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No Packing Septoplasty: Is It Possible?

Posted Jul 08 2010 8:16am 1 Comment

When I was 6 years old, I was broke my nose while trying to see how far I could jump off a swing. After my nose was reset in the operating room, my nose was completely stuffed. I do remember it being very uncomfortable and did have trouble sleeping. During my one week post-op visit, I was shocked when my surgeon puled out 3-4 feet of gauze packs from each nostril.

When patients hear about a septoplasty procedure, one of the first things that come to mind is the miserable feeling of having your nose packed for a few days after the procedure and the extreme discomfort and pain when the packs have to be removed.

When I first began in private practice about 12 years ago, I did what I was taught to do by more senior surgeons during training: I packed the nose routinely after a septoplasty procedure. The reason for using packing is to prevent blood from accumulating between the two layers of the mucous membrane. If the blood supply to the remaining septum is disrupted, then the entire cartilaginous septum can literally melt away, and your nasal tip can droop later on. I've even seen a few septal hematomas after nasal packings were removed during residency training. Ever since I began avoiding using any sort of nasal packing, I've yet to see a septal hematoma. 

Besides the discomfort issue, the other main reason for doing this is that I realized that blocking your nose even to a small degree can aggravate apneas. Studies have shown that nasal congestion can significantly increase your rate of obstructions and arousals. 

What's my technique? I use a small needle and a quilting suture to go back and forth from one side to the other. This quilting suture is what keeps the mucous membrane layer pressed together. I don't even use splints or silastic sheets. It takes some extra time to do, but it's well worth it for the patient's sake. I'm not the first one to use this technique, and I'm sure that there may be other surgeons that do this, but so far, I haven't personally met any. 

If you underwent a septoplasty procedure in the past, what was your experience? Was your nose packed?

Comments (1)
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Dr P, I had a septoplasty performed 9 days ago in Glasgow (Scotland).  My consultant told me he had no need for packing or splints, which - as the patient - was a huge relief.  I had read so many stories and generally the consensus is that the packing is the worst aspect of the surgery.  It's early days results-wise, but certainly I'm surprised that more surgeons don't seem to be operating this way.  From a patient perspective it makes the whole "experience" that much more tolerable. 
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