Nasal packing is widely used in nasal surgeries, such as septoplasty and septorhinoplasty, in order to maintain hemostasis, inhibit hematoma, prevent nasal synechia and support septal flap. Nasal packs are produced in various types. An ideal nasal pack should be hemostatic and absorbable, and it should not exert any negative effect on wound healing. Negative effects of the nasal packs on quality of life have been shown before. The most common morbidity associated with nasal packs is postoperative pain . But the use of nasal packing has been proposed to minimize postoperative complications such as hemorrhage, formation of synechiae and septal hematoma. The use of septal splints is also associated with increased postoperative pain. The routine use of septal splint or any nasal packs does not appear to decrease postoperative complications or improve surgical outcomes when compared less morbid techniques, such as pack free septoplasty . A study by Deniz et al. compared different nasal packs on postoperative complications was recently published in your journal. I have read their study with great interest. They reported 19.71% nasal synechia and 11.26% septal perforation in the Merocel packing group whereas no synechia and 10.16% septal perforation in the intranasal splint group. Even if they had been mentioned trans-septal suturing technique, it had not been discussed enough. The height of this ratio is noteworthy. The incidence of septal perforation varied from 0% to 30.4% for submucous resections . In particular, in the same manner, both groups have high perforation rates, and it appears to be associated with the surgical technique used rather than the pack or splint effect.

Surgery and follow-up were done by the same surgeon, and use of Killian incision is stated in the article. In surgery, entering with Cottle’s hemitransfixion incision instead of Killian’s could both provides surgical field dominance and reduce dechirur rates. Dechirur is an important factor in the formation of perforation. Furthermore, removed cartilage and bone tissues placed again after crushed suitable are effective in preventing the perforation during septoplasty.

In our clinic, pack-free and trans-septal suturing technique is routinely applied and recommended in septoplasty. Generally this technique does not cause any problem, if the patients are followed well. In our practice, we did not encounter perforation as we replaced and did not damage the tissues . It should not be forgotten that pack-free technique is the most comfortable for the patients.