna. Bilateral septal mucoperichondrial flap elevations were performed following submucosal infiltration. The intraoperative bleeding amount, operation time, accessibility of the surgical plane, field quality and degree of mucoperichondrial injury were recorded. The three groups were compared histopathologically.

Results

The amount of bleeding and duration of the operation were significantly higher and the accessibility of the surgical plane score was significantly lower in the saline group vs. the other groups (p < 0.05). The mucosal damage rate was significantly higher in the saline group compared with adrenaline + lidocaine (p < 0.05). The surgical field quality was significantly lower in the saline group compared with adrenaline + lidocaine (p < 0.05). The accessibility of the correct surgical plane score was significantly lower in the saline group compared with the adrenaline + lidocaine and mesna groups (p < 0.05). The amount of bleeding, duration of operation, surgical field quality and accessibility of the surgical plane did not differ significantly between the adrenaline + lidocaine and mesna groups (p > 0.05). The pericondrium thickness was significantly lower in the saline group than the other groups. Cartilage thickness was significantly higher in the saline group compared with the mesna group (p > 0.05).

Conclusion

Use of mesna instead of normal saline or adrenaline + lidocaine in septoplasty was not more advantageous in terms of intraoperative parameters. The adrenaline + lidocaine group was superior to normal saline for all intraoperative parameters. In conclusion, the use of adrenaline may be more advantageous in facilitating septal mucoperichondrium elevation due to its widespread use, low cost and superiority to physiological saline.

Quest for the Ideal Nasal Pack in Post Operative Cases of Septo-Turbinoplasty: Study in a Tertiary Care Hospital

To compare the efficacies and post operative outcomes of patients with nasal packing with merocel, intranasal splints and merocel along with intra-nasal infant feeding tubes following septo-turbinoplasty, in patients with nasal obstruction secondary to septal deviation and inferior turbinate hypertrophy. A prospective study was done in 60 patients of symptomatic deviated nasal septum with inferior turbinate hypertrophy. Septoturbinoplasty was performed. Patients' nasal cavity was packed for 48 h after being randomly divided into 3 groups: (1) packing using merocel, (2) intra-intra nasal septal silicone splint, (3) packing using truncated merocel along with infant feeding tube. Patients were given a questionnaire 24 h post operatively and their reponse was analysed to compare nasal blockage, epistaxis, epiphora and headache. Pain on pack removal was recorded after 48 h. We found that merocel with infant feeding tube had better tolerance than plain merocel in almost all cases, with symptoms of nasal blockage, epiphora, headache and pain on pack removal being lesser than with plain merocel, and comparable to the results produced by nasal splints. Also the epistaxis control in merocel with infant feeding tube was better than with nasal splints. Truncated merocel with infant feeding tubes provides a suitable and cheap replacement for nasal splints which may not be affordable to a lot of patients, or may not in available in many settings. The results are superior to plain merocel and the control of post operative bleeding is better than with intra nasal splints.

Creation of Experimental Human Nose Model With Lyophilized and Decellularized Bovine Cartilage Xenograft

The nose anatomy is a functional and aesthetically important organ because of its three-dimensional structure, visible location in the face region, and its connection with the respiratory tract. Aesthetic and reconstructive nasal surgery requires correction of deformations in cartilage and bone structures as well as preservation of the natural connections between all subunits. The minimal mistake made can result in functional or aesthetically bad results. In this study, the authors aimed to create an experimental nose model that help aesthetic and reconstructive nose surgery operations.

Nasal Septal Suture Technique versus Nasal Packing after Septoplasty

Background

The aim of this study was to compare eustachian function and blood gas changes with nasal packing (NP) and nasal septal suturing (NSS) after septoplasty.

Methods

Eighty patients who have nasal septal deviation and who otherwise are healthy were studied. Forty of these patients had finger glove NPs in their nasal cavities for 48 hours after septoplasty. Another 40 patients had NSS performed after septoplasty. Acoustic tympanometry and pH, PCO2, and PO2 analyses of arterial blood were performed preoperatively and 48 hours postoperatively.

