Nasal Packing after Rhinoplasty Surgery
Dr. Oleh Slupchynskyj, MD
What is Nasal Packing?
In Nasal Surgery, whether it is Rhinoplasty Surgery, Septoplasty or Endoscopic Sinus Surgery, it has been and still is customary for many Ear Nose Throat (ENT) doctors, Otolaryngologists and trained Plastic Surgeons to pack the nasal cavities with cotton or gauze following surgery. Packing is routinely used to achieve hemostatis, (i.e. to prevent and control bleeding and dripping).
Back in 1970s and 1980s, nasal packings were often left in the patient’s nose for 10 and up to 14 days. As technology and surgical techniques advanced in the late 1980s and early 1990s, less compressive and lighter packings were used due to the reduction in bleeding after Rhinoplasty, Septoplasty and Endoscopic Sinus Surgery. However, and even today, many surgeons still use nasal packing. There are many varieties of nasal packings. The simplest kind is Telfa, which is a very thin gauze and a smooth outer lining. This is attached to a string so that it may be easily removed 24 hours following surgery. There are other nasal packing materials, known as hemostatic packings, such as SURGICEL, which is a fibrin sealant. This type of packing promotes blood clotting when placed in an area that is bleeding. These hemostatic packings are comprised of coagulation materials.
Why Dr. Slupchynskyj does not Utilize Nasal Packing
Over the past 18 years of performing Rhinoplasty, Dr. Slupchynskyj has perfected his surgical technique resulting in a dry surgical field during and post-surgery. In other words, patients of Dr. Slupchynskyj who undergo Rhinoplasty or Septoplasty Surgery mostly experience a bloodless surgery so there is no need for nasal packing to control or prevent bleeding. Nor is there need for any other materials to deal with incisions and bleeding, such as tissue sealants.
Dr. Slupchynskyj’s Rhinoplasty and Septoplasty Surgeries result in no bleeding or a dry surgical field based upon two factors: the technique he employs to anesthetize the nose and his surgical technique which he has perfected over the last 18 years. Post-operatively, 98% to 100% of his patients do not experience any bleeding.
Dr. Slupchynskyj has created a proprietary method for anesthetizing the nasal cavity and the nasal vault where the intranasal muscosa is injected in such a way to not only anesthetize the mucosal walls but also to vaso-constrict the vasculature during surgery resulting in almost 100% hemostatis.
By not using nasal packing, there are several critical advantages for the patient in the recovery period. Our patients do not have discomfort or congestion in the first 24 hour period post-surgery, which used to be and sometimes still is the norm elsewhere. This is extremely important with patients who may have certain anxieties and phobias about not having the ability/being able to breath thorough their nose. Second, by not using the packing, possible swelling caused by the insertion of a foreign substance in the nasal cavity immediately following surgery is eliminated. Third, because Dr. Slupchynskyj’s patients experience a bloodless post-operative period, there is also much less swelling and bruising. Rare circumstances where he may consider packing prudent would be if patient had a medical problem, specifically a coagulopathic pathology or bleeding disorder.
All patients are given a special antibiotic ointment intranasally and post-operatively to protect incision sites from bacterial colonization. No other material, sealant or glue is ever used or required.