• Archives of Plastic Surgery
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• v.38 no.5
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• pp.602-608
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• 2011

Purpose: Nasal bone fracture is the most common type of facial bone fracture and most of nasal bone fracture is combined with septal fracture frequently. Nasal septum is important to support the distal nose and to maintain the nasal airway. But nasal septal fractures are usually unrecognized and untreated at the time of operation. Recently, various materials were using for nasal packing after closed reduction, however these materials are not focused on the correction of nasal bone and nasal septal fracture and many patients are suffered from nasal packing materials. Thus, the purpose of this study is to compare routine packing materials and rolled silastic sheet with respect to postoperative effect of correction of nasal bone fracture and discomfort of nasal packing materials. Methods: We examined 320 patients treated nasal bone fracture from January 2008 to December 2010. For Group I (n=92), $Merocel^{(R)}$ was used for nasal packing, for Group II (n=152) vaseline gauze was used, and Rolled silastic sheet (RSS) with vaseline gauze packing (VGP) was used for Group III (n=76). Under the general anesthesia, all patients were operated by closed reduction and nasal packing was done using three kinds of packing materials. At the time of postoperative 7 days, packing material was removed and studied for pt's satisfaction and postop. complications. Results: In patients with RSS with VGP, the complaints (nasal obstruction, foreign compressive sensation and discomfort during food ingestion) of keeping the nasal packing were decreased ($p$ <0.05) and the postoperative complication (deviation) were decreased comparing to vaseline gauze packing and $Merocel^{(R)}$ packing, however, these differences were not statistically significant ($p$ >0.05). Conclusion: Postoperative nasal packing with RSS with VGP was more comfortable to the patients and it was more effective method to correct the nasal bone fracture and nasal septal fracture.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1979.05a
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• pp.5.2-6
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• 1979

It is clinically well-known observation that Nasal packing is associated with the eustachian tube dysfunction, and this study seldom appeared in the literature. In our country, Nasal Surgery requiring Nasal packing is still the most frequent operation in the field of otorhinolaryngology and it is our interest to study this effects of Nasal packing on the eustachian tube function. Using tympanometry, we experienced eustachian tube dysfunction in 40 patients (80 ears) with anterior packing due to Nasal Surgery and epistaxis and in 13 patients (26 ears) with anterior packing and posterior packing due to epistaxis. The results were as fllows; 1) Thirty of the 80 ears (37%) in the patients with anterior packing revealed reduction in middle ear pressure, of which 16 ears (20%) demonstrated negative middle ear pressure of greater than 100mm H20. 2) Fifteen of the 26 ears (50.7%) in the patients with posterior packing revealed reduction in middle ear pressure, of which 11 ears (42.3%) demonstrated negative middle ear pressure of greater than l00mm H20. 3) Posterior packing is associated with a greater incidence of eustachian tube dysfunction than anterior packing. 4) The eustachian tube dysfunction associated with Nasal packing is temporary and this function is returned to normal within 2 to 9 days after removal of the packing.

• Archives of Craniofacial Surgery
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• v.13 no.2
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• pp.119-124
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• 2012

Purpose: Closed reduction and nasal packings for 3-7 days is usual procedures in managing nasal bone fracture. Most patients experience several discomfort owing to lack of nasal breathing. There are many reports concerning how to reduce patient's discomforts or complications. But it is obvious that the duration of nasal packing is 3-7 days. The aim of this study is evaluate the effect of half day nasal packing in results of nasal bone fracture. Methods: The study was performed on 97 nasal bone fracture patients who had simple nasal bone fractures from January to June 2012. The incidence, cause, patient's discomfort and satisfaction with half day nasal packing are analyzed according to patient's medical records and questionnaire at each nasal packing removal, postoperative 4 weeks. Results: Young male patients, especially the teenagers and the twenties were the common age group, and physical violence was most common cause of injury. A total of 78 out of 97 patients were male. In 92 cases, closed reduction were applied. Approximately, 87% of the patients were satisfied with the outcomes. Conclusion: Half day nasal packing is considered as an effective method to minimize patient's discomfort owing to prolonged absence of nasal breathing with maintenance of stability.

