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Question About Splints and Packing After Rhinoplasty?

Do all surgeons put splints into a nose after rhinoplasty that consisted of breaking bones, removing a bump from the top of the nose, making the nose narrower, and straighten the nose? Why would you and why would you not put splints and/or packing after rhinoplasty? I see that some people don’t get packing but a lot have splints after rhinoplasty. I would like to understand the benefit and reasons why some surgeons put them in while others don't.

Doctor Answers (17)

Use of splints and packing following rhinoplasty

+2

Splints are used almost always after any rhinoplasty to give the tissues support during the first few days of surgery. They are also a “reminder” to the patient to protect the nose early on, as usually there is not much pain after the procedure. Packing is not always done, though useful for internal “splinting” for the first 24 hours or so. This also helps in compression to prevent bleeding during the early couple of days post-op.


Dubai Plastic Surgeon
5.0 out of 5 stars 12 reviews

Packing and Splints

+2

Packing and splints are used to prevent bleeding in the nasal septum by compressing skin and mucous membrane that may have been raised during a septoplasty and rhinoplasty.   Some surgeons, my self included, also quilt the septum with through and through sutures.  Not all septums need splints or packing.  I generally do not pack noses.  I tend to use silicone plastic splints for 7 days in most of my cases.

Stuart H. Bentkover, MD
Boston Facial Plastic Surgeon
5.0 out of 5 stars 18 reviews

Splints and Packing After Rhinoplasty #nosejob

+2

Every Rhinoplasty surgeon has their way of doing things. There are some commonalities between us though. If you have septal work or bony work most of us put some type of internal support to hold the mucosal layers on either side of the septum together. This helps prevent hematoma formation between these two layers. Sometimes I will sew these layers together with a dissolvable suture and forego the internal splints. As far as a splint over the outside of the nose, most of us that perform some type of repositioning of the nasal bones want to splint those bones to try and hold them in position until they begin to scar in place. Hope this helps clear some of your questions up.

Richard J. Brown, MD
Scottsdale Plastic Surgeon
5.0 out of 5 stars 21 reviews

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Splints and packing after rhinoplasty.

+2

External splints are placed for two reasons: help control the swelling and protect the bones that were relocated from moving. Internal splints and packing are placed for two reasons: to bring the mucosa(internal lining of the nose) back against the cartilage and bones and to support the septum. There are less important reasons for the external and internal support but these are thee mainones. Depending on the extent of the surgery, the technique used, and what part of the nose was operated on the surgeon will decide what he needs to maintain the result and proper healing.

M. Vincent Makhlouf, MD, FACS
Chicago Plastic Surgeon
5.0 out of 5 stars 8 reviews

Rhinoplasty Splinting is Universal. Packing and Breathing are Variable

+2

Hello, Chicago friend.

Greetings from a native Chicagoan, Dr. Robert Kotler.

Every surgeon provides protection to a rhinoplasty case by placing a customize, firm plastic or metal splint on the outside.

Management of the inside nasal passages is more customized. Some surgeons use no packing; others do and some use internal splints, packing and provide an airway to assure comfort and safety.

Remember, a rhinoplasty changes only the outside. No major changes are made on the inside. However, if breathing is a problem, then it is wise to tackle that issue at the same time as the  rhinoplasty. Examples of problems which call for such attention  are: deviated septum, enlarged turbates ( usually due to allergy), sinus infections. If one is correcting a crooked nose, perhaps from a nasal fracture, most likely the inside will need some attention as it is routine to straighten a deviated septum if it is contributing to the crookedness of the nose.

 

The more work you have done on the inside, the greater the need for internal packing, possible splinting ( securing the tissues together using a plastic part)

Of course, the patient is more interested in, and concerned about, breathing well, immediately after surgery. Technical particulars are confusing and of secondary importance. That brings up the issue of the surgeon providing a clear airway, regardless of whether the nose is packed or not.

 

Personally, I like packing because it allows for control of unusual bleeding, if such occurs. And it allows us to place some internal antibiotics to reduce the chance of infection. Not all surgeons will agree but these are good reasons for many. Some surgeons are reluctant to pack because they are worried that the patient will be unhappy because the breathing is shut off.

Because I have investigated the issue of providing the patient with good breathing after surgery, I invented the KOTLER NASAL AIRWAY. That device is one, among several, that can help patients breathe well after surgery.

You should investigate all these issues but the first question should be asked of the doctors you consult with: "Are you doing any inside work and if so, what about packing, splints and airways?"

Hope this helps.

 

Robert Kotler, MD, FACS

Author, SECRETS OF A BEVERLY HILLS COSMETIC SURGEON

 

Robert Kotler, MD
Beverly Hills Facial Plastic Surgeon
5.0 out of 5 stars 59 reviews

Packing usually not necessary after rhinoplasty.

+2

Hi.

Packing is used only when extensive work on the septum and the turbinates is done.  Splint is applied when the nasal bones are broken (usually).

George J. Beraka, MD (retired)
Manhattan Plastic Surgeon
5.0 out of 5 stars 9 reviews

Rhinoplasty

+2

Dear Renap1,

 

Internal packing is one option to control and prevent a collection of blood from developing over your nasal septum.  This can have devastating consequences.  Another option is to use quilting sutures on the septum - I find this is less bothersome to patients.

As for external splints/casts - there's no good evidence that I know of to support this.  Many surgeons use it to protect the nose and decrease post-op swelling.  I don't think it's critical.  If anything, I think it's main function is to remind people that they have had surgery and that they should be careful.

Cheers,

Asif Pirani, MD, FRCS(C)

Asif Pirani, MD, FRCS(C)
Toronto Plastic Surgeon
5.0 out of 5 stars 28 reviews

Splints and packing

+2

I alomst always use a nasal splint especially when I infracture the bones.  As for packing I sometimes use it when I perform septal work.

Steven Wallach, MD
Manhattan Plastic Surgeon
4.5 out of 5 stars 18 reviews

Splints vs Packing in Rhinoplasty

+2

Dear Renap

  • Splints are normally referring to removable silicone sheets that help hold the septum in the middle for a week after surgery.  These are not necessary if the septum is not badly crooked.
  • External splints or "casts" come in lots of shapes and sizes and can be thought of as a brace over the nose (for protection and to limit swelling like an ankle wrap on a sprained ankle)
  • Packing of the nose with sponges or gauze was used more routinely in the past than it is now.
  • Most of the time, if the nose has some bleeding after surgery, a small amount of nonadherent gauze can be placed, which is easy to remove.

Hope this helps.

Best Wishes

Travis T. Tollefson, MD, MPH
Sacramento Facial Plastic Surgeon
5.0 out of 5 stars 5 reviews

Doctors do their own thing -

+2

I use an external splint on almost all rhinoplasties and I do not routinely pack noses. Even if I do the septum, I do not use packing and have not done so for over 25 years.

William B. Rosenblatt, MD
New York Plastic Surgeon
4.0 out of 5 stars 9 reviews

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.