Results

We observed a statistically significant increase in middle ear pressure (p < 0.001) and a significant reduction of PO2 (p < 0.001) and increase of PCO2 (p = 0.041) in the NP group but no difference in the NSS group, postoperatively.

Conclusion

NSS should be preferred as an alternative to intranasal packing.

The Effects of Nasal Packing and Transseptal Suturing After Septoplasty on Olfactory Function, Patient Comfort, and Mucociliary Clearance

BACKGROUND

This study compared the effects of nasal packing and transseptal suturing after septoplasty by evaluating olfactory function, pain, and mucociliary clearance.

METHODS

The study enrolled 39 patients diagnosed with isolated septal deviation. The patients were randomly assigned to 2 groups. In Group A (n = 21), transseptal sutures were placed for septal stabilization after the septoplasty. In Group B (n = 18), both nasal passages were packed with Merocel tampons after the septoplasty. It was made Sniffin Sticks test, sacchranirine test, and pain and discomfort scales preoperatively, 1 week postoperatively and 3 months postoperatively on all patients.

RESULTS

There was no postoperative bleeding, submucoperichondrial haematoma, or abscess formation in either group. The postoperative discomfort and pain scores were increased in Group B (the packing group) in our study, the mucociliary clearance improved after septoplasty in both groups, and there was no significant difference in mucociliary clearance between the 2 groups. The odor threshold, odor identification, and odor discrimination were significantly increased 3 months postoperatively, but not 1 week postoperatively.

CONCLUSIONS

Nasal packing causes more discomfort and pain than transseptal suturing, while there was no significant difference in olfactory functions or the mucociliary clearance after septoplasty between nasal packing and transseptal suturing.

Nasal Septal Chain Suture: A New Suturing Technique

As a new technique for suturing the nasal septum, the nasal septal chain suture has been described in this study, and compared with nasal packing and the quilting suture technique in terms of patient comfort after septoplasty. A total of 75 patients were evaluated in 3 groups: Merocel nasal packing group, absorbable quilting suture group, and nonabsorbable nasal septal chain suture group. The symptoms of these patients were evaluated using the nasal obstruction symptom evaluation (NOSE) scale and rhinomanometry measurements. The NOSE scale values were significantly higher on the postoperative 1st and 3rd days in the nasal packing group (P < 0.001 and P < 0.001, respectively). The nasal resistance was significantly lower (P = 0.011) and the nasal airflow significantly higher (P < 0.001) in the suture groups on the postoperative 3rd day. The use of nasal packing was found to shorten the surgery duration significantly (P < 0.001), while there was no difference between the 2 suture groups (P = 1.000). There was significantly severe pain during the removal of the nasal packing when compared to the nasal septal chain suture removal (P < 0.001), but there was no difference in the bleeding (P = 0.460). Overall, nasal septal sutures significantly improve patient comfort during the postoperative period, when compared to nasal packing, with an earlier return to nasal respiration. The nasal septal chain suture that has been described in this study for the first time can be an alternative to nasal packing and the nasal septal suture techniques currently in use, since both absorbable and nonabsorbable materials can be used, it is easy to remove, and there is no pain during the suture removal.

Nasal septum suture combined with inferior turbinate coblation after septoplasty: Does it improve quality of life and reduce complications?

Objective

Nasal packing is routinely applied after septoplasty. Patients, however, report feeling very uncomfortable while the packing is in place. The aim of this study was to compare the effects of nasal septum suture combined with inferior turbinate coblation to the effects of nasal packing after septoplasty.

Methods

In this study, 135 patients undergoing septoplasty were divided into 3 groups: group 1 patients had microdebrider with packing, group 2 received coblation with packing and group 3 had coblation with suture. Early postoperative quality of life and complications were compared between the 3 groups.

