AQUACEL® Ag Advantage reduces the stress of postoperative packing removal after endoscopic sinus surgery

Abstract Objective: After Endoscopic Sinus Surgery (ESS), packing plays an important role in wound healing and hemostasis. However, the effect of the packing removal procedure on physician stress has not been evaluated. The purpose of this study was to evaluate physician stress during packing removal for patients treated with AQUACEL® Ag Advantage versus KALTOSTAT®. Methods: This retrospective study included 15 patients who underwent packing with ESS for chronic rhinosinusitis performed at two centers; 9 were treated with AQUACEL® Ag Advantage and 6 were treated with KALTOSTAT®. Physician stress during packing removal was evaluated with the National Aeronautics and Space Administration-Task Load Index (NASA-TLX). The time required to remove the packing and the number of instruments used in the procedure were recorded. Postoperative bleeding (Boezaart bleeding score) and wound healing were graded. Patient symptoms on the day after surgery and pain during packing removal were assessed using a visual analog scale. Results: Computed tomography scores, asthma complications, and blood eosinophil counts were significantly higher in the AQUACEL® Ag Advantage group. Patient symptoms on the day after surgery were not significantly different between the two groups. Physician stress during the task of packing removal was significantly lower in the AQUACEL® Ag Advantage group than in the KALTOSTAT® group (35.5 vs. 81.0, p = 0.016) according to the NASA-TLX scores. The number of instruments used in the procedure was significantly lower in the AQUACEL® Ag Advantage group than in the KALTOSTAT® group (3.0 vs. 6.0, p = 0.015). There were no significant differences in procedure time for packing removal, postoperative bleeding, wound healing, or patient pain at the time of packing removal between the groups. Conclusion: Physicians feel stressed about packing removal. In addition, AQUACEL® Ag Advantage is useful for packing after ESS, requiring fewer instruments for the procedure than KALTOSTAT® and reducing physician stress about the procedure. Level of evidence: Level 3.

Uso de profilaxis antibiótica en el taponamiento nasal, una revisión actualizada

Resumen El uso de profilaxis antibiótica en el taponamiento nasal es una práctica ampliamente usada por el eventual riesgo de síndrome de shock tóxico o complicaciones infecciosas locales. En los últimos años, se ha cuestionado su real impacto tomando en cuenta los riesgos asociados al uso de antibióticos y la baja o casi nula incidencia de las complicaciones infecciosas. Se realizó una revisión exhaustiva de la literatura sobre el uso de profilaxis antibiótica en taponamiento nasal. Se observó que no existían diferencias estadísticamente significativas en la incidencia de complicaciones infecciosas y no hubo reportes de síndrome de shock tóxico en ninguno de los grupos con y sin profilaxis antibiótica. No hubo diferencias significativas en los cultivos de los pacientes con o sin antibióticos en taponamiento nasal por epistaxis. El uso de profilaxis antibiótica en taponamiento nasal es una práctica cuestionable y se requieren más estudios al respecto.

Abstract Antibiotic prophylaxis in nasal packing is a widely used practice due to the possible risk of toxic shock syndrome and infectious complications. Lately, its real impact has been questioned due to the associated risks with antibiotic use and low incidence of infectious complications. A comprehensive review of the literature on the use of antibiotic prophylaxis in nasal packing was performed. No statistically significant differences in the incidence of infectious complications and no reports of toxic shock syndrome were reported in any of the groups with and without antibiotic prophylaxis. There were no significant differences in the antibiotic cultures of patients with or without prophylactic antibiotics in nasal packing due to epistaxis. The use of antibiotic prophylaxis in nasal packing is a questionable practice and further studies are required.

