Is nasal packing required with septoplasty?

Nasal Packing After Septoplasty: Not Routinely Required

Nasal packing is not routinely necessary following septoplasty and should be reserved only for patients with increased risk of bleeding. 1, 2 Multiple studies have demonstrated that routine nasal packing after septoplasty provides no significant benefits while causing considerable patient discomfort and potential complications.

Evidence Against Routine Nasal Packing

• Meta-analysis shows nasal packing after septoplasty does not reduce:

  • Postoperative bleeding
  • Hematomas
  • Septal perforations
  • Adhesions
  • Residual septal deviation 2

• Randomized studies demonstrate that patients with nasal packing experience significantly more:

  • Postoperative pain
  • Headache
  • Epiphora (excessive tearing)
  • Dysphagia (difficulty swallowing)
  • Sleep disturbance 1
  • Moderate to high pain during packing removal 1

Effective Alternatives to Nasal Packing

Septal suturing (quilting sutures) has been shown to be a valid alternative to nasal packing with several advantages:

• Minimal patient discomfort
• Allows for outpatient/day-surgery procedures
• Similar complication rates to packing
• Avoids the pain associated with pack removal 3, 4

When Nasal Packing Should Be Considered

Nasal packing should be reserved for specific situations:

1. Patients with increased risk of bleeding:

   • Known bleeding disorders
   • Patients on anticoagulant or antiplatelet medications 5
   • Extensive surgery with significant mucosal trauma

2. When active bleeding cannot be controlled by other means 5

If Nasal Packing Is Required

When packing is deemed necessary:

• Type of packing: Resorbable packing is preferred for patients with suspected bleeding disorders or those using anticoagulation/antiplatelet medications 5

• Duration: Packing should remain in place for a time agreed upon with the clinician, but typically no longer than 5 days 5

• Patient education: Patients should be informed about:

  • Type of packing used
  • Expected duration
  • Post-procedure care
  • Signs/symptoms requiring prompt reassessment 5

• Antibiotic considerations: Prophylactic antibiotics are not routinely needed if packing duration is less than 48 hours in immunocompetent patients, but should be considered if packing remains for more than 72 hours 6

Potential Complications of Nasal Packing

When nasal packing is used, be aware of these potential complications:

• Discomfort and pain
• Nasal obstruction and difficulty breathing
• Risk of infection
• Pressure necrosis of nasal tissues
• Septal perforation
• Toxic shock syndrome (rare but serious)
• Sleep-disordered breathing/worsening of sleep apnea 5

Activity Restrictions With Nasal Packing

Patients with nasal packing should:

• Avoid straining, lifting over 10 pounds, bending over, and exercising
• Sleep with the head slightly elevated
• Avoid over-the-counter pain medications that may increase bleeding (aspirin, ibuprofen)
• Not blow their nose while packing is in place
• Sneeze with mouth open 5

In conclusion, the evidence strongly supports that nasal packing after septoplasty is unnecessary for most patients and should be reserved only for those with specific risk factors for bleeding. Septal suturing techniques provide a more comfortable alternative with equivalent outcomes for most patients undergoing septoplasty.