Results

The patients in group 1 experienced the most postoperative nasal pain, headache, dysphagia, sleep disturbance and bleeding on the night of surgery; while the patients in group 3 experienced the fewest symptoms. No difference in epiphora was observed between the 3 groups. More pain and bleeding were experienced when comparing the pack removal (Group 1 and 2) with the clearance of the nasal cavity (Group 3). We noted one case of postoperative bleeding in group 1, one septal hematoma in group 1 and a second septal hematoma in group 2. No such postoperative complications were found in group 3.

Conclusion

Nasal septum suture combined with inferior turbinate coblation was not only associated with less pain, increased patient satisfaction and an improved quality of life; but also reduced postoperative complications. Our results confirm that it is a more comfortable, reliable alternative to the more common nasal packing.

The dragonfly splint: a new disposable device designed to prevent both medial and lateral turbinate synechiae after sinonasal surgery

Periturbinal adhesions are among the most frequent and challenging complications of sinonasal surgery. Endonasal paraseptal splints have proved to be very efficient in preventing "medial synechiae," that is, adhesions located between the medial faces of the middle/inferior turbinates and the septum. However, none of these devices for guiding mucosal healing can prevent "lateral synechiae" (adhesions between the lateral face of the middle turbinate and the lateral nasal wall) inside the middle meatal cleft, which is a very critical area for the physiology of the anterior sinus system. For this reason, if followed by the formation of lateral synechiae, the surgical maneuvers used to treat sinus diseases could paradoxically become a cause of persistent functional impairment and lead to iatrogenic sinusitis or mucocele.We describe our preliminary experience with a new endonasal splint called "Dragonfly" (because of its shape), which has been designed to prevent both medial and lateral postsurgical synechiae. This device has a long lateral wing designed to separate the mucosal surfaces of the middle meatal/ethmoid cavities and prevent adhesions during the postoperative process of healing. The device must be kept in situ for 3 to 4 weeks to permit the re-epithelialization of the internal nasal surfaces. Our experience shows that the splints are well tolerated and highly efficient, preventing both medial and lateral synechiae in 100% of cases. A randomized controlled study has now been started to confirm these positive preliminary findings in a larger patient population.

Histopathological evaluation of Ankaferd blood stopper use in the rabbit septoplasty model

OBJECTIVE

The purpose of this study was to assess the use of Ankaferd blood stopper (ABS), an organic hemostatic agent of plant origin, in septoplasty operations, and to determine its effect on nasal septal tissues in the rabbit model.

METHOD

The study was performed on 30 New Zealand adult male rabbits each weighing 2500-3500g (average: 3000g). The rabbits were randomly divided into 4 groups, namely, the control group (without septoplasty), the septoplasty+tampon group, the septoplasty+ABS group, and the septoplasty+tampon+ABS group. All animals were sacrificed after two weeks, and the nasal septums were total removed using the lateral rhinotomy technique. The specimens were obtained from similar sites of cartilaginous nasal septum. The sections were stained with hematoxylin-eosin and Mason trichrome stains and studied under the light microscope by the same pathologist who evaluated the mucosal ulcerations, the severity of inflammatory cell infiltration, the mucosal thickness, and the cartilage thickness. The data obtained were statistically analyzed using the Kruskal-Wallis variance analysis and the Mann-Whitney U test.

RESULTS

No mucosal ulceration or inflammatory cell infiltration was detected in any of the rabbit groups. There was a statistically significant difference between the groups in terms of mucosal thickness and cartilage thickness (p<0.05). The values of mucosal thickness in the groups mentioned above were 147.7±17.6μm, 205.7±36.7μm, 139.6±14.8μm, and 190.2±17.5μm, respectively. The values of cartilage thickness were 398.2±28.9μm, 546.2±35.3μm, 363.7±24.7μm, and 447.8±28.2μm, respectively. There was no significant difference between the control group and the septoplasty+ABS group in terms of mucosal thickness and cartilage thickness (p>0.05). However, there was a significant increase in nasal mucosal and cartilage thickness in tampon-using groups when compared with the other groups (p<0.05).