The influence of standardized dry ivy leaf extract on the proportion of nasal secretion after post-septoplasty nasal packing removal / A influência do extrato de folha de hera seca na secreção nasal após remoção de tampão nasal pós-septoplastia

Abstract Introduction: After post-septoplasty nasal packing removal, a certain proportion of nasal secretion occurs, leading to local and sometimes systemic infections. Objective: The aim was to determine if standardized dry ivy leaf extract application after nasal packing removal influences the reduction of nasal secretion and diminish the occurrence of local infections. Methods: The study included 70 post-septoplasty patients (divided into two equal groups) whose nasal packing was removed on the third day after the procedure. Group I was treated with standardized dry ivy leaf extract syrup along with regular nasal irrigation for the five days after the nasal packing removal whereas the Group II had only nasal lavage. On the sixth day after nasal packing removal, the quantity of nasal secretion was determined using a visual analog scale and nasal endoscopic examination. Results: The group treated with standardized dry ivy leaf extract syrup had significantly lesser nasal secretion both by subjective patients' assessment (p < 0.001) and by nasal endoscopic examination (p = 0.003). The post-surgical follow up examination on the sixth day after nasal packing removal showed no development of local infection in the Group I, while in the Group II a local infection was evident in five patients (14.29%) and antibiotic therapy was required. Conclusion: The use of the standardized dry ivy leaf extract after nasal packing removal significantly lowers the proportion of nasal secretion.

Resumo Introdução: Após a remoção do tampão nasal pós-septoplastia, ocorre produção de secreção nasal, predispondo infecções locais e, por vezes, sistêmicas. Objetivo: O objetivo foi determinar se a aplicação do extrato padronizado de folhas de hera seca após a remoção do tampão nasal influencia a redução da secreção nasal e diminui a ocorrência de infecções locais. Método: O estudo incluiu 70 pacientes pós-septoplastia (divididos em dois grupos iguais) cujo tampão nasal foi retirado no terceiro dia após o procedimento. O grupo I foi tratado com xarope padronizado de extrato de folha seca de hera juntamente com irrigação nasal regular por cinco dias após a remoção do tamponamento nasal, enquanto ao grupo II foi recomendado apenas lavagem nasal. No sexto dia após a remoção do tampão nasal, a quantidade de secreção nasal foi determinada pela escala EVA (escala visual analógica) e pelo exame endoscópico nasal. Resultados: O grupo tratado com xarope de extrato seco de folhas de hera apresentou secreção nasal significativamente menor tanto pela avaliação subjetiva dos pacientes (p < 0,001) quanto pelo exame endoscópico nasal (p = 0,003). O exame de acompanhamento pós-cirúrgico no sexto dia após a remoção do tampão nasal não mostrou desenvolvimento de infecção local nos pacientes do grupo I, enquanto que no grupo II, cinco apresentaram sinais de infecção local (14,29%) com necessidade de antibioticoterapia. Conclusão: O uso do extrato padronizado de folhas secas de hera após a remoção do tampão nasal reduz significativamente a produção de secreção nasal.

Influence of different nasal cavity treatment schemes on symptom scores and complications of patients undergoing nasal septum deviation correction / 中国医师进修杂志

Objective To investigate the influence of nasal packing and modified suture after operation on symptom scores and complications of patients undergoing nasal septum deviation correction. Methods One hundred and forty patients who had underwent nasal septum deviation correction were chosen in the period from January 2016 to August 2018 in People′s Hospital of Lishui City and randomly divided into two groups including control group (70 patients) with nasal packing after operation and experiment group (70 patients) with nasal modified suture after operation. The bleeding loss volume, subjective symptoms visual analogue scale(VAS) score, Lund-Kennedy score and complication incidence after operation of both groups were compared. Results There was no significant difference in the bleeding loss volume between two groups (P>0.05). The VAS score of nasal pain, head pain, dizziness, tears, nasal itching, nasal congestion and dyskoimesis after operation of experiment group were significantly lower than those of control group: (2.29 ± 0.65) scores vs. (5.42 ± 1.19) scores, (2.72 ± 0.67) scores vs. (5.60 ± 0.85) scores, (3.03 ± 0.46) scores vs. (5.25 ± 0.73) scores, (1.54 ± 0.40) scores vs. (2.70 ± 0.64) scores, (2.64 ± 0.56) scores vs. (5.68 ± 0.83) scores,(1.72 ± 0.57) scores vs. (2.10 ± 0.71) scores, (2.80 ± 0.63) scores vs. (4.96 ± 0.91) scores, P<0.05. There was no significant difference in the complication incidence after operation between two groups (P > 0.05). Conclusions Compared with nasal packing after operation, modified suture after operation in the treatment of patients undergoing nasal septum deviation correction can efficiently relieve subjective symptoms and decrease postoperative pain degree; but nasal packing and modified suture after operation possess the same clinical effects on controlling bleeding volume and promoting nasal mucosa repair and safety.

