Nose Surgery (Rhinoplasty) Without External Immobilization and Without Internal Packing: A Review of 812 Cases

Abstract

In a review of 812 cases of rhinoplasty, none of our patients had early bone or septal displacement; swelling, bruising, and pain were almost nonexistent. This confirms that an external splint would not have been of any benefit in these cases. Packing should help prevent epistaxis, synechiae, and early bone and septal displacement. Not using any packing, we have not encountered these complications. Besides, we have not seen a single submucosal hematoma or a septal necrosis. Therefore, we doubt the value of packing in our patients. The inconveniences and complications of external splints and internal packing are described. Early postoperative photographs show the reduced swelling and bruising, and late photographs show the final results. Difficult primary and secondary rhinoplasty cases are demonstrated.

Rhinoplasty without nasal packing and splinting

“…Splint is used to immobilize the bone and septum and to decrease the pain and swelling. Our results are the same as the results of Camirand 41 and Camirand et al 42 , because there were no bone and septal displacements or excessive pain and swelling. The placement of adhesive sterile skin tapes was quite enough for adequate nose fixation, because the nose does not have joints.…”

“…Nasal packing is used to maintain immobilization and hemostasis, to prevent bleeding, septal hematoma and necrosis as well as to prevent synechiae between the septum and lateral nasal wall. Our results differ from those of Guyuron 39 , but they are the same as results of many other researchers [41][42][43][44][45][46][47][48][49][50][51] because postoperative bleeding occurred in only 1 patient on the day 10 after surgery, when the most surgeons already removed internal packing. Also, there were no cases of the bone and septal displacements, septal hematoma, septal necrosis and synechiae.…”

“…Sometimes, we can see in practice, that some patients try to take out the tamponade in the postoperative period. According to some studies [39][40][41][42][43][44] , there were significantly more postoperative pain, headache, epiphora, dysphagia, and disturbed sleep at night after surgery in patients whose nose was tamponaded. After a few days, due to potentiated rhinorrhea, nasal tamponades and poor hygiene, an unpleasant odor started to appear.…”

“…Guyuron 39 has released the results of a study on patients who underwent septorhinoplasty and concluded that complication rate was lower in those with the nose tamponade. Several studies were done later with suggestion that the nose tamponade did not give an effect [40][41][42][43][44] . Camirand 41 and Camirand et al 42 , concluded that it was not necessary to do even external nasal immobilization and that the septoplasty could be done in the same way.…”

Comparison of anterior nasal packing and absence of packing after rhinoplasty

“…29 In yet another study by Camirand et al, septoplasty was suggested to avoid even the external immobilization of the nose. 30,31 …”