CONCLUSION

Although nasal tampons provide the contact of mucoperichondrium with the cartilage, they are generally accepted as a discomfort for patients. Ankaferd blood stopper can be used instead of nasal tampons to increase patient comfort.

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 2 years 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 4 weeks postoperatively). At 2 weeks 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 4 weeks 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.

Assessment of mucosal changes associated with nasal splint in a rabbit model

INTRODUCTION

There is no consensus on duration of the nasal splint after nasal septum surgeries. The pressure of nasal splint on the mucosa may cause tissue necrosis and nasal septum perforation.

OBJECTIVES

To investigate the histopathological changes of the nasal mucosa caused by nasal splints in a rabbit model.

METHODS

No splint was used in group A. Bilateral silicone nasal splints were placed for five, ten, and 15 days in groups B, C, and D, respectively. Biopsy of the nasal mucosa was performed after removal of splint. Histopathologic evaluations were performed. The severity and depth of the inflammation were scored.

RESULTS

Group A had a normal histological appearance. Comparison of the results of groups B, C, and D with group A demonstrated statistically significant differences with regards to the severity of histopathological findings. There was no statistically significant difference between groups B and C. There were statistically significant differences between the groups B and D, and also between groups C and D.

CONCLUSIONS

Longer duration of nasal splint had a higher risk for septal perforation. Therefore, removal of the splint as soon as possible may be helpful for preventing potential perforations.

A novel way of trans-septal splint suturing without nasal packing for septoplasty

Nasal packing has evolved over the years. Though effective in preventing postoperative bleeding complications, they are associated with significant morbidity and pain. In recent years nasal splints have been used to reduce the duration of nasal packs. The aim of this study is to compare the postoperative results in 200 nasal surgeries where in nasal packing was replaced by trans-septal splint suturing. Two hundred cases of septoplasties were prospectively studied over a period of 5 years at Adichunchanagiri Institute of Medical Sciences. In 100 cases (group A) nasal packing was done postoperatively whereas in other 100 (group B) trans-septal splint suturing was done. Post operatively patients were followed up in both groups regarding the presence of pain, bleeding, crusting and synechiae for a period of 6 months. Two hundred patients were prospectively studied over a period of 5 years with a male-female ratio of 1.35:1 and the mean age was 31. In group A out of 100 patients followed postoperatively, ten had mild bleeding on second day after pack removal none of which required repacking, 22 patients had mild pain on second and third day, 18 had moderate crusting on day 4, 12 had synechiae after 2 weeks. In group B, out of 100 patients, minimal bleeding was noted in 13 patients on day 1 and 2, mild discomfort was noted in the nose in 34 patients till day 7 (day of splint removal), crusting was noted in six patients, synechiae was noted in one patient. Elimination of pain and discomfort for the patients and absence of complications like synechiae. Also the hospital stay is less than with nasal packing. Therefore, suturing of the nasal septum with a splint after septoplasty should be a preferred alternative to nasal packing.

Comparison of septoplasty with and without nasal packing and review of literature

Septoplasty is routinely performed for symptomatic deviated nasal septum. The most unpleasant part of this procedure is the pain during removal of nasal pack. The objective of this study was to compare the results of septoplasty with and without post-operative nasal packing and thereby assess the necessity of nasal packing after septoplasty. This descriptive study was carried out in ENT Department of D.Y. Patil Hospital, Kolhapur. 50 patients between the age groups of 18-50 years, having symptomatic deviated septum were selected. Out of which 25 patients underwent septoplasty with packing and 25 patients underwent septoplasty without packing with quilting sutures taken on the septum. Patients who underwent septoplasty without packing, experienced less pain and bleeding was minimal. Only one patient developed septal hematoma postoperatively. All the patients were satisfied at the end of 3 months. Simple DNS can be safely treated with septoplasty without Anterior Nasal Packing and by taking Quilting sutures on the septum. The sutures are also useful for closing any inadvertent tears of the septal mucosa and providing additional support for the cartilage pieces retained in septoplasty. Nasal packing should be should be reserved only for the patients with increased risk of bleeding.

