Optimizing Postoperative Care in Rhinoplasty and Septoplasty: A Review of the Role of Nasal Packing and Alternatives in Complication Management

Caimi E, Balza A, Vaccari S, Bandi V, Klinger F, Vinci V.

PubMed 38485786 Publisher (DOI)Free full text (PMC)

What this paper says

A review of 30 articles from 2000-2023 finds nasal packing after rhinoplasty and septoplasty gives limited benefit for bleeding, swelling or bruising, causes discomfort, and can be replaced by splints in many cases.

Overview

Whether to pack the nose after surgery is contested: some surgeons believe it aids healing and stops bleeding; others avoid it for patient comfort. The Italian authors reviewed the literature from 2000 to 2023, selecting 30 relevant articles from 62, and weighed the benefits and harms of packing and its alternatives.

Sections of note

Early complications addressed: nosebleed and hematoma; late: scarring and deformity.
Steroids and tranexamic acid are used to prevent and manage complications.
Packing offered "limited benefits" in reducing bleeding, oedema and ecchymosis.
Packing may lead to adverse outcomes; nasal splints offer similar advantages.
Level of Evidence III.

What it means for a patient

Packing, the gauze stuffed into the nose that patients dread, is not clearly necessary for routine rhinoplasty.
Thin silicone splints can do the same job with less discomfort.
Practice varies; ask what your surgeon uses and why.

Why this paper matters

It summarises the case against routine packing, consistent with a broader move away from it. Limits: narrative review, no pooled numbers.

Terms

Nasal packing: absorbent material placed inside the nose after surgery.
Nasal splint: a thin plastic or silicone sheet sutured against the septum.
Epistaxis: nosebleed.
Hematoma: a collection of blood under the tissue, which in the septum can destroy cartilage.

Summary written by rhinoplasty.cc from the abstract, 2026-09-08; not medical advice. The authors' own abstract follows.

Abstract

Rhinoplasty, a common surgical procedure for nose reshaping, demands meticulous preoperative evaluation and precise execution. When coupled with septoplasty to address medical issues stemming from a deviated nasal septum, these procedures can lead to noteworthy postoperative complications. These encompass early issues like epistaxis and hematoma, as well as long-term challenges such as scarring and aesthetic deformities. Strategies like steroids and tranexamic acid are employed to prevent and manage these complications. A contentious aspect in postoperative care is the use of nasal packing. While some argue it aids healing and hemostasis, others avoid it due to patient discomfort. This review assesses the pros and cons of postoperative nasal packing following rhinoplasty and septoplasty. A thorough literature review spanning 2000-2023 yielded 30 relevant articles from 62. Discussion reveals that nasal packing offers limited benefits in reducing bleeding, edema and ecchymosis. In conclusion, the decision to employ nasal packing in rhinoplasty and septoplasty should be made carefully, considering patient comfort and surgical context. Evidence suggests that nasal packing may not consistently provide significant advantages and could lead to adverse outcomes. Nasal splints offer similar advantages and may be considered viable alternatives. Surgeons should tailor their approach to individual patient needs, with further research needed to refine postoperative management for these procedures.Level of Evidence III This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Abstract as indexed by PubMed; the article is open access (PubMed Central).