YAJOT-01579; No of Page 1 AMER IC AN JOURNAL OF OT OLA RYNGOLOGY–H E A D A N D NE CK M E D ICI N E AN D S U RGE RY X X (2 0 1 5) XXX –XXX
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Letter to editor
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Effect of nasal packs in septoplasty☆
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REFERENCES
[1] Shinkwin CA, Beasley N, Simo R, et al. Evaluation of Surgicel Nu-knit, Merocel and Vasolene gauze nasal packs: a randomized trial. Rhinology 1996;34:41–3. [2] Dubin MR, Pletcher SD. Postoperative packing after septoplasty: is it necessary? Otolaryngol Clin North Am 2009; 42:279–85. [3] Deniz M, Ciftci Z, Isık A, et al. The impact of different nasal packings on postoperative complications. Am J Otolaryngol 2014;35:554–7. [4] Tzadik A, Gilbert SE, Sade J. Complications of submucous resections of the nasal septum. Arch Otorhinolaryngol 1988; 245:74–6. [5] Eski E, Adadan I, Hızal E, et al. Effect of nasal pack use on surgical success in septoplasty. Turk J Ear Nose Throat 2014;24: 206–10.
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are followed well. In our practice, we did not encounter perforation as we replaced and did not damage the tissues [5]. It should not be forgotten that pack-free technique is the most comfortable for the patients.
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Nasal packing is widely used in nasal surgeries, such as septoplasty and septorhinoplasty, in order to maintain hemostasis, inhibit hematoma, prevent nasal synechia and support septal flap. Nasal packs are produced in various types. An ideal nasal pack should be hemostatic and absorbable, and it should not exert any negative effect on wound healing. Negative effects of the nasal packs on quality of life have been shown before. The most common morbidity associated with nasal packs is postoperative pain [1]. But the use of nasal packing has been proposed to minimize postoperative complications such as hemorrhage, formation of synechiae and septal hematoma. The use of septal splints is also associated with increased postoperative pain. The routine use of septal splint or any nasal packs does not appear to decrease postoperative complications or improve surgical outcomes when compared less morbid techniques, such as pack free septoplasty [2]. A study by Deniz et al. [3] compared different nasal packs on postoperative complications was recently published in your journal. I have read their study with great interest. They reported 19.71% nasal synechia and 11.26% septal perforation in the Merocel packing group whereas no synechia and 10.16% septal perforation in the intranasal splint group. Even if they had been mentioned trans-septal suturing technique, it had not been discussed enough. The height of this ratio is noteworthy. The incidence of septal perforation varied from 0% to 30.4% for submucous resections [4]. In particular, in the same manner, both groups have high perforation rates, and it appears to be associated with the surgical technique used rather than the pack or splint effect. Surgery and follow-up were done by the same surgeon, and use of Killian incision is stated in the article. In surgery, entering with Cottle's hemitransfixion incision instead of Killian's could both provides surgical field dominance and reduce dechirur rates. Dechirur is an important factor in the formation of perforation. Furthermore, removed cartilage and bone tissues placed again after crushed suitable are effective in preventing the perforation during septoplasty. In our clinic, pack-free and trans-septal suturing technique is routinely applied and recommended in septoplasty. Generally this technique does not cause any problem, if the patients
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To the editor:
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Erkan Eski MD Department of Otolaryngology, Zubeyde Hanim Practice and Research Center, Baskent University, Izmir, Turkey Corresponding author at: Department of Otolaryngology Zubeyde Hanım Training and Research Center, Baskent University, 6371 sk. No.34 Bostanlı/Karşıyaka, Izmir, Turkey Tel.: +90 2323305230; fax: +90 2323369421 E-mail address:
[email protected]
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Ismail Yilmaz MD Department of Otolaryngology, Faculty of Medicine Baskent University, Adana, Turkey E-mail address:
[email protected]
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© 2015 Elsevier Inc. All rights reserved. 85 http://dx.doi.org/10.1016/j.amjoto.2014.12.012 86
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No sponsorships or competing interests have been disclosed for this article.
Please cite this article as: Eski E, Yilmaz I, Effect of nasal packs in septoplasty, Am J Otolaryngol–Head and Neck Med and Surg (2015), http://dx.doi.org/10.1016/j.amjoto.2014.12.012
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