Postoperative Complications Followed by Septoplasty Comparison between Conventional Nasal Packing and Glove Finger Pack

Objective

Objective of this study is to compare complications in postseptoplasty patients using conventional nasal packing and glove finger packing.

Materials and methods

In our study 95 patients who underwent septoplasty were enrolled and written consent taken for the study among these 95 patients, 50 patients were put in group A and 45 patients in group B. In group A patients glove finger packing was done and in group B patients conventional packing using medicated gauze was done and postoperative complications like postoperative pain, hemorrhage, septal perforation, toxic shock syndrome, septal hematoma, septal deviation and synechia/adhesion bands were compared between two groups, follow-up was done for both groups for 3 weeks.

Result

Our study showed that their was significantly less pain in group A patients and also their was less incidence of synechia in group A patients as compared to group B patients, their was not much difference in other complications.

Conclusion

Our results point out that glove finger pack has more advantage than conventional medicated gauze pack. We recommend use of glove finger pack after septoplasty procedure.

How to cite this article

Beigh Z, Yousuf A, Malik MA, Ahmad R. Postoperative Complications Followed by Septoplasty Comparison between Conventional Nasal Packing and Glove Finger Pack. Clin Rhinol Int J 2012;5(1):11-13.

Modified technique of anterior nasal packing: a comparative study report

Anterior nasal packing, which is a common procedure in otorhinolaryngology practice, has different complications. Pain during introduction and removal of pack, bleeding after removal due to mucosal damage and synechia formation are common among them. A continuous effort is going on worldwide to combat those by modifying the nature of pack material or inventing new materials for nasal packing. In the present study an effort was made to compare a new modification of conventional gauze pack by using aluminum foil prepared from the cover of suture materials as septal splint (to reduce the mucosal damage) with conventional gauze pack and another costly material, nasal tampon (merocel). Comparisons were done in terms of cost, efficacy and complications. Prospective hospital based interventional study. Patients were distributed into three groups according to the material used for anterior nasal packing. Comparisons were made in terms of cost of the material used, pain during introduction of pack, rise of systolic blood pressure, incidences of bleeding while pack in situ, incidences of bleeding after removal of pack that required repacking and incidences of synechia formation after pack removal. The episodes of bleeding while pack in situ, within first 48 h and forced for repacking was observed to be significantly more prevalent among nasal tampon groups (12.5%) of patients but only 2.1 and 2.4% with use of conventional gauze pack and our modification respectively. Regarding bleeding after removal of pack, 10.6% patients experienced bleeding with conventional gauze pack, whereas with our modification it was only 2.4%. Synechia formation was found to be highest among the cases with conventional gauze pack (14.9%), but with our modification it is only 2.4%. In this study it is found that use of aluminum foil prepared from the cover of suture materials can be very useful and cost effective method to reduce some of the complications of anterior nasal packing.

Nasal packing and transseptal suturing techniques: surgical and anaesthetic perspectives

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.

A clinical evaluation of bioresorbable staples for mucoperichondrial flap coaptation in septoplasty

BACKGROUND

During septoplasty surgery, the formation of dead space between the mucosal flaps must be minimized to prevent septal hematoma and promote healing. Historically, this has been achieved by using techniques such as nasal packing or the continuous septal quilting or whip suturing. This study presents the first clinical results using a septal stapling device that uses bioresorbable staples to achieve mucoperichondrial flap coaptation during septoplasty.

METHODS

The septal stapler was used in 24 subjects. The primary outcome measure was whether septal coaptation was accomplished 1 week postoperatively. The extent of tissue reaction at the site of staple placement was also evaluated.