The comfort of the patients with nasal packing after nasal endoscopic surgery: a qualitative research / 中国实用护理杂志

Objective To explore the comfort of the patients with nasal packing after nasal endoscopic surgery from the angle of the patients, and to provide references for improving the comfort of the patients and developing the nasal comfort scale. Methods The phenomenology research method was adopted in this study. Sixteen patients with nasal packing after nasal endoscopic surgery participated in the in-depth interview which interview outline was designed basis on Kolcaba K's comfort theory. Data were analyzed by using Colaizzi's phenomenological method. Results Four level-1 themes and sixteen level-2 themes were extracted. The physical discomfort included discomfort in nose, head, eye, month, face, ear, sleep, diet and movement. The psychological discomfort included sense of unevenness and anxiety. The sociocultural discomfort included discomfort in the role of patients and bad relationship. The environmental discomfort included dry, noise and bad air in the ward. Conclusions Patients with nasal packing after nasal endoscopic surgery had many uncomfortable experiences, especially the physical discomfort. So the nurses should pay attention and develop a good reliability and validity nasal comfort scale to evaluate the comfort of these patients. Then the nurses should take active measures to relieve these discomforts, improve the patients' quality of life, make nurse-patient relationship harmonious and improve patients'satisfaction.

Effects of Compound Lidocaine Cream on Postoperative Pain After Endoscopic Sinus Surgery / 中国微创外科杂志

Objective To explore the effects of compound lidocaine cream applied to postoperative wound and nasal packing on postoperative sinus pain after endoscopic sinus surgery . Methods From April 2015 to June 2016, 100 cases of endoscopic sinus surgery were carried out in our hospital under general anesthesia .The patients were randomly divided into two groups , with 50 cases in each group .The group A was given compound lidocaine cream 4 g on the nasal surgery wound and medical inflation sponge for intranasal packing;the group B was given saline 4 g on the nasal surgery wound and medical inflation sponge for intranasal packing . The heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were measured at the time of extubation (T0), 1 h after extubation (T1), 4 h after extubation (T2), 10 h after extubation (T3), and 12 h after extubation (T4), respectively.The visual analogue scale (VAS) of pain after extubation was recorded . Results The HR, SBP and DBP at T0, T1, T2 and T3 in the group A were significantly lower than those in the group B (P0.05), while the DBP was significantly lower in the group A than that in the group B (t=-2.562, P=0.012).The VAS scores were significantly lower in the group A than those in the group B at T 0, T1, T2 and T3 (P=0.000).No statistical difference was seen in VAS scores at T4 between the two groups (t=-1.199, P=0.233). Conclusions Application of compound lidocaine cream on nasal endoscopic wound and intranasal packing can effectively relieve the pain after endoscopic sinus surgery .The method has good analgesic effects and is worthy of popularization and application .

