Septoplasti Sonrası Transseptal Sütür ile Nazal Tamponların Karşılaştırılması

Yıl 2019, , 90 - 101, 30.06.2019

Deniz Baklacı , İsmail Güler , İhsan Kuzucu , Rauf Oğzuhan Kum , Müge Özcan

https://doi.org/10.33716/bmedj.567573

Cited By: 3

Öz

Amaç: Nazal tamponlar septoplasti sonrası yaygın olarak kullanılır.
Bununla birlikte, literatürde nazal tampon kullanımı ile ilişkili çok sayıda
komplikasyon vardır. Bu çalışmada, septoplasti uygulanan hastalarda transseptal
sütür tekniği (TSS) ile üç farklı tip nazal tampon postoperatif komplikasyonlar
ve operasyon sonrası hasta memnuniyeti açısından karşılaştırıldı.

Gereç ve Yöntem: Çalışma grubuna septoplasti uygulanan 80 hasta dahil
edildi: Hastalar 4 gruba ayrıldı. Merocel grubu (grup 1), internal nasal splint
(INS) grubu (grup 2), sentetik poliüretan köpük (SPK) grubu (grup 3) ve TSS
grubu (grup 4). Grupların VAS skorları ağrı (tamponlu kaldığı süre içerisinde,
tamponun çıkarılması sırasında), basınç hissi, disfaji ve postnazal akıntı
açısından karşılaştırıldı. Her grupta kanama, sineşi, septal hematom ve septal
perforasyon gibi komplikasyonlar karşılaştırıldı.

Bulgular: Tamponlu kaldığı süre içerisinde ve tamponların çıkarılması
sırasındaki postoperatif ortalama ağrı, basınç hissi ve disfaji VAS skorları
Merocel grubunda silikon ve Nasopore gruplarına göre anlamlı olarak yüksek
bulundu. Diğer üç grup arasında VAS skorları açısından anlamlı fark yoktu.
Kanama oranı Merocel grubunda en yüksek, TSS grubunda en düşüktü. Sineşi oranı
Merocel grubunda en yüksek, ardından TSS ve SPK grupları ile en düşük INS grubundaydı.
Gruplar arasında septal hematom ve septal perforasyon açısından fark yoktu.

Sonuç: Sonuçlarımız septoplasti hastalarında TSS tekniğinin yüksek hasta
memnuniyeti ve düşük komplikasyon oranları açısından güvenle
kullanılabileceğini göstermiştir. Merocel, yüksek komplikasyon oranları ve
düşük hasta yaşam kalitesi nedeniyle septoplasti için uygun bir materyal gibi
görünmemektedir.

Anahtar Kelimeler

Septoplasti, nazal tamponlar, transseptal sütür tekniği

Comparison of the Transseptal Suturing with Nasal Packs After Septoplasty

Öz

Objective: Nasal packs are commonly used after septoplasty. However,
there are numerous complications associated with nasal packing in the literature.
This study aimed to compare the efficacy of transseptal suture technique (TSS)
versus three different types of nasal packs regarding to postoperative
complications and patient satisfaction after septoplasty. 

Material and Method: The study group included 80 patients who underwent
septoplasty. The patients were randomly divided into four groups: Merocel group
(group 1), internal nasal splint (INS) group (group 2), synthetic polyurethane
foam (SPF) group (group 3) and TSS group (group 4). The VAS scores of groups
were compared for pain (during pack, on removal of the pack), sense of
pressure, dysphagia and postnasal drip. The complications including bleeding,
synechiae, septal hematoma and septal perforation were also compared for each
group. 

Results: The mean VAS scores of postoperative pain during packed and on
removal of packs, sense of pressure and dysphagia found significantly higher in
Merocel group than in silicone and Nasopore groups. There was no significant
difference between other three groups regarding to VAS scores. Bleeding ratio
was highest in Merocel group, and lowest in TSS group. Synechiae ratio was
highest in Merocel group followed by TSS and SPF groups and lowest in INS
group. There was no difference between groups regarding to septal hematoma and
septal perforation.

Conclusion: Our results showed that TSS technique might be safely used
in septoplasty patients regarding to high patient’s satisfaction and low
complication ratios. Merocel does not seem to be an appropiate material for
septoplasty due to its high complication and low patient’s quality of life
ratios. 