RESULTS

In all subjects, coaptation with septal staples was successfully accomplished with no septal hematoma formation. At 1 week follow-up, there was either no (79%) or minimal (21%) tissue reaction at the site of staple placement.

CONCLUSION

The use of bioresorbable staples appears to be a safe, efficient, and effective alternative to other methods used for mucoperichondrial flap coaptation in septoplasty surgery.

Use of N-butyl cyanoacrylate in nasal septoplasty: histopathological evaluation using rabbit nasal septum model

OBJECTIVES

This study was designed to investigate the effects of the tissue adhesive N-butyl cyanoacrylate on nasal septal tissues after septal surgery in a rabbit model.

METHODS

Forty-two adult New Zealand rabbits were randomly divided into three groups (14 in each group): septoplasty alone, septoplasty plus N-butyl cyanoacrylate, and controls. The open approach was used to explore the nasal septum. After raising mucoperichondrial and mucoperiosteal flaps on both sides of the septum, the septum was detached from the nasal floor in the septoplasty alone and septoplasty plus N-butyl cyanoacrylate groups. In the septoplasty plus N-butyl cyanoacrylate group, the mucoperichondrial and mucoperiosteal flaps were fixed to the septum and the septum was fixed lateral to the nasal spine using N-butyl cyanoacrylate; in the septoplasty alone group, the septum was packed with Merocel. In the control group, no further septal surgery was performed after flap elevation. Animals were observed for bleeding and haematoma formation over the first 24 hours. Seven animals in each group were used to evaluate early histopathological effects on the septal tissues, at four weeks post-operatively; the other seven in each group were used to evaluate late effects, at 12 weeks.

RESULTS

Haematoma formation was observed in 10 animals in the septoplasty alone group, in four animals in the control group, and in only one animal in the septoplasty plus N-butyl cyanoacrylate group. The difference in haematoma incidence between the septoplasty alone and the septoplasty plus N-butyl cyanoacrylate groups was significant (p = 0.000). Histopathological evaluation revealed no significant difference between the groups as regards granulation tissue formation at week four versus week 12; however, there was a significant difference between the septoplasty plus N-butyl cyanoacrylate group and the control groups as regards inflammation at week 12 (p = 0.038). There was a significant difference between the septoplasty plus N-butyl cyanoacrylate group and the septoplasty alone group as regards the composition of the bone-cartilage junction zone at week four (p = 0.001). There was also a significant difference between the septoplasty plus N-butyl cyanoacrylate group and the control group as regards the cellular structure of new cartilage formation at week 12 (p = 0.004).

CONCLUSIONS

In this rabbit septoplasty model, N-butyl cyanoacrylate appeared to be an effective nasal tissue adhesive, with a low complication rate.

Is nasal packing really required after septoplasty?

OBJECTIVE

Septoplasty is one of the most common operations performed by otorhinolaryngologists. Nasal packing is not an innocuous procedure. The most common problem encountered by the patients after septoplasty is the pain and discomfort during removal of the nasal packs. The objective of this study was to evaluate the results of septoplasty without postoperative nasal packing.

METHODS

Septoplasty was performed by standard technique. No nasal packing was used in these cases.

RESULTS

Seventy-eight patients were included in the study. The majority of the patients (64.1%; 50/78) on a morning list were operated. Sixty-two patients were discharged home the same day, the remaining others were discharged the next day. Our postoperative haemorrhage rate was 7.7% (6/78) and only 3.8% (3/78) patients required nasal packing. Majority (84.6%) of the patients were satisfied with the operation at the postoperative follow up 3 months later.

CONCLUSIONS

Septoplasty can be safely performed without postoperative nasal packing. Only 3.8% patients required nasal packing in this study.

