Question About Splints and Packing After Rhinoplasty?

It is rarely necessary to utilize packing following rhinoplasty. Bleeding after rhinoplasty is exceedingly rare, and internal sutures are sufficiently effective in preventing hematoma (blood clot) formation. 

Internal splints serve several purposes and are especially useful when turbinate reduction is concomitantly performed during rhinoplasty. They prevent formation of adhesions and scars between the septum and the lateral nasal wall by acting as a physical barrier. It is unclear whether splints can help stabilize the septum in the midline post-operatively. Lastly, internal nasal splitnts with built-in conduits for air can help patients breathe through swollen nasal tissues.

In summary, i never pack, but use splints about half the time. Hope this helps,

Grigoriy Mashkevich MD

New York Facial Plastic Surgeon

Not all surgeons use packing after rhinoplasty surgery. For instance, I don't typically place anything in the nose when I finish performing rhinoplasty surgery. On rare occasion I will place a small packing inside that is removed within a few days. But, by avoiding nasal packing, my patients are much more comfortable following surgery. Instead of packing, I use more absorbable suture inside of the nose to close the lining together.

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