Abstract
Objective
The 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.
Methods
This 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.
Results
The 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).
Conclusion
Our 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.
1
Introduction
Septoplasty and reduction of the inferior turbinates are the most commonly used surgical interventions to enhance nasal airway compromised secondary to septal deviations or spurs and turbinate hypertrophy. Following these operations nasal packing materials are used in an attempt to prevent synechia and hematoma formation, support septal flap apposition and reduce the dead space between the subperichondrial flaps . However, various complications, such as nasal synechia formation, septal perforation, postoperative infection and epistaxis were reported to be associated with the use of nasal packings .
Nasal splints and Merocel nasal packings are used following endonasal surgical interventions. The literature review showed that use of nasal splints is favored by some authors whereas use of Merocel nasal packing is advocated by others . It was even suggested by some authors that use of any nasal packing material was associated with the above-mentioned complications and they should be replaced by trans-septal suturing techniques .
The main objective of our 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. This topic is quite interesting for otolaryngologists because septoplasty and concha reduction are day-in/day-out procedures in ENT surgery. A careful reflection of the use of well-known medical products is just as important as the investigation of new material. For this purpose, we retrospectively investigated the complication rates associated with the use of septal splints and Merocel nasal packings in our patients and discussed our findings under the scope of literature.
2
Materials and methods
This investigation was done with the permission of Namık Kemal University Ethics Committee. Following endonasal surgery, septal splints or Merocel nasal packings are routinely used in our department. One hundred thirty patients, randomly selected among patients who underwent septoplasty and inferior turbinate reduction with radiofrequency in Namık Kemal University Hospital between January 1st 2012 and August 1st 2013, were enrolled in this study. Operative reports and follow-up notes of patients were inspected and the association between the use of different nasal packings and frequencies of nasal synechia formation, septal perforation, postoperative infection and epistaxis was investigated. According to operative reports and follow-up notes all operations were performed by the same surgeon, with a classical Killian incision for septoplasty and radiofrequency for Concha reduction. Bilateral anterior Merocel nasal packs were removed on the second day after the surgery and nasal splints were removed on the seventh day. All patients who had surgery used antibiotics (sulbactam–ampicilin), 750 mg PO BID for 7 days and nasal shower with 0.9% saline solution for 3 weeks. The patients were evaluated on a weekly basis following removal of the packings. All patients were examined, crusts were removed and retained secretions were aspirated in the first, second and fourth postoperative weeks. A last control was performed at the end of second month. In every control visit, the patients were examined with 0 (zero) degree rod telescope in our clinic and follow-up notes were recorded.
The statistical analysis of data was performed by SPSS for Windows, version 13 (SPSS Inc., Chicago, IL), computer software. While comparing the groups’ Kruskal–Wallis test (KW), for comparing the double groups’ Mann–Whitney U test (MWU) and the qualitative data, Chi square tests (× 2) were used. Results are assessed at the level where p < 0.05.
2
Materials and methods
This investigation was done with the permission of Namık Kemal University Ethics Committee. Following endonasal surgery, septal splints or Merocel nasal packings are routinely used in our department. One hundred thirty patients, randomly selected among patients who underwent septoplasty and inferior turbinate reduction with radiofrequency in Namık Kemal University Hospital between January 1st 2012 and August 1st 2013, were enrolled in this study. Operative reports and follow-up notes of patients were inspected and the association between the use of different nasal packings and frequencies of nasal synechia formation, septal perforation, postoperative infection and epistaxis was investigated. According to operative reports and follow-up notes all operations were performed by the same surgeon, with a classical Killian incision for septoplasty and radiofrequency for Concha reduction. Bilateral anterior Merocel nasal packs were removed on the second day after the surgery and nasal splints were removed on the seventh day. All patients who had surgery used antibiotics (sulbactam–ampicilin), 750 mg PO BID for 7 days and nasal shower with 0.9% saline solution for 3 weeks. The patients were evaluated on a weekly basis following removal of the packings. All patients were examined, crusts were removed and retained secretions were aspirated in the first, second and fourth postoperative weeks. A last control was performed at the end of second month. In every control visit, the patients were examined with 0 (zero) degree rod telescope in our clinic and follow-up notes were recorded.
The statistical analysis of data was performed by SPSS for Windows, version 13 (SPSS Inc., Chicago, IL), computer software. While comparing the groups’ Kruskal–Wallis test (KW), for comparing the double groups’ Mann–Whitney U test (MWU) and the qualitative data, Chi square tests (× 2) were used. Results are assessed at the level where p < 0.05.
3
Results
The review of patient files showed that of 130 patients, 61 were female and 69 were male. The number of patients who received septal splint was found to be 59 (45.38%). The number of patients who received Merocel nasal packing was found to be 71 (54.61%). The mean ages for septal splint group and Merocel packing group were 36.61 ± 11.2, and 37.1 ± 10.3, respectively, ranging from 18 to 61. The two groups were similar in demographic parameters.
Postoperative nasal synechia was found to occur in 14 of 71 patients (19.71%) in the Merocel packing group, whereas no synechia was found in patients in the intranasal splint group (0%) ( Fig. 1 ). This difference was found to be statistically significant with a p value of < 0.05 (KW = 16.46, p = 0.0026) ( Table 1 ).
| Synechia present | Synechia absent | Total | |
|---|---|---|---|
| Merocel packing | 14 (%19.71) | 57 (%80.28) | 71 |
| Intranasal splint | 0 (%0) | 59 (%100) | 59 |
| Total | 14 | 116 | 130 |
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