A survey of postoperative nasal packing among UK ENT surgeons

Packing of the nasal cavity following routine nasal surgery is a common but controversial practice. We aimed to evaluate nasal packing practices among UK ENT consultants for common nasal operations. A questionnaire was sent to 648 consultant ENT surgeons regarding their packing practice in patients undergoing nasal surgery. Data were collected regarding rhinology subspecialty interest, number of nasal operations performed per year, likelihood of packing for six common nasal procedures, and types of pack used. In all, 282 (43.5%) replies were received. Fifty-four (78.3%) rhinologists claimed to perform >100 nasal operations per year versus 64 (31.8%) non-rhinologists (P < 0.005). For specific operations, there was a universal trend towards less routine packing (>70% frequency) in the rhinologist group (P < 0.005). Surgeons who specified a subspecialty interest in rhinology packed significantly less often than the non-rhinologists for common nasal operations. There was great variation in the type of pack favoured by different surgeons.

Nasal Packing after Septoplasty: A Randomized Comparison of Packing versus no Packing in 88 Patients

The once-common practice of packing the nose after septoplasty was based on a desire to prevent postoperative complications such as bleeding, septal hematoma, and adhesion formation. However, it was since found that not only is nasal packing ineffective in this regard, it can actually cause these complications. Although the consensus in the world literature is that packing should be avoided, to the best of our knowledge, no truly randomized study has been undertaken in Southwest Asia upon which to justify this recommendation here. Therefore, we conducted a prospective randomized comparison of the incidence of a variety of postoperative signs and symptoms in 88 patients, 15 years of age and older, who did (n = 44) and did not (n = 44) undergo nasal packing following septoplasty. We found that the patients who underwent packing experienced significantly more postoperative pain, headache, epiphora, dysphagia, and sleep disturbance on the night of surgery. Oral and nasal examinations 7 days postoperatively revealed no significant difference between the two groups in the incidence of bleeding, septal hematoma, adhesion formation, and local infection. Finally, the packing group reported a moderate to high level of pain during removal of the packing. Our findings confirm that nasal packing after septoplasty is not only unnecessary, it is actually a source of patient discomfort and other signs and symptoms.

Synechia formation after endoscopic sinus surgery and middle turbinate medialization with and without FloSeal

BACKGROUND

The aim of this study was to determine the incidence, outcomes, and risk factors for synechia formation after endoscopic sinus surgery (ESS) and middle turbinate medialization with and without FloSeal.

METHODS

A retrospective review was performed of patients who underwent primary ESS with middle turbinate medialization, with or without the placement of FloSeal. Medialization was performed with the placement of an absorbable conchopexy suture and silastic splint. Operative variables and outcomes were analyzed to identify risk factors for synechia formation.

RESULTS

One hundred thirty-five patients underwent medialization alone and 37 patients underwent medialization with placement of FloSeal. Overall, synechia formation was noted in 16 patients (9.3%). A statistically significant higher incidence of synechia formation was noted in patients who underwent middle turbinate medialization with the placement of FloSeal versus medialization alone (18.9% versus 6.7%). The incidences of intraoperative complications (6.2% versus 4.7%) and postoperative complications (6.2% versus 7%) were similar between patients with and without synechia, respectively. Patients experiencing synechia, however, underwent a statistically significant higher rate of revision procedures (25% versus 5.1%).

CONCLUSION

Despite adequate prevention with middle turbinate medialization, synechia formation after ESS may result in higher rates of revision procedures. The placement of FloSeal in conjunction with middle turbinate medialization may result in a higher incidence of synechia formation.