Efficacy and Safety of Guardcel Nasal Packing After Endoscopic Sinus Surgery: A Prospective, Single-Blind, Randomized Controlled Study

OBJECTIVES: Nasal packing after endoscopic sinus surgery is frequently used to control postoperative bleeding, enhance the wound healing process, and prevent lateralization of the middle turbinate, which causes insufficient ventilation. Many biodegradable materials have been developed to reduce pain and mucosal damage during packing removal. The purpose of this study was to compare the efficacy of Guardcel (Genewel Co.) middle meatal packing with a traditional nonabsorbable middle meatal packing, Merocel (Medtronic Xomed), on wound healing and patient satisfaction. METHODS: In this prospective, single-blind, randomized controlled study, we enrolled 32 consecutive patients (64 nostrils) undergoing bilateral endoscopic sinus surgery at Korea University Guro Hospital from February 2015 to August 2015. Guardcel and Merocel were inserted postoperatively into a randomly assigned side. Objective findings about bleeding, hemostasis, adhesion, and infection were evaluated with nasal endoscopy. Patients’ symptoms including pain and nasal obstruction were evaluated with a visual analog scale. Each evaluation was done at 2–3 days, 1 week, 2 weeks, and 4 weeks after surgery. RESULTS: At 2–3 days after endoscopic sinus surgery, the Guardcel side had a significantly less hemostasis time than the Merocel side (P=0.001). During this period, the pain during packing removal was significantly lower on the Guardcel-inserted side than the Merocel-inserted side (P=0.002). At two weeks after surgery, the adhesion score on the Guardcel side was significantly lower than that of the Merocel side (P=0.011). Other parameters during the study follow-up periods were not statistically significant. There were no severe adverse reactions. CONCLUSION: Guardcel, a newly developed packing material, appeared to shorten the hemostasis time and reduce pain sensation at 2–3 days after surgery; it also prevented adhesion formation 2 weeks after surgery when compared with the control. Guardcel can be an effective and safe candidate to replace conventional packing materials after endoscopic sinus surgery.

Transeptal suturing - a cost-efficient alternative for nasal packing in septal surgery / Sutura transeptal - uma alternativa custo-benefício para tamponamento nasal em cirurgia do septo

ABSTRACT INTRODUCTION: Nasal packing is routinely used in septal surgery to prevent postoperative bleeding. OBJECTIVE: To demonstrate the possibility of transeptal suture as a safe and effective way to avoid nasal packing and to improve efficiency. METHODS: This is a prospective, descriptive, inferential cost study comprising 92 patients. Two randomized groups of patients were analyzed, one with nasal packing and the other with transeptal suture. RESULTS: In the group of transeptal suture no patient experienced postoperative bleeding, and a statistically significant reduction of pain and headache was demonstrated. At the same time, we improved efficiency by saving on material costs. CONCLUSIONS: Transeptal suture is an effective and safe alternative to classic nasal packing in septal surgery. Moreover, it improves the efficiency of the intervention by saving costs.

Resumo Introdução: O tamponamento nasal é usado rotineiramente na cirurgia septal para evitar sangramentos no pós-operatório. Objetivo: Demonstrar a possibilidade de se realizar uma sutura transeptal como alternativa eficaz e segura ao tamponamento nasal, com melhora na eficiência da intervenção. Método: Este é um estudo prospectivo, descritivo e de custo inferencial, compreendendo 92 pacientes. Dois grupos aleatórios foram estudados: um com tamponamento nasal e o outro com sutura transeptal. Resultado: No grupo de sutura transeptal, nenhum paciente experimentou sangramento no pós-operatório, tendo sido estatisticamente demonstrada uma significante redução de cefaléia e dor. Ao mesmo tempo, houve melhora na eficiência da intervenção, com economia no custo de material. Conclusões: A sutura transeptal é uma alternativa eficaz e segura ao tamponamento nasal clássico. Além do mais, melhora a eficiência da intervenção, economizando no custo de material.

