Trans-septal quilting suture versus intranasal silicone splint for preventing complications post endoscopic septoplasty




Hematoma, Nasal obstruction, Otolaryngology, Septoplasty, Silicone, Suture


Background: Septoplasty is a common procedure in the field of otolaryngology for treatment of septal deviations. Intranasal splints and trans-septal quilting suture are commonly utilized to prevent post-operative complications. The silicone splint is a quick and simple technique to aid in cartilage support; however, it can cause discomfort. Trans-septal quilting suture is more available, well-tolerated and can help in mucosal tear closure, though is time-consuming. This study aimed to compare the efficacy of intranasal silicone splints versus quilting suture in the prevention of post endoscopic septoplasty complications.

Methods: This was a retrospective COHORT study comprised of patients who underwent endoscopic septoplasty between January 2017 and December 2019 at Qatif central hospital. The patients were assigned into two groups: group S, who received intranasal splints and group Q, who received trans-septal quilting suturing. Patients’ medical records were reviewed for evaluation of post-operative visits and post-operative nasal endoscopic video recordings from the image archive software were evaluated to document complications. Statistical analysis was conducted using SPSS 23.0 software.

Results: The study included 65 patients, of whom 41 were in group S and 24 were in group Q. None of the patients had major bleeding, local infection or mucosal synechia. There was a higher complication rate in terms of mucosal crustation, septal hematoma and perforation among group S; however, the difference was not statistically significant.

Conclusions: We conclude that trans-septal quilting suture and intranasal silicone splints are both equally effective in preventing complications following septoplasty.

Author Biographies

Rana F. Al Muslem, Department of Otolaryngology and Head and Neck Surgery, Qatif Central Hospital, Saudi Arabia

R4 ORL resident

Hussain A. Al Baharna, Department of Otolaryngology and Head and Neck Surgery, Qatif Central Hospital, Saudi Arabia

ORL consultant at qatif central hospital


Mladina R, Čujić E, Šubarić M, Vuković K. Nasal septal deformities in ear, nose, and throat patients. An international study. Am J Otolaryngol. 2008;29(2):75-82.

Hong CJ, Monteiro E, Badhiwala J, Lee J, deAlmeida JR, Vescan A, et al. Open versus endoscopic septoplasty techniques: A systematic review and meta-analysis. Am J Rhinol Allergy. 2016;30(6):436-42.

Asaka D, Yoshikawa M, Okushi T, Nakayama T, Matsuwaki Y, Otori N, et al. Nasal splinting using silicone plates without gauze packing following septoplasty combined with inferior turbinate surgery. Auris Nasus Larynx. 2012;39:53-8.

Lau J, Elhassan HA, Singh N. History of intranasal splints. J Laryngol Otol. 2018;132(3):198-201.

Hari C, Marnane C, Wormald PJ. Quilting sutures for nasal septum. J Laryngol Otol. 2008;122(5):522-3.

Naik K. A novel way of trans-septal splint suturing without nasal packing for septoplasty. Indian J Otolaryngol Head Neck Surg. 2015;67(1):48-50.

Dubin MR, Pletcher SD. Postoperative packing after septoplasty: is it necessary? Otolaryngol Clin North Am. 2009;42(2):279-85.

Kim JS, Kwon SH. Is nonabsorbable nasal packing after septoplasty essential? A meta-analysis. Laryngoscope. 2017;127(5):1026-31.

Ardehali MM, Bastaninejad S. Use of nasal packs and intranasal septal splints following septoplasty. Int J Oral Maxillofac Surg. 2009;38(10):1022-4.

Kuboki A, Kikuchi S, Asaka D, Onda N, Nakayama T, Kojima H, et al. Nasal silicone splints and quilting sutures using a septum stitch device following septoplasty: a prospective comparative study. Eur Arch Otorhinolaryngol. 2018;275(7):1803-9.

Karatas A, Pehlivanoglu F, Salviz M, Kuvat N, Cebi IT, Dikmen B, et al. The effects of the time of intranasal splinting on bacterial colonization, postoperative complications, and patient discomfort after septoplasty operations.. Braz J Otorhinolaryngol. 2016;82(6):654-61.

Yanagisawa E, Joe J. Endoscopic septoplasty. Ear Nose Throat J. 1997;76(9):622-3.

Dąbrowska-Bień J, Skarżyński PH, Gwizdalska I, Łazęcka K, Skarżyński H. Complications in septoplasty based on a large group of 5639 patients. Eur Arch Otorhinolaryngol. 2018;275(7):1789-94.

Bloom JD, Kaplan SE, Bleier BS, Goldstein SA. Septoplasty complications: avoidance and management. Otolaryngol Clin North Am. 2009;42(3):463-81.

Wang WW, Dong BC. Comparison on effectiveness of trans-septal suturing versus nasal packing after septoplasty: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol. 2017;274(11):3915-25.

Hasan DA, Amin AK, Jaff AMS. Trans-septal suture method versus intranasal silicone splint in septoplasty. Int J Tech Res Appl. 2015;3:159-65.

Mahmood K, Baig MN, Ayub N, Aziz T. Efficacy of nasal splints in reducing the incidence of intranasal adhesions following septoplasty. Braz J Otorhinolaryngol. 2016;11(1):8-10.

Jung YG, Hong JW, Eun YG, Kim MG. Objective usefulness of thin silastic septal splints after septal surgery. Am J Rhinol Allergy. 2011;25(3):182-5.

Quinn JG, Bonaparte JP, Kilty SJ. Postoperative management in the prevention of complications after septoplasty: a systematic review. Laryngoscope. 2013;123:1328-33.

Tang S, Kacker A. Should intranasal splints be used after nasal septal surgery? Laryngoscope. 2012;122(8):1647-8.

Ozdogan F, Ozel HE, Esen E, Yuce T, Eyisarac S, Genc S, et al. Optimal time for intranasal splint removal after septoplasty: a prospective clinical study. Eur Arch Otorhinolaryngol. 2016;273(10):3203-6.

Cayonu M, Acar A, Horasanli E, Altundag A, Salihoglu M. Comparison of totally occlusive nasal pack, internal nasal splint, and transseptal suture technique after septoplasty in terms of immediate respiratory distress related to anesthesia and surgical complications. Acta Otolaryngol. 2014;134(4):390-4.

Karataş D, Yüksel F, Doǧan M, Şentürk M. Another advantage of the transseptal suture: Shortens the duration of waking up after anesthesia. J Craniofac Surg. 2014;25(2):602-3.






Original Research Articles