Anahtar Kelimeler

Septoplasty, nasal packs, transseptal suture technique

Kaynakça

• 1.Yıldırım G, Cingi C, Kaya E. Septal stapler use during septum surgery. European Archives of Oto-Rhino-Laryngology 2013;270(3):939-43.
• 2.Wadhera R, Zafar N, Gulati SP, Kalra V, Ghai A. Comparative study of intranasal septal splints and nasal packs in patients undergoing nasal septal surgery. Ear, Nose & Throat Journal 2014;93(9):396.
• 3.Moumoulidis I, Draper MR, Patel H, Jani P, Price T. A prospective randomised controlled trial comparing Merocel and Rapid Rhino nasal tampons in the treatment of epistaxis. European Archives of Oto-Rhino-Laryngology and Head & Neck 2006;263(8):719-22.
• 4.Lemmens W, Lemkens P. Septal suturing following nasal septoplasty, a valid alternative for nasal packing? Acta oto-rhino-laryngologica Belgica 2001;55(3):215-21.
• 5.Von Schoenberg M, Robinson P, Ryan R. Nasal packing after routine nasal surgery—is it justified? The Journal of Laryngology & Otology 1993;107(10):902-5.
• 6.Weber R, Hochapfel F, Draf W. Packing and stents in endonasal surgery. Rhinology 2000;38(2):49-62.
• 7.Acıoğlu E, Edizer DT, Yiğit Ö, Onur F, Alkan Z. Nasal septal packing: which one? European Archives of Oto-Rhino-Laryngology 2012;269(7):1777-81.
• 8.Ardehali M, Bastaninejad S. Use of nasal packs and intranasal septal splints following septoplasty. International journal of oral and maxillofacial surgery 2009;38(10):1022-4.
• 9.Shoman N, Gheriani H, Flamer D, Javer A. Prospective, double-blind, randomized trial evaluating patient satisfaction, bleeding, and wound healing using biodegradable synthetic polyurethane foam (NasoPore) as a middle meatal spacer in functional endoscopic sinus surgery. Journal of Otolaryngology--Head & Neck Surgery 2009;38(1).
• 10.Walikar BN, Rashinkar S, Watwe M, Fathima A, Kakkeri A. A comparative study of septoplasty with or without nasal packing. Indian Journal of Otolaryngology and Head & Neck Surgery 2011;63(3):247-8.
• 11.Günaydın RÖ, Aygenc E, Karakullukcu S, Fidan F, Celikkanat S. Nasal packing and transseptal suturing techniques: surgical and anaesthetic perspectives. European Archives of Oto-Rhino-Laryngology 2011;268(8):1151-6.
• 12.Bernardo MT, Alves S, Lima NB, Helena D, Condé A. Septoplasty with or without postoperative nasal packing? Prospective study. Brazilian journal of Otorhinolaryngology 2013;79(4):471-4.
• 13.Özkırış M, Kapusuz Z, Saydam L. Comparison of nasal packs with transseptal suturing after nasal septal surgery. American journal of otolaryngology 2013;34(4):308-11.
• 14.Yildirim A, Yasar M, Bebek AI, Canbay E, Kunt T. Nasal septal suture technique versus nasal packing after septoplasty. American journal of rhinology 2005;19(6):599-602.
• 15.Arya AK, Butt O, Nigam A. Double-blind randomised controlled trial comparing Merocel with Rapid Rhino nasal packs after routine nasal surgery. Rhinology 2003;41(4):241-3. 16.Lubianca-Neto JF, Sant'anna GD, Mauri M, Arrarte JLF, Brinckmann CA. Evaluation of time of nasal packing after nasal surgery: a randomized trial. Otolaryngology—Head and Neck Surgery 2000;122(6):899-901.
• 17.Hwang JH, Liu CM, Liu TC, Hsu MC. Sphenopalatine ganglion block before removal of nasal packing. The Laryngoscope 2003;113(8):1423-4.
• 18.Kuo M, Zeitoun H, Macnamara M, Wagstaff K, Carlin W, Turner N. The use of topical 5% lignocaine ointment for the relief of pain associated with post‐operative nasal packing. Clinical Otolaryngology 1995;20(4):357-9.
• 19.Thomas D, Tierney P, Samuel D, Patel K. Audit of pain after nasal surgery. Annals of the Royal College of Surgeons of England 1996;78(4):380.
• 20.Dalgic A, Dinc ME, Ulusoy S, Avinçsal MÖ, Kulekci M. The effects of nasal packing and transseptal suturing after septoplasty on olfactory function, patient comfort, and mucociliary clearance. Journal of Craniofacial Surgery 2016;27(5):e487-e90.
• 21.Lee I, Vukovic L. Hemostatic suture for septoplasty: how we do it. The Journal of otolaryngology 1988;17(1):54-6.
• 22.Yilmaz MS, Guven M, Elicora SS, Kaymaz R. An evaluation of biodegradable synthetic polyurethane foam in patients following septoplasty: a prospective randomized trial. Otolaryngology--Head and Neck Surgery 2013;148(1):140-4.
• 23.Cukurova I, Cetinkaya E, Mercan G, Demirhan E, Gumussoy M. Retrospective analysis of 697 septoplasty surgery cases: packing versus trans-septal suturing method. Acta otorhinolaryngologica italica 2012;32(2):111.
• 24.Soylu Özler G, Arli C, ÇEvİK C, Akbay E, Berber Ö. Comparison of Two Different Types of Nasal Packing Materials and Trans-Septal Suturing Technique After Septoplasty. 2014. p. 47-50.
• 25.Watson M, Campbell J, Shenoi P. Nasal surgery: does the type of nasal pack influence the results? Rhinology 1989;27(2):105-11.
• 26.Kayahan B, Ozer S, Suslu A, Ogretmenoglu O, Onerci M. The comparison of the quality of life and intranasal edema between the patients with or without nasal packing after septoplasty. European Archives of Oto-Rhino-Laryngology 2017;274(3):1551-5.