Day-case endoscopic sinus surgery using dissolvable haemostatic nasal packs: a pilot study

In a prospective pilot study, we assessed the efficacy and safety of dissolvable nasal packs (Sinu-knit) for control of post-operative bleeding in patients undergoing endoscopic sinus surgery (ESS), as well as potential complications of this novel packing material and patients' satisfaction with the dissolvable nasal packs. The patients included were considered suitable for a day-case procedure. We excluded subjects under 16-year-old, as well as patients on warfarin or with any coexisting medical or social reasons rendering them unsuitable for a day-case procedure. The main outcome measures were: readmission rate, postoperative bleeding rate, any other postoperative complications and patient satisfaction survey (including management as a day case and views about the packs). Fifteen patients fulfilled our criteria and were enrolled in this study (between March and August 2005). Fourteen patients were able to go home on the same day. One patient stayed overnight because of vomiting. All operations were performed by the same surgeon and the same anaesthetist. There were no readmissions due to postoperative bleeding. All patients were followed up with rigid video-nasendoscopy weekly for three weeks with further reviews at 6 weeks, 3 months and a final follow-up 6 months postoperatively. No postoperative adhesions were seen on nasendoscopy up to 6 months postoperatively. Dissolvable packs appear to be safe and effective and can be used for day case sinus surgery. There is no need for packing removal, thus greater patients' satisfaction.

Effects of Fibrin Glue on Nasal Septal Tissues

OBJECTIVES

To investigate the changes in adult rabbit nasal septal tissues after application of fibrin glue during septoplasty.

STUDY DESIGN

Preclinical animal study.

METHODS

Nineteen adult albino Vienna rabbits were included in the study. Rabbits were randomly divided into study (n = 14) and control groups (n = 5). The study group was subsequently divided into two subgroups with seven rabbits in each group to investigate short- and long-term effects of fibrin glue. After raising the mucoperichondrial flap on one side of the septum, fibrin glue was used to fix the mucoperichondrial flap over the septal cartilage. Rabbits were killed 3 weeks and 6 weeks after septoplasty. Samples from the excised nasal septa underwent routine tissue procedure for histopathologic investigation.

RESULTS

Both short-term and long-term results were compared with the control group and with each other. There was a significant difference regarding mucosal inflammation and cartilaginous damage between groups. A significant difference was found between groups in terms of loss of cilia, loss of goblet cells, the presence and degree of fibrosis. Loss of cartilage was significantly different between groups. In comparing the thickness of the mucosa, thickness of the perichondrium, and thickness of cartilage, there were significant differences between groups.

CONCLUSION

Our results demonstrate that fibrin glue causes distinctive inflammation, creates mucosal damage, increases mucosal thickness, decreases perichondrial thickness and cartilaginous thickness, and causes segmental cartilage loss in rabbits. Further comparative clinical investigations are required to assess the clinical efficacy of fibrin glue in nasal septal surgery in humans.

Rhinoplasty model in rabbit

BACKGROUND

Rhinoplasty has become one of the most frequently requested and performed surgical procedures for both functional and aesthetic purposes. As an attention-attracting prominence, even the slightest disfigurement of the nose causes serious disturbance to the patient before or after the operation. Functional problems also cause discomfort. For these reasons, postrhinoplasty complications are regarded as challenging problems for both for the patient and the surgeon. Some cases necessitate grafts for better aesthetic or functional outcome, but there is still controversy over the preference for autogenous or allogenous grafts, both for primary and secondary cases. Evaluation of autogenous and allogenous grafts implanted in the nose is quite challenging for several reasons, including the possibility of unpredictable complications leading to catastrophic disfigurements, the impossibility of obtaining pathologic specimens, and the need for a long follow-up period for stable results. An experimental model for rhinoplasty, fulfilling the need for precise evaluation, was planned and performed after anatomical observation of the noses of rabbits.

METHODS

Fifteen adult New Zealand rabbits were used, five for the anatomical evaluation and 10 for the rhinoplasty model. Computed tomographic images and measurements were obtained before and after the surgical processes.

RESULTS AND CONCLUSION

This experimental model for rhinoplasty has not been reported in any previous studies. This study demonstrates the surgical anatomy of the rabbit in detail and constitutes a guide for researchers as a convenient experimental model for rhinoplasty, with all stages similar to those performed on humans.