Abstract
This study was conducted to compare the outcome of septoplasty with or without Nasal packing. The study subjects were randomly allocated into two groups. There was significant reduction in frequency of post operative pain, headache, discomfort and duration of hospital stay in patients who have undergone septoplasty without nasal packing. However there was no difference in post operative bleeding and septal perforation between two groups. Therefore after Septoplasty without nasal packing is preferred alternative to with nasal packing.
Keywords: Septoplasty, Nasal packing
Introduction
Septoplasty is a common surgical procedure performed by otorhinolaryngologist. This is a common operation used to overcome nasal obstruction when due to a distortion in the mid line cartilage or septum of the nose. Some people are born with a bent septum, others acquire a bend as a result of trauma often a sporting injury. The operation is performed usually with the patient asleep and the incisions are all made inside the nose there should be nothing visible externally. If you put one finger up each of your own nostrils you will feel between those fingers the septum which should be in the mid line. The skin on one side is incised with a knife and lifted off the cartilage, the bent bit of cartilage is then removed and the remaining septum is repositioned toward the mid line to improve the airway. Our common practice of packing the nose after septoplasty was based on desire to prevent post operative complications such as bleeding, septal-hematoma and adhesion formations. However it was since forced that not only is nasal packing ineffective in this regard it can actually causes these complications.
Materials and Methods
151 patients attending Al-Ameen Medical College & Civil Hospital between 2005 and 2008 were selected for studies.
Inclusive Criteria’s—All patients with anterior deviated nasal septum were selected.
Exclusive Criteria’s—Posterior deviation of nasal septum, midfacial anomalies, and patients with HIV were excluded from the study.
Informed consent regarding the procedure were done.
Patients were randomly assigned to undergo septoplasty with or without nasal packing. Our study included 151 patients. Both groups were compared.
Results and Discussion
The majority of the patients were between 10 and 30 years of age (Table 1). Male and female patients were almost equal in both groups (Table 2). We have done the study to compare the results between Septoplasty with or without nasal packing. Septoplasty used to be done with nasal packing. Post operative pain and discomfort will be more when nasal packing is removed on second and third day. However study done by Hajiioannou et al. [1] showed decreased rate of post operative discomfort when nasal packing was removed on day first. Postoperative bleeding was minimal on day third in patients without nasal packing compared to patients with nasal packing (Table 3). Incidence of post-operative pain, headache and discomfort was less in a group of patients without nasal packing (Table 4). Study done by Tzadik et al. [2] reports unnecessary of nasal packing with septoplasty. 79.3% of patients with nasal packing had post operative pain, headache and discomfort compared to 25.7% of patients without nasal packing. Bajaj et al. [3] showed decreased rates of postoperative complications in patients who have undergone septoplasty without nasal packing. The study done by Awan and Iqbal [4] showed similar results. And there was not much difference in incidence of septal perforation between two groups (Table 5). The patients without nasal packing were discharged on the same day compared to patients with nasal packing who were discharged on second and third day (Table 6). Study done by all Al-Raggad et al. [5] showed the similar findings.
Table 1.
Age and sex wise distribution
| Age group | Male | Female | Total |
|---|---|---|---|
| 10–30 | 76 | 50 | 126 |
| 31–50 | 13 | 12 | 25 |
| Total | 89 | 62 | 151 |
Majority of the patients were between 10 and 30 years of age
Table 2.
Showing Allocation of patients in two groups
| Male | Female | Total | |
|---|---|---|---|
| With packing | 35 | 42 | 77 |
| Without packing | 54 | 20 | 74 |
| Total | 89 | 62 | 151 |
Almost equal numbers of patients were allocated per two groups
Table 3.
Post operative nasal bleeding (minimal oozing)
| First day | Second day | Third day | |
|---|---|---|---|
| With packing | 12 | 3 | 32 |
| Without packing | 20 | 7 | 0 |
P = 0.03, significant
Table 4.
Post operative pain, headache and discomfort
| Male | Female | Total | |
|---|---|---|---|
| With packing | 33 | 28 | 61 |
| Without packing | 13 | 6 | 19 |
P = 0.001, highly significant
61/77 (79.3%) of patients with nasal packing experienced postoperative pain, headache, and discomfort compared to 25.7% (19/74), of patients without nasal packing
Table 5.
Septal perforation (unilateral or bilateral tear)
| Male | Female | Total | |
|---|---|---|---|
| With packing | 10 | 12 | 22 |
| Without packing | 15 | 05 | 20 |
P = 0.20, not significant
28.6%(22/77) of patients with packing had septal perforation compared to 27% (20/74) of patients without nasal packing had septal perforation
T independent test is used here to test whether the difference is significant or not with respect to packing and without packing of nose after septoplasty
Table 6.
Discharge of patients
| First day | Second day | Third day | |
|---|---|---|---|
| With Packing | – | 12 | 65 |
| Without Packing | 62 | 12 | – |
Hospital stay is less in group, without nasal packing
Conclusion
Septoplasty can be performed safely without postoperative nasal packing.
References
- 1.Hajiioannou JK, Bizaki A, Fragiadakis G, Bourolias C, Spanakis I, Chlouverakis G, et al. Optimal time for nasal packing removal after septoplasty. A comparative study. Rhinology. 2007;45(1):68–71. [PubMed] [Google Scholar]
- 2.Tzadik A, Gilbert SE, Sade J. Complications of submucous resections of the nasal septum. Arch Otorhinolaryngol. 1988;245:74–76. doi: 10.1007/BF00481439. [DOI] [PubMed] [Google Scholar]
- 3.Bajaj Y, Kanatas AN, Carr S, Sethi N, Kelly G. Is nasal packing really required after septoplasty? Int J Clin Pract. 2009;63(5):757–759. doi: 10.1111/j.1742-1241.2008.01799.x. [DOI] [PubMed] [Google Scholar]
- 4.Awan MS, Iqbal M. Nasal packing after septoplasty; a randomized comparison of packing versus no packing in 88 patients. J Ear Nose Throat. 2008;87(11):624–627. [PubMed] [Google Scholar]
- 5.Al-Raggad DK, El-Jundi AM, Al-Momani OS, Al-Serhan MM, Nawasrah OO, Qhawi MA, Husban AM, et al. Suturing of nasal septum after septoplasty, is it an effective alternative to nasal packing? Saudi Med J. 2007;28(10):1534–1536. [PubMed] [Google Scholar]