Solving the Problem of Post-operative Airway Obstruction in Nasal/Sinus Surgery
A Strategy and New Device to Ensure Patient Safety, Comfort, and Satisfaction
Robert Kotler, MD, FACS* Beverly Hills, CA
Keith Wahl, MD, FACS* La Jolla, CA
Kimberly J. Lee, MD,FACS* Beverly Hills, CA
Sinus surgery, septoplasty-with or without turbinate reduction-and rhinoplasty are among the most common surgical procedures performed by our specialty. In 2006, 600,000 sinus surgeries were performed in the United States. A recent paper reported more than 300,000 rhinoplasties done per year.Septoplasties and ancillary procedures accounted for an additional 489,000 procedures.
Packing or No Packing, the Post-operative Period Is not Popular with Patients
Some surgeons choose not to place any packing. But, patients still complain of impaired breathing due to endonasal edema, blood and mucus accumulation. More commonly, however, nasal and sinus surgery typically features some surgeon-inserted “packing,” placed or injected into the nasal fossae, at the conclusion of the operation. In the recent National Interdisciplinary Rhinoplasty Survey, 39% of surgeons reported using packing 81%-100% of the time, with 81% of the surgeons leaving the packing in place for 0-3 days post-operatively.2
Here are the common reasons/indications for packing:
To stabilize manipulated/repositioned/reconstructed elements in the proper and anatomically correct positions
To prevent synechiae formation
To reduce the chance of bleeding and prevent hematoma formation
To act as a substrate for medications, e.g., antibiotics and steroids
To act as a conduit for topical medications to be instilled after surgery, e.g., nasal decongestant drops to reduce bleeding and/or relieve congestion
– Clinical Instructor, Department of Surgery, Division of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA. Corresponding author, firstname.lastname@example.org.
– Partner, A-K Technology Consultants; Clinical Assistant Professor, Retired, UCSD School of Medicine, Division of Otolaryngology, Department of Surgery, La Jolla, CA.
– Clinical Assistant Professor, Department of Surgery, Division of Head and Neck Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.