Influence of moist healing dressing on comfort degree and complications in patients with nasal ;packing for epistaxis patients / 中国实用护理杂志

Objective To investigate the moist healing dressing nasal packing for epistaxis patients′physiological comfort and complications. Methods 70 patients of epistaxis patients with nasal packing by drawing lots were divided into A, B two groups of 35 cases. Group A used Vaseline gauze, and group B used moist healing dressings of composite fillings. Comparison of the two groups of pain, nasal odor, sleep disorders, hemostatic effect, nasal mucosa reaction, fever, nasal adhesions were conducted. Results Patients when nasal packing group A pain, sleep disorders and nasal odor scores were (9.80 ± 0.12), (7.10 ± 0.33) and (9.44 ± 0.25) points, group B were (3.82 ± 0.16), (3.22 ± 0.16) and (0.37 ± 0.09) points. Group A scored significantly higher than group B, the difference was statistically significant (t=-179.97,-7.22,-7.33, P <0.05). Group A fever and nasal adhesions were 33 cases and 6 cases respectively, while those figures in group B both were 0, the difference was statistically significant (χ2=62.43, 6.56, P<0.05). Conclusions Nasal packing varying degrees of discomfort in patients, the use of moist healing dressings for epistaxis targeted composite filling, can significantly increase the patients ’ physiological comfort and reduce the complications of nasal packing.

Treatment effect of continuous suture technique for nasal septum after septoplasty / 中国耳鼻咽喉头颈外科

OBJECTIVE To explore the method of replacing nasal packing after septoplasty. METHODS A total of 158 patients who had undergone septoplasty were included in this study. The patients were randomly allocated into two groups: packing group and suturing group. Postoperative signs and symptoms were compared between the two groups by visual analogue scale(VAS). RESULTS The patients of packing group experienced significantly more postoperative nasal pain, headache, epiphora, tinnitus/ear fullness, sleep disturbance after surgery(all P0.05). CONCLUSION Nasal septum continuous suture is a simple technique to decrease patients' suffering. It does not increase the complications and is a feasible method to replace nasal packing after septoplasty.

Observation on Effect of Double Silicone Balloon Catheter for Nasal Packing after Endoscopic Sinus Surgery / 中国医科大学学报

Objective To explore the effect of double silicone balloon catheter used as nasal packing materials after functional endoscopic sinus sur?gery(FESS). Methods Totally 80 patients(47 males and 33 females,median age of 43 years)with bilateral chronic sinusitis who underwent en?doscopic surgery under general anesthesia were randomly divided into two groups,each group with 40 patients. The hemostatic sponge group used he?mostatic sponge for postoperative nasal packing and the hemostatic catheter group used double silicone balloon catheter plus medical sponge. Patients were observed for postoperative pain,ventilation and bleeding after packing removal to evaluate efficacy. Results Double silicone balloon catheter was superior to hemostatic sponge in ventilation maintenance(mean scores:78.8 vs 2.32)and pain relief(mean scores:0 vs 5.26),the difference was statistically significant(P<0.05). Moreover,double silicone balloon catheter was also superior to hemostatic sponge regarding to nasal bleeding after packing removal. Conclusion Double silicone balloon catheter is a preferable material for nasal packing after endoscopic surgery,which has reliable hemostatic effect and can better maintain the nasal ventilation,reduce pain in patients,and improve the patient's quality of life during treat?ment.

The Clinical Efficacy of Cutanplast(R) Nasal Packing after Endonasal Dacryocystorhinostomy

