Post-op Rhinoplasty: Nasal Tubes?

Question

I asked my doctor if he will be putting "packing" in my nose post op, he said no but that he may use two tubes inside my nose. I searched the internet but I cant find any information on that. What are the tubes, how do they work, and are they painful?

Oakley Smith, MD, FRCSC · Answer

Packing is different to stenting a nose after surgery. Packing is soft foam or gauze used to control bleeding. Stents are for support. Immediately after surgery the nose is in a weakened state and needs internal support to maintain the septum in the middle and also to press the mucous lining against the septal cartilage.

Thomas A. Lamperti, MD · Answer

The tubes your surgeon mentioned are most likely Doyle splints. These are silicone sheets with a tube placed on one side to allow air to flow. You'll know that they're there but they aren't too painful, in my experience. They're usually slid out of the nose a week after surgery - this burns for a few minutes. It certainly not as bad as having the nose packed -- something that used to be done more routinely a few decades ago.

	You can check out the below video clip where I discuss this further.

Andrew P. Trussler, MD · Answer

Rhinoplasty (Nose job) is a common operation that is performed in multiple different ways. Depending on what is done, your post-operative management and care may vary. The tubes your surgeon is referring to are "Doyle" splints which help the healing of the septum and the inner nose. Denver splints or aquaplast splints can be applied over tape to protect the nasal bones. All of these are usually removed after a week. Nasal packing is usually removed sooner secondary to the risk of infection. Nasopore or gelfoam can be utilized, which absorb. I hope this helps. Dr. Trussler

Matthew Bridges, MD, FACS · Answer

As mentioned, Doyle splints are commonly used in the nose after septal surgery. The idea is that they provide some compression to the septum and prevent septal hematomas (blood clots between the septal mucosa). However, I personally believe that they do not do this and only unnecessarily cause pain for the patient. I always place a "mattress" suture back and forth through the septum after septoplasty. The suture dissolves by itself and therefore does not need to be removed. This more effectively prevents septal hematoma. In my experience, eliminating Doyle splints eliminates about 90% of the postoperative pain. Some patients are absolutely miserable because of the splints. Finally, studies have been done that show no real benefit to placement of nasal splints in most cases.

Otto Joseph Placik, MD · Answer

These are called Doyle splints and the purpose of the tube  is as follows :"The NEW Doyle Open Lumen Splint is designed to keep the nasal airway patent while maintaining support of the septum"

Kevin Sadati, DO · Answer

Dear rhinoplasty patient from Cleveland, OH,
	There are nasal packings (spongy) with silicone tubes in the center that help patient breath through them while providing compression. There are septal splints (with a tube in the center made of silicone) that are used after Septoplasty to keep the septum in the center. Talk to your surgeon and ask him to describe the type material he is planning to use. Good luck.

William A. Wallace, MD, FACS · Answer

Doyle splints, as they are called, are used to stabilize the nasal septum after septoplasty, or when some of the septal cartilage was taken to help reshape other parts of the nose. They provide a more stable, regular support to the septum than traditional nasal packing. 

	In my experience most patients prefer the splints over the packing, because there is a canal which can allow for nasal breathing (sometimes it can clog though).

Peter A. Aldea, MD · Answer

To operate on the cartilage and bone wall partition between the nostrils (the septum), its lining must be peeled off exposing the actual wall. Once the procedure is completed, the lining which has the feel of thin wall paper needs to be pushed seamlessly against the septum. The purpose of doing so is to promote scarring and adhesion to the septum ASAP without allowing fluid or blood accumulation in between these 2 linings and the septum (such as a septal hematoma). To achieve this effect for many years surgeons would pack the nose with gauze which kept the septal lining in place. The problem is that is is VERY uncomfortable for patients now forced to breath through the mouth for several days. The tubes you were told about are soft silastic tubes incorporated in a compressed foam splints which expands when it comes in contact with liquid . Once placed in the nose the foam expands just like a packing but now the patient can breath making the experience more comfortable.

But in the interests of full disclosure, depending on your Septoplasty, you may not need splints at all. The mucosal lining on both sides of the septum can be stitched together with a dissolving quilting stitch which holds them nicely in place without ANY packing. You may want to ask your surgeon about it.

Dr. Peter Aldea

Lawrence Tong, MD, FACS, FRCSC · Answer

Dear IvyK ,

	The purpose of nasal packing is to support the septum, and to place compression on the lining of the septum  to prevent fluid/blood build up around the septum. This function may also be served by using various splints and nasal tubes that are commonly used as part of rhinoplasty. In general these devices are very well tolerated and are not painful. They may be uncomfortable if they have hard edges that 'dig in' to the lining of the nose. Surgeons may trim these devices as they are placed in order to prevent this from happening. Removal of these devices may also be uncomfortable; I advise my patients to take a pain pill before they arrive for their splint removal. Discuss these issues with your surgeon. Good luck.

	Best regards,

	Lawrence Tong MD FACS FRCSC

Verne Weisberg, MD (retired) · Answer

Hi Ivy,

	After surgery on the nasal septum (the wall that separates the two nasal airways from each other), a type of silicone splint, called a Doyle splint, may be placed to maintain the alignment of the septum as well as to compress the space created by the surgery. these typically stay in about 5-7 days. That's likely what your surgeon is talking about. It isn't used by every nasal specialist, and some just use sutures alone. A lot depends on the stability of the nose at the end of the surgery.

	 

	Hope this helps

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