Does Nasal Packing Affect Postoperative Complications of Surgery for Deviated Nasal Septum?

INTRODUCTION

Nasal packing is a common procedure used by otorhinolaryngologists to control postoperative bleeding after nasal surgeries. It is used to hasten the wound-healing process and to prevent septal hematoma, postoperative adhesion formation, and lateralization of the middle turbinate. Nasal packing is also used for the internal stabilization of bony and cartilaginous structures.¹

The ideal nasal packing should be easy to insert and remove without causing any discomfort; it should not cause much pain; it should prevent postoperative bleeding without injuring the mucous membrane of the nose, and it should be comfortable in situ.² Nasal packing has the potential to produce serious complications such as severe damage to the nasal mucosa, allergic reactions, and toxic shock syndrome.³ In addition to preventing synechiae formation and hematoma production, nasal packing is utilized to facilitate septal flap apposition.⁴

This study is being conducted if to find out if nasal packing has any direct effect on postoperative complications of surgery for deviated nasal septum.

MATERIALS AND METHODS

Patients who underwent any septal surgery in the department of otorhinolaryngology from a period of 18 months from 2021 to 2022 were included in the study after explaining the purpose and need of the study; informed consent was obtained to participate in the study before the surgery.

Based on nasal packing, the included subjects were allocated into groups I and group II. After septal surgery, group I patients were packed with conventional nasal packing, and group II patients were packed with Merocel. Surgery was performed and packs were inserted. The packs were kept in situ for 24 hours. Nasal packing was removed after 24 hours without any analgesics or tranquilizers. A diagnostic nasal endoscopy was done postoperatively on the first and second weeks to assess any synechia or hematoma formation as well as any mucosal trauma. Both groups irrespective of nasal packing were advised nasal douching with the alkaline nasal solution and were prescribed nasal decongestants. After the data collection, parameters were analyzed.

RESULTS

Our study shows that the group with the conventional pack had more synechiae formation than the Merocel pack and was significant (p = 0.01) (Table 1). The group with the conventional pack had more hematoma formation compared to the group with the Merocel pack and was significant (p = 0.04) as depicted in Table 2.

DISCUSSION

In our study, all 40 patients who had deviated nasal septum underwent septoplasty. The patients who gave their consent were divided into two groups: group I underwent conventional nasal packing, and group II underwent nasal packing with Merocel postoperatively. Follow-up was done and the findings were noted.

On analyzing the data, there was only one patient who had hematoma formation in the Merocel group, while there were three in the group with a conventional nasal pack which was statistically significant (p < 0.05). In our study, the Merocel group did not have synechiae formation while the group with the conventional nasal pack had synechiae formation in six patients and the association is statistically significant among study participants (p < 0.01).

In the study conducted by Dutta et al.⁴ to evaluate and compare three distinct approaches (Merocel, gauze with sisomycin cream, gauge pack with sisomycin cream with a septal splint) of nasal packing in the treatment of epistaxis, as well as for complications. In this study, they included both epistaxis patients and postoperative cases. The study showed that lower incidence of synechiae formation in comparison to other groups. This study shows results similar to our study; however the study population was different.

In this study, hematoma formation was lower in patients who had Merocel nasal pack post-septal surgeries compared to patients who had conventional nasal packing. The Merocel nasal pack is easy to insert with a single step but the conventional nasal pack has to be done in “accordion fashion” in multiple layers so that each layer extends the entire length of the nasal cavity. A possible explanation for the finding in our study might be that the surgeon handled the septum roughly in view that packing would control bleeding. The study conducted by Said and Abdulrazzaq⁵ showed that the group with a Merocel pack developed a septal hematoma similar to our study, however the study conducted by Cukurova et al.⁶ in 2012 reported no case with septal hematoma in their study. In both studies, they evaluated the postoperative complications of different materials in different study populations. However, the sample size in our study was less. Similar study in larger population could help us in understanding these outcomes in a better way.

CONCLUSION

To conclude, the Merocel nasal pack is considered the safest technique for post-septal surgeries when compared to conventional nasal packing, minimizing the risk of postoperative complications (hematoma and synechia formations).

REFERENCES

1. Bingöl F, Budak A, Şimşek E, Kılıç K, Bingöl BÖ. Comparison of early-period results of nasal splint and Merocel nasal packs in septoplasty. Turk Arch Otorhinolaryngol 2017;55(3):136–139. DOI: 10.5152/tao.2017.2259.

2. Bresnihan M, Mehigan B, Curran A. An evaluation of Merocel and series 5000 nasal packs in patients following nasal surgery: A prospective randomized trial. Clin Otolaryngol 2007;32(5):352–355. DOI: 10.1111/j.1749-4486.2007.01517.x.

3. Hesham A, Ghali A. Rapid rhino versus Merocel nasal packs in septal surgery. J Laryngol Otol 2011;125(12):1244–1246. DOI: 10.1017/S0022215111002179.

4. Dutta S, Mukherjee A, Saha J, Biswas G, Haldar D, Sen I, et al. Modified technique of anterior nasal packing: A comparative study report. Indian J Otolaryngol Head Neck Surg 2012;64(4):341–345. DOI: 10.1007/s12070-011-0343-2.

5. Said SM, Abdulrazzaq AF. Effect of trans-septal suture technique versus nasal packing after septoplasty. Int J Tech Res Appl 2015;3(4):33–40. e-ISSN: 2320-8163.

6. Cukurova I, Cetinkaya EA, Mercan GC, Demirhan E, Gumussoy M. Retrospective analysis of 697 septoplasty surgery cases: Packing versus trans-septal suturing method. Acta Otorhinolaryngol Ital 2012;32(2):111–114. PMID: 22767972.