• Archives of Craniofacial Surgery
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• v.10 no.1
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• pp.14-18
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• 2009

Purpose: Nasal packing materials are almost inserted at the end stage of closed reduction of nasal bone for postoperative bleeding control and stabilization of nasal bone. Conventionally, vaseline gauze was used for packing of nasal cavity. These days, Surgeons have tried to apply $Merocel^{(R)}$ into the nasal cavity more easily. It is difficult for patients to continue keeping the nasal packs for more than a week due to breathing difficulty. Moreover, nasal packing itself can also cause headache, dry mouth, stuffiness, etc. Methods: We performed a prospective study from March 1, 2008 to July 31, 2008. One hundred patients were divided into "$Merocel^{(R)}$ packing group" and "$Merocel^{(R)}$ and Airway Tube $Merocel^{(R)}$ packing group". Using two kinds of materials to each group after closed reduction, we observed and compared the amount of bleeding between two groups. We recorded patient's uncomfortable symptoms which were divided into four groups each 6, 24, 48 hours after nasal packing. Results: The result of the bleeding amount of Air Tube $Merocel^{(R)}$ group after 6 hours of nasal packing is that 3 people belong to mild group, 38 people moderate group, and 9 people severe group. After 6 hours of nasal packing, 11 patients have no complains. 16 patients were mild, 21 patients were moderate, 2 patients were severe. After 24 hours of nasal packing, no complain(18 patients), mild(24 patients), moderate(6 patients), severe(0 patient). After 48 hours of nasal packing, no complain(25 patients), mild(20 patients), moderate(5 patients), severe(0 patient). Conclusion: Regarding the amount of bleeding, there are no difference between two groups. In case of Air Tube $Merocel^{(R)}$ group, patient's discomfort is gradually improved after 24 hours of nasal packing, After 48 hours of nasal packing, most of the patients do not experience headache, dry mouth, stuffiness, etc. Therefore, Air Tube $Merocel^{(R)}$ can be useful for bleeding control. Moreover, it helps patients to breathe through nose more easily and reduce discomfort.

• Archives of Craniofacial Surgery
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• v.12 no.1
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• pp.22-27
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• 2011

Purpose: Packing the nose is a common procedure after the closed reduction of a nasal bone fracture to prevent postoperative complications, such as bleeding and adhesion formation as well as to stabilize the framework of the nasal bone. On the other hand, it is difficult for a patient to endure nasal packing because of breathing difficulties, headaches, chest discomfort, insomnia, general weakness and hypoxia. This study examined the availability of a bronchodilator to improve the decreased oxygen saturation and postoperative symptoms on nasal packing. Methods: From February, 2010 to July, 2010, a prospective randomized comparison of the incidence of a range of postoperative signs and symptoms was conducted on 60 patients, who did (n=30) and did not (n=30) undergo bronchodilator infusion (aminophylline 250 mg/10 mL + normal saline 100 mL IV qd) following nasal packing. The postoperative symptoms and oxygen saturation in the two groups were compared. Results: Patients who had infused the bronchodilator showed improved oxygen saturation. Nevertheless, there were no significant differences in the postoperative uncomfortable symptoms (dyspnea, headache, chest discomfort, insomnia, general weakness) between the two groups. Conclusion: A bronchodilator after nasal packing improves oxygen saturation by dilating the airway tract but it cannot reduce the uncomfortable symptoms caused by nasal obstruction. Overall, the bronchodilator is a useful medication for improving the level of oxygen saturation.

• Journal of Dental Anesthesia and Pain Medicine
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• v.17 no.4
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• pp.281-287
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• 2017

Background: Various techniques have been introduced to decrease complications during nasotracheal intubation. A common practice is to use nasal packing with a cotton stick and 0.01% epinephrine jelly. However, this procedure can be painful to patients and can damage the nasal mucosa. Xylometazoline spray can induce effective vasoconstriction of the nasal mucosa without direct nasal trauma. In this study, we aimed to compare the efficacy of these two methods. Methods: Patients were randomly allocated into two groups (n = 40 each): xylometazoline spray group or epinephrine packing group. After the induction of general anesthesia, patients allocated to the xylometazoline spray group were treated with xylometazoline spray to induce nasal cavity mucosa vasoconstriction, and the epinephrine packing group was treated with nasal packing with two cotton sticks and 0.01% epinephrine jelly. The number of attempts to insert the endotracheal tube into the nasopharynx, the degree of difficulty during insertion, and bleeding during bronchoscopy were recorded. An anesthesiologist, blinded to the intubation method, estimated the severity of epistaxis 5 min after intubation and postoperative complications. Results: No significant intergroup difference was observed in navigability (P = 0.465). The xylometazoline spray group showed significantly less epistaxis during intubation (P = 0.02). However, no differences were observed in epistaxis 5 min after intubation or postoperative epistaxis (P = 0.201). No inter-group differences were observed in complications related to nasal intubation and nasal pain. Conclusion: Xylometazoline spray is a good alternative to nasal packing for nasal preparation before nasotracheal intubation.