PURPOSE: The purpose of this study was to investigate the clinical efficacy of Cutanplast(R) nasal packing after endonasal dacryocystorhinostomy. METHODS: The present study included a total of 76 adult patients (98 eyes) with primary acquired nasolacrimal duct obstruction who underwent endonasal dacryocystorhinostomy. Fifty-four eyes were packed with Cutanplast(R) and 44 eyes were packed with Merocel(R). Patient discomfort while the packing was in situ, degree of bleeding during the day after operation, functional and anatomical success rate, and postoperative complications such as synechiae, granulation, wound healing (osteal mucosal epithelium epithelization), and revision rate were compared between the packing materials. RESULTS: The Cutanplast(R) was significantly more comfortable and effective at preventing hemorrhage after endonasal dacryocystorhinostomy during the day following the operation. There was no significant difference between the two groups in postoperative anatomical and functional surgical success rate at 1 week, 1 month and 3 months. In comparison with postoperative complications, the Cutanplast(R) group showed a lower incidence of delayed wound healing (delayed epithelialization of the osteal mucosal epithelium) than the Merocel(R) group, whereas there was no difference in granulation, synechiae, or revision rate. CONCLUSIONS: The Cutanplast(R) nasal pack resulted in significantly less discomfort and less bleeding compared to the Merocel(R) nasal pack. Moreover, the Cutanplast(R) showed a lower proportion of delayed wound healing after endonasal dacryocystorhinostomy and had the advantage of low cost compared to other hemostatic nasal packing materials. Therefore, Cutanplast(R) nasal packing after endonasal dacryocystorhinostomy can be considered a comfortable, cost-effective and clinically-effective method.

Feasibility study of no nasal packing after endoscopic sinus surgery for chronic sinusitis / 中国医师进修杂志

Objective To compare the efficacies between nasal packing and no nasal packing after endoscopic sinus surgery for chronic sinusitis,and explore the feasibility of no nasal packing after endoscopic sinus surgery.Methods Eighty-two type 1 or type 2 chronic sinusitis patients who received endoscopic sinus surgery under general anesthesia were divided into no nasal packing group (44 cases,75 sides) and nasal packing group (38 cases,65 sides) by random digits table method.The patients in 2 groups were taken preoperative anti-inflammatory and regulation blood pressure treatment.The volume of bleeding,postoperative pain (visual analogue score,VAS),degree of mucosal edema,efficacy and postoperative complications between 2 groups were compared.Results There were no statistical difference in volume of bleeding and efficacy between 2 groups (P ＞ 0.05).The postoperative VAS in no nasal packing group was significantly lower than that in nasal packing group [(2.46 ± 0.54) scores vs.(5.49 ± 1.26) scores],there was statistical difference (P＜ 0.01).There was no statistical difference in mucosal edema score postoperative 1 week and 6 months between 2 groups (P ＞ 0.05),but the mucosal edema score postoperative 1 month in no nasal packing group was significantly lower than that in nasal packing group [(1.32 ±0.63) scores vs.(3.52 ±0.72) scores],there was statistical difference (P ＜ 0.01).Postoperative comphcations in nasal packing group were significantly more than those in no packing group.Conclusion No nasal packing can be performed for type 1 or type 2 chronic sinusitis patients who has no significant bleeding after endoscopic sinus surgery under general anesthesia,it is actually beneficial of relieving distress of the patient and reducing postoperative complications.

Analysis of the Results Endonasal Dacryocystorhinostomy Related to Nasal Cavity State

PURPOSE: This study evaluated the relationship of nasal cavity state and surgical results after endonasal dacryocystorhinostomy (DCR). METHODS: We retrospectively analyzed 306 eyes of 204 patients between January 2007 and December 2011. The correlation between the existence of preoperative nasal cavity abnormality, postoperative nasal cavity complications after proper management of nasal cavity abnormality, and postoperative nasal cavity complications according to nasal packing material were investigated. We analyzed the success rates and the correlation between each set of factors. RESULTS: The success rate of primary operations performed six months after tube removal was 87.3% (267/306). The success rate after secondary revision, granuloma removal and punctoplasty was 90.5% (277/306). Postoperative nasal cavity complications were inspected in 40 eyes. Of the 306 eyes, patients treated with Nasopore showed significantly more postoperative nasal cavity complications (47.8%, 32/67) than in patients treated with Merocel (3.3%, 8/239). The rate of postoperative nasal cavity complications was 8.7% in patients with normal nasal cavity, 16.7% in patients who received treatment, and 20% in patients without treatment, with significant statistical increase if the nasal cavity was abnormal (p = 0.019). The incidence of complications influenced the primary success rate (p = 0.008); however, preoperative nasal cavity abnormalities were not correlated with primary success (p = 0.479). CONCLUSIONS: In the case of endonasal DCR, preoperative nasal cavity abnormality and type of nasal packing material used did not affect the success rate but significantly affected postoperative nasal cavity complications. In conclusion, endonasal DCR with preoperative treatment of nasal cavity abnormality and Merocel packing is expected to reduce postoperative nasal cavity complications and increase patient satisfaction.

