A comparative study between nasal clips and anterior nasal packing in septoplasty/submucosal resection patients at VIMS Bellary, Karnataka
Keywords:Deviated nasal septum, Anterior nasal packing, Nasal septal clip, Septoplasty, Submucosal resection
Background: Nasal packing is used primarily to control bleeding, for internal stabilization and to prevent postoperative complications in endonasal surgeries. Nasal septal clip is one of the alternatives, whose effectiveness in surgical practice is less studied upon. To compare the effectiveness between nasal septal clip and anterior nasal packing following septoplasty/submucous resection.
Methods: Prospective Randomised Controlled Study was conducted in Department of Otolaryngology at Vijayanagara Institution of Medical Sciences, Bellary, between November 2014 to May 2016. Study involved 100 patients fulfilling inclusion and exclusion criteria. Adopting sealed envelope technique, patients were allotted into two equal groups for anterior nasal pack and nasal septal clip following septoplasty or submucosal resection. Interventions were done following standard procedures and data was collected by using pre-tested proforma.
Results: Mean age of anterior nasal pack group and nasal septal clip group was 27.86 and 25.24 years respectively. Intra-operatively, packing with nasal septal clip was easier with significantly less trauma to mucous membrane (X2= 6.353, P= 0.011), consuming significantly less time (t= 9.329, P<0.0001) and support provided to septum could be assessed visually when compared to anterior nasal packing. During immediate post-operative period and while pack removal, nasal septal clip had significantly less complications (P < 0.001). Follow-up complications like septal haematoma, synaechiae & septal perforations were lesser in nasal septal clip group
Conclusions: During intra-operative period, immediate post-operative period, during nasal pack removal and during follow-up period nasal septal clip provided technical superiority, smooth post-operative experience and lesser complications compared to anterior nasal packing proving nasal septal clip to be a better choice for nasal packing. Limitations of NSC are its availability and cost.
Stucker FJ, Ansel DG. A case against nasal packing. Laryngoscope. 1978;88(8):1314–7.
Basha SI, Gupta D, Kaluskar. S.K. Indian J Otolaryngol Head Neck Surg. 2005;57:69.
Reiter D, Alford E, Jabourian Z. Alternatives to packing in septorhinoplasty. Arch Otolaryngol Head Neck Surg. 1989;115(10):1203-5.
Rahat ZM, Naqvi NU, Raza N, Azeem QA, Hussian B. Post SMR intranasal packing - do we really need it? Pak J Otolaryngol. 2008;24:66-7.
Brain D. The nasal septum. In: Scott-brown’s Otolaryngology, editors. Ken AG. 5th edition. London, Butterworth and Co; 1987: 159-179.
Brown D, Scott-Brown Otolaryngology (Rhinology), and Vol.4. London: Butterworth Heinemann. 1997;4:11-7.
Murray JAM. Epistaxis. Logan Turner’s Diseases of the Nose, Throat and Ear. 10th ed, 31.
Nasal septal clip, 2016. Available at URL:http://entanand.com/web/nasalseptalclip.html. Accessed on 3 January 2017.
Udgir R. A comparative clinical study of use of anterior nasal packing to septal clips typr (III) in nasal septal sub-mucus resection and Septoplasty surgeries. Bangaore: RGUHS; 2011.
Veluswamy A, Handa S, Shivaswamy S. Nasal septal clips: An alternative to vassal packing after septal surgery?. Indian J Otolaryngol Head Neck Surg. 2012;64(4):346-50.
Ardehali MM, Bastaninejad S. Use of nasal packs and intranasal septal splints following septoplasty. International J Oral Maxillofac. Surg. 2009;38(10):1022-4.
Awan MS, Iqbal M. Nasal packing after septoplasty: a randomized comparison of packing versus no packing in 88 patients. Ear Nose Throat J. 2008 Nov;87(11):624-7