• Archives of Plastic Surgery
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• v.39 no.6
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• pp.612-617
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• 2012

Background Packing after closed reduction of a nasal bone fracture causes inconvenient nasal obstruction in patients. We packed the superior meatus with Vaseline gauze to support the nasal bone, and packed the middle nasal meatus with a Doyle Combo Splint consisting of an airway tube, a silastic sheet, and an expandable sponge to reduce the inconvenience. In addition, we aimed to objectively identify whether this method not only enables nasal respiration but also sufficiently supports the reduced nasal bone. Methods Nasal ventilation was measured via spirometry 1 day before surgery and compared to 1 day after surgery. To compare support of the reduced nasal bone by the 2 methods, 2 plastic surgeons assessed the displacementon X-rays taken after the surgery and after removing the packing. The extent of nasal obstruction, dry mouth, sleep disturbance, headache, and swallowing difficulty were compared with visual analog scales (VAS) on a pre-discharge survey. Results In the experimental group, the nasal respiration volume 1 day after surgery remained at $71.3%{\pm}6.84%$ on average compared to 1 day prior to surgery. Support of the reduced bone in the experimental group ($2.80{\pm}0.4$) was not significantly different from the control group ($2.88{\pm}0.33$). The VAS scores for all survey items were lower in the experimental group than in the control group, where a lower score indicated a lower level of inconvenience. Conclusions The nasal cavity packing described here maintained objective measures of nasal respiration and supported the reduced bone similar to conventional methods. Maintaining nasal respiration reduced the inconvenience to patients, which demonstrates that this packing method is useful.

• Archives of Plastic Surgery
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• v.36 no.2
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• pp.242-246
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• 2009

Purpose: The majority of nasal bone fractures have been managed by routine procedure of closed reduction and intranasal packing. However, nasal packing can cause nasal injury, hypoxia and patient's discomfort. And, synechiae formation is a frequently occurred after the nasal surgery. Various methods are used to reduce the incidence of synechiae formation. The purpose of this study was to compare routine procedure and nasal packing with reverse "U" shaped silicone sheet with respect to postoperative nasal synechiae formation and final outcome. Methods: We analyzed the medical records of 100 patients with nasal bone fracture who were operated by closed reduction in the last one year. The silicone sheet was designed in reverse "U" fan - shape and inserted between the middle turbinate and the septal wall. Nasal packing was removed at two days after the operation, and silicone sheet was removed at 10 to 14 days. Results: Synechiae in the middle meatus developed in 2 of 75 patients. Although synechiae between the middle meatus and nasal septum occurred in patients, the patients did not complaint of any olfactory disturbance and nasal obstruction. Conclusion: The reverse "U" fan - shape silicone sheet caused less pain for patients and no significant differences in outcome were found. The results of this study suggest that insertion of silicone sheet between the middle meatus and septum can be a useful method in the prevention of intranasal synechiae formation. The reverse "U" silicone sheet is a good alternative for routine packing methods.

• Archives of Craniofacial Surgery
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• v.9 no.1
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• pp.8-11
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• 2008

Purpose: The majority of nasal bone fractures have been managed by routine procedure of closed reduction, intranasal packing or intranasal Kirschner wire (K-wire) splinting. But it leaves rooms for many complaints from patients such as pain, rhinorrhea and nasal obstructioon. Another option is, of course, no packing at all. The study was initiated to assess the necessity to pack or splint the nasal bone after routine closed reduction. Methods: We analysed the medical records of 35 patients with nasal bone fracture who were operated by closed reduction in the last 2 years. We evaluated the postoperative CT scan scores and external deviation criterias 1 month after the operation. Results: The postoperative deviation criteria and postoperative CT scan score were favorable and there were no serious complications using this technique. Conclusion: The present study demonstrates that the use of packing or splinting need not be routine in the majority of cases. The risks and discomforts associated with these procedures can often be avoided.

• Archives of Craniofacial Surgery
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• v.17 no.4
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• pp.202-205
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• 2016

Background: Packing after closed reduction of nasal fracture causes uncomfortable nasal obstruction in patients. We packed the superior meatus with synthetic polyurethane foam (SPF) to support the nasal bone, and packed the middle nasal meatus with a nasal airway splint (NAS) and SPF. The aim of this article is prospectively to compare the subjective patient discomfort of SPF (Nasopore Forte plus) packing alone and SPF with NAS. Methods: We compared the prospectively subjective patient discomfort of SPF packing alone (group A) and SPF with NAS (group B) via visual analog scale (VAS; 0, no symptom; 100, most severe symptom). Results: At first postoperative day group B showed significant lower scores in dry mouth, sleep disturbance, conversation difficulty. However at third postoperative day, VAS scores of each group had no statistically significant differences. Moreover at fifth postoperative day group A had statistically significant lower scores for nasal pain, dry mouth than the group B. Conclusion: Combination method of using NAS and SPF have some advantage on the patient comfort from first postoperative day to third postoperative day.