Analysis of the Results Endonasal Dacryocystorhinostomy Related to Nasal Cavity State

PURPOSE: This study evaluated the relationship of nasal cavity state and surgical results after endonasal dacryocystorhinostomy (DCR). METHODS: We retrospectively analyzed 306 eyes of 204 patients between January 2007 and December 2011. The correlation between the existence of preoperative nasal cavity abnormality, postoperative nasal cavity complications after proper management of nasal cavity abnormality, and postoperative nasal cavity complications according to nasal packing material were investigated. We analyzed the success rates and the correlation between each set of factors. RESULTS: The success rate of primary operations performed six months after tube removal was 87.3% (267/306). The success rate after secondary revision, granuloma removal and punctoplasty was 90.5% (277/306). Postoperative nasal cavity complications were inspected in 40 eyes. Of the 306 eyes, patients treated with Nasopore showed significantly more postoperative nasal cavity complications (47.8%, 32/67) than in patients treated with Merocel (3.3%, 8/239). The rate of postoperative nasal cavity complications was 8.7% in patients with normal nasal cavity, 16.7% in patients who received treatment, and 20% in patients without treatment, with significant statistical increase if the nasal cavity was abnormal (p = 0.019). The incidence of complications influenced the primary success rate (p = 0.008); however, preoperative nasal cavity abnormalities were not correlated with primary success (p = 0.479). CONCLUSIONS: In the case of endonasal DCR, preoperative nasal cavity abnormality and type of nasal packing material used did not affect the success rate but significantly affected postoperative nasal cavity complications. In conclusion, endonasal DCR with preoperative treatment of nasal cavity abnormality and Merocel packing is expected to reduce postoperative nasal cavity complications and increase patient satisfaction.

Sinocutaneous Fistula Induced by Long-Standing, Retained, Non-Absorbable Nasal Packing in The Paranasal Sinus

Orbital complications after endoscopic sinus surgery (ESS), such as optic nerve or medial rectus injuries, are well known, but isolated complete oculomotor nerve palsy has never been reported. In this case, a 31-year-old male was transferred to our hospital after ESS. Physical examination showed complete left oculomotor nerve palsy, with a bony defect on the sellar floor, which had not fully recovered after more than 1 year. We hypothesized that blunt trauma could be the main cause of the oculomotor palsy. Surgeons performing ESS must keep in mind the possibility of oculomotor palsy due to blunt trauma, especially when operating around the sphenoid and posterior ethmoid sinus.

Septoplastia com ou sem tamponamento pós-operatório? Estudo prospectivo / Septoplasty with or without postoperative nasal packing? Prospective study

O tamponamento nasal anterior é efetuado num grande número de cirurgias nasais, nomeadamente na septoplastia. Contudo, não é um procedimento inócuo pelo que o seu benefício tem vindo a ser questionado. OBJETIVO: Avaliar a necessidade do tamponamento nasal anterior e a qualidade de vida nos doentes submetidos à septoplastia. MÉTODO: Doentes submetidos à septoplastia, com ou sem turbinoplastia inferior, foram randomizados para a colocação ou não de tamponamento nasal anterior no pós-operatório. Foram registados e comparados os dados relativos ao pós-operatório (dor, hemorragia). A qualidade de vida foi avaliada no pré e pós-operatório. Estudo prospetivo randomizado. RESULTADOS: Foram incluídos 73 doentes (37 tamponados e 36 não tamponados) com seguimento mínimo de 3 meses. Nos doentes tamponados, a dor nasal e as cefaleias no pós-operatório imediato foram superiores. Destes doentes, 75,7% referiram dor moderada/intensa no destamponamento. Nos doentes não tamponados, a hemorragia foi mais frequente, mas apenas um doente necessitou tamponamento. Houve melhoria da qualidade de vida em todos os doentes. CONCLUSÃO: A septoplastia melhora a qualidade de vida do doente com desvio do septo e obstrução nasal. O uso por rotina do tamponamento nasal anterior deve ser questionado por não apresentar benefício comprovado.

