Is Packing the Nose Needed After Rhinoplasty and Septoplasty?

Internal Splints: Inside the nose, most surgeons place some sort of internal splints after rhinoplasty. The internal splints do several things: (1) put mild pressure on the septum to prevent a septal hematoma, (2) help hold the inside straight during the early healing process, and (3) prevent scar bands from forming from the lateral side of the nasal passage to the septum. These can be soft plastic, silicone, telfa pads. They are left in place for one day to one week depending on the... more

Packing of the nose has been out of vogue for over 20 years. The only reason to pack the nose is for a sudden nosebleed that will not stop with other methods. Packing the nose is painful, and stronger narcotics will then be required if packing is in place. Antibiotics will also have to be taken if packing is placed to prevent toxic shock syndrome. There is no reason to pack a nose after a septoplasty or a rhinoplasty.

No one likes packing the nose. Not the patient or the surgeon. It makes breathing more difficult and is uncomfortable for the patient. In general, most surgeons will avoid using it if they don't need it. However, sometimes when we are fixing the septum, we realize that the septum is much more deviated than we thought. Or, sometimes, we have to do extra things in order to make it more straight. In these cases, we may need to pack the one or both nostrils to support the delicate septum... more

This varies among surgeons. To simplify the explanation I will use an analogy: Think of the septum as a sandwich of two layers of mucoperichondrium (bread) and the cartilage between them (meat). A septoplasty involves lifting the mucopericondrium from the cartilage (lifting the bread off of the meat and sometimes removing it). This leaves an empty space between the two layers (bread) that can fill with blood under pressure (septal hematoma). This can cause the layers to erode and open the... more