A survey of postoperative nasal packing among UK ENT surgeons

Abstract

Packing of the nasal cavity following routine nasal surgery is a common but controversial practice. We aimed to evaluate nasal packing practices among UK ENT consultants for common nasal operations. A questionnaire was sent to 648 consultant ENT surgeons regarding their packing practice in patients undergoing nasal surgery. Data were collected regarding rhinology subspecialty interest, number of nasal operations performed per year, likelihood of packing for six common nasal procedures, and types of pack used. In all, 282 (43.5%) replies were received. Fifty-four (78.3%) rhinologists claimed to perform >100 nasal operations per year versus 64 (31.8%) non-rhinologists (P < 0.005). For specific operations, there was a universal trend towards less routine packing (>70% frequency) in the rhinologist group (P < 0.005). Surgeons who specified a subspecialty interest in rhinology packed significantly less often than the non-rhinologists for common nasal operations. There was great variation in the type of pack favoured by different surgeons.

Packing and Postoperative Rhinoplasty Management: A Survey Report

“…5 However, research has suggested that not only can packing fail to prevent complications, but it may actually precipitate them. 6 Furthermore, packing has been shown to be directly associated with postoperative pain, discomfort, soft palate laceration, septal perforation, nasopulmonary reflex (a life-threatening vagal response that can lead to hypoxia and bradycardia), and even toxic shock. 7,8 A few large case series have questioned the utility of packing in nasal surgeries, with predominantly unfavorable results.…”

Evaluation and Reduction of Nasal Trauma

“…However, research has suggested that not only can packing fail to prevent complications, but also it may actually precipitate them. 35 Packing has been shown to be directly associated with postoperative pain, discomfort, soft palate laceration, septal perforation, nasopulmonary reflex (a life-threatening vagal response that can lead to hypoxia and bradycardia), and even toxic shock. 36,37 We recommend packing in cases of extreme comminution of nasal bones, such that packing is necessary to maintain their position.…”

Postoperative Care in Aesthetic Rhinoplasty Patients

“…33 Indeed, while many surgeons also support the use of packing in the belief that it reduces postoperative bleeding and adhesion formation, studies such as those by Repanos et al demonstrated that such complications may actually be precipitated by nasal packing. 34 Although multiple studies caution against the use of nasal packing because of the risk of cardiopulmonary complications, Banglawala et al found that bilateral anterior nasal packing does not cause adverse cardiopulmonary changes after septoplasty. 35 Over the past 20 years, the senior authors (H.A.S.…”