Bleeding during rhinoplasty/septoplasty - Is it not always necessary to use throat packing?

Question

Bleeding during rhinoplasty I wonder why some anesthetists put throat packs in the throat during surgery and not others and if you don't put these packs how are the tracheas protected from blood aspiration during surgery apart from the tube you put in the throat. Is it not always necessary to use throat packing during rhinoplasty/septoplasty?

Ronald J. Edelson, MD · Answer

Sone surgeons use throat packs and others do not. I usually use a throat pack to prevent blood in the trachea but I know many who don’t. I don’t think it’s a basis for selecting one surgeon over another.  I am aware of a case where there was an airway problem after rhinoplasty and the fact that a throat pack was not used became a major issue ( not my case) . Since then I usually use a throat pack. There is nothing  bad about using one.

Richard G. Reish, MD, FACS · Answer

Hello and thank you for your question. In my practice, I prefer to place a throat pack. I always do this myself. I recommend that you seek consultation with a qualified board-certified rhinoplasty surgeon who can evaluate you in person.

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Best wishes and good luck.

Richard G. Reish, M.D.
Harvard-trained plastic surgeon

Jacob Carlson, MD · Answer

Using a throat pack during rhinoplasties is fairly common, but it's not absolutely necessary. The throat pack is intended to prevent blood from entering both the airway and the esophagus. Blood that enters the esophagus during surgery can cause the patient to experience post-operative nausea and vomiting. If the patient is still sedated when this happens, then they could aspirate the blood and/or stomach contents. The endotracheal tube usually does a good job of protecting the airway and prevents blood from entering the airway. It is also very common for surgeons/anesthesiologists to pass a nasogastric or orogastric tube into the esophagus/stomach before the patient wakes up from anesthesia to remove any blood that may have entered the upper GI tract during the surgery.

Edward Buckingham, MD · Answer

Both approaches are safe. Some surgeons elect to place a throat pack during surgery to physically block and absorb blood run down that occurs during the procedure. Others elect against this and rely on the endotracheal tube balloon, which is generally sufficient to protect against blood entry into the airway. Any blood that bypasses the wind pipe and enters the stomach should be suctioned out at the end of the case.

Bleeding during rhinoplasty/septoplasty - Is it not always necessary to use throat packing?

Answers (4)

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