Septoplasty without Packing, Splints or Clip-Our Experience

Authors: Varghese GM

DOI: 10.23880/ijsst-16000109

Volume 1, Issue 2

Abstract

Introduction: Septoplasty is a very commonly done surgery for deviated nasal septum in any Otorhinolaryngological department. Sometimes it may be combined with other procedures like FESS, synechiae release, AC polypectomy, Adenoidectomy, or turbinoplasty also. As the last step, nasal cavity is often packed with medicated gauze or splinted or rarely clips are also used for stabilization and to promote adhesion between the mucosal flaps of the septum. Most often a nasal pack is the choice for the surgeon as it is a simple procedure compared to splints and clips which are costly and have to be kept in the nose for variable time. This causes problems like, a blocked nose till the pack is removed, dry mouth, watering of eyes, and severe pain during removal of the pack blocked ears, headache, difficulty in swallowing, hypoxia, etc. We have conducted a prospective study 0f 58 patients undergoing Septoplasty for nasal blockage and these patients did not undergo any packing, or splints or clips Study Design: longitudinal observational Methods: 58 patients, who came to our department with a complaint of nasal obstruction during the period of one year from October 2015 to October, 2016. There were 46 male and 12 female patients. Youngest patient was 10 year old and the oldest was 55 years. We sutured the septal mucosa with 4 zero vicryl with a few quilting sutures and then continuous sutures for the approximation of the flaps and to prevent hematoma of the septum .On the day of operation and later also they were followed up for any bleeding or ,hematoma .All these patients were initially assessed with NOSE score to assess the degree of blockage, and then followed up, on the next day after a suction clearance with the same criterion to assess the comfort level, and after 1 week and finally after 1 month . During the follow up the nasal cavities were looked for any synechiae, hematoma or perforation of the septum or residual deviation. Results: In one patient, minor bleeding occurred within a few hours in the recovery room and the nose was packed. In another patient, since there was no perfect hemostasis, packing was done on the table itself. For two patients, since there was a little bleeding, I .V Tranexamic acid 500 mg was given and no packing was done. No complication occurred for the rest of the patients. No patient had any long term complication.Conclusion: Septoplasty by putting multiple continuous trans septal sutures after an initial one or two quilting sutures for stabilizing the corrected septum with absorbable 4 zero polyglactin suturing material, without packs, clips or splints inside the nose is a very effective method of preventing hematoma, or synechiae inside the nose at the same time, avoiding all the problems with a foreign material inside the nose even though temporarily with an obstructed airway. Thus, Septoplasty can be a day care procedure. The only problem is the extra time required for putting the suture which is negligible when considering the advantages.

Keywords: Septoplasty; Nasal Packing; Nasal Splints; Nasal Clips; Quilting Sutures; Continuous Tran’s Septal Sutures

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