Anterior nasal packing is carried out in a number of nasal surgeries, especially in septoplasty. However, it is not an innocuous procedure and for this its benefit has been challenged. OBJECTIVE: To assess the need for anterior nasal packing and the quality of life of patients submitted to septoplasty. METHOD: Patients submitted to septoplasty with or without inferior turbinoplasty were randomized to receive or not anterior nasal packing postoperatively. We recorded and compared postoperative data (pain and bleeding). Quality of life was assessed before and after surgery. This is a randomized prospective study. RESULTS: We had 73 patients (37 packed and 36 who did not receive a nasal packing) with a minimum follow-up of 3 months. Patients with nasal packing complained more of nasal pain and headache in the immediate postoperative period. Of these patients, 75.7% reported moderate/intense pain upon nasal packing removal. Bleeding was more frequent in those patients who did not receive a nasal packing, and only 1 patient required packing. All the patients enjoyed an improvement in quality of life. CONCLUSION: Septoplasty improves the quality of life of patients with septal deviation and nasal obstruction. Routine use of anterior nasal packing should be challenged for not presenting proven benefit.

Atypical Stress Induced Cardiomyopathy During Endoscopic Sinus Surgery With Septoplasty in an Elderly Male Patient

Stress-induced cardiomyopathy, also known as Takotsubo cardiomyopathy, is caused by emotional or physical stressors and mimics acute myocardial infarction. Stress-induced cardiomyopathy is characterized by acute, reversible left ventricular apical ballooning without significant coronary artery stenosis. New variants of stress-induced cardiomyo pathy with localized wall motion abnormalities or an inverted pattern with a hyperdynamic apex have been reported. We present a rare case of a sudden cardiac arrest due to atypical stress-induced cardiomyopathy (mucosal packing and the injection of epinephrine) in an elderly male patient during elective endoscopic sinus surgery with septoplasty under local anesthesia. In this case, only the basal and midportions of the left ventricle were affected, whereas the apex was completely spared. The patient rapidly and completely recovered without sequelae.

The Usefulness of Latex-covered Merocel(R) Packing in Septal Surgery

BACKGROUND AND OBJECTIVES: Nasal packing after nasal surgery is commonly practiced. Merocel(R) is one of the most popular packing material, however it can be associated with significant pain and bleeding on its removal. A prospective study was performed to compare the efficacy and patient tolerance of Merocel(R) and newly designed Latex-covered Merocel(R) (LCM). MATERIALS AND METHOD: Sixty patients underwent septoplasty for septal deviation. Following septoplasty, the patients were randomly allocated into two groups of 30 patients each who underwent insertion of either Merocel(R) or LCM. Patients were asked to record pain levels using a visual analogue scale(VAS) before and after packing removal, and number of analgesic injection were recorded. Resistance and amount of bleeding on packing removal were also recorded. RESULTS: Both nasal packs effectively prevented post-operative bleeding. However the VAS score for nasal pain and numbers of analgesic use before and after packing removal were significantly lower in the LCM group. LCM was removed more smoothly causing significantly less amount of bleeding on removal. CONCLUSION: LCM provides good post-operative hemostasis and its removal is less traumatic and painful for the patients, therefore improving patient's comfort.