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PURPOSE: This retrospective study assesses the risks and benefits linked to the non-use of nasal packing after a (rhino)septoplasty, compared with post-operative care with anterior nasal packing such as Merocel®. METHODS: Complication rates observed during the first week after surgery were compared between groups with and without use of classic nasal packing over a large sample of 534 patients, who had undergone either a closed or open procedure, with bilateral turbinoplasty, and with or without osteotomies. Complications listed include epistaxis, haematoma, impetiginization, septal perforation, hyperalgesia, and dyspnoea. RESULTS: No significant difference was observed between the group with and without packing regarding the immediate post-operative complications of epistaxis (4.4% of the cases with nasal packing versus 3% without, p = 0.918) and impetiginization (3% of the cases with nasal packing versus 4.2% without, p = 0.478). The technique used, as well as any osteotomies performed, had no impact on the results. CONCLUSION: Non-use of nasal packing after a (rhino)septoplasty is a safe alternative to classic post-operative methods. Provided that there is a rigorous surgical technique and strict clinical control, it should be used as a principal technique in any routine practice due to its safety for patients immediately post-surgery.

Introduction and objective: epistaxis is one of the most frequent otorhinolaryngological emergencies. One of its causes is alterations in hemostasis caused by anti-thrombotic therapy. The aim of the study is to determine if there are differences in the management of epistaxis between patients with anti-thrombotic therapy and control patients. Method: retrospective analytical observational study of patients admitted to the Otorhinolaryngology service of a tertiary hospital, between January 2010 and December 2016. Epidemiological, clinical and therapeutic characteristics of the patients have been collected through their electronic medical records and comparative statistical analysis was performed between patients with anti-thrombotic therapy and control patients. Results: a total of 85 patients (74.1% male) were analyzed. Mean age at diagnosis of 66.7 years. 49.4% were undergoing anti-thrombotic therapy. Anterior nasal packing was performed in all patients and posterior nasal packing in 16 patients. 37 patients required endoscopic nasal surgery. Embolization was performed in four patients. In the comparative statistical study, no statistically significant differences were found between both groups in any of the variables analyzed. Discussion and conclusions: the current indications for anti-thrombotic therapy are very broad and therefore it is common to treat epistaxis in this type of patient. Although it has not been clearly demonstrated that anti-thrombotic therapy alone is associated with more serious bleeding, we believe that multidisciplinary management of these patients is essential in order to achieve adequate control of bleeding without the need for more aggressive interventions., Introducción y objetivo: la epistaxis es una de las urgencias otorrinolaringológicas más frecuentes. Una de sus causas son las alteraciones de la hemostasia provocadas por fármacos antitrombóticos. El objetivo del estudio es determinar si existen diferencias en el manejo de epistaxis entre pacientes con terapia antitrombótica y pacientes controles. Método: estudio observacional analítico retrospectivo de pacientes ingresados en el servicio de Otorrinolaringología de un hospital de tercer nivel, entre enero de 2010 y diciembre de 2016. Se han recogido características epidemiológicas, clínicas y terapéuticas de los pacientes a través de su historia clínica electrónica y se ha realizado análisis estadístico comparativo entre los pacientes con terapia antitrombótica y pacientes controles. Resultados: 85 pacientes analizados (74,1% varones) con una edad media al diagnóstico de 66,7 años. El 49,4% realizaban terapia antitrombótica. En todos los pacientes se realizó taponamiento anterior y en 16 pacientes, posterior. 37 pacientes precisaron cirugía endoscópica nasal. La embolización se realizó en cuatro pacientes. En el estudio estadístico comparativo no se han encontrado diferencias estadísticamente significativas entre ambos grupos en ninguna de las variables analizadas. Discusión y conclusiones: las indicaciones actuales de terapia antitrombótica son muy amplias y por ello es frecuente atender epistaxis en este tipo de pacientes. Aunque no está claramente demostrado que la terapia antitrombótica por sí sola se asocie con sangrados más graves, creemos que es fundamental realizar un manejo multidisciplinar de estos pacientes con el fin de conseguir un adecuado control del sangrado sin necesidad de recurrir a intervenciones más agresivas.

Introduction  Following  septoplasty,  the  usual  norm  is  to  pack  the  nose  using polyvinyl alcohol or  white petroleum  jelly impregnated gauze. But  due  to  side  effects  like  pain,  respiratory  problems, headache  or  pain  during  pack  removal,  trans-septal  suturing  is  recommended  as  it  provides  stability  and  prevents  septal  hematoma  formation  without  causing  the  above mentioned  complaints.  This  study  aims  to  conduct  an  in-depth  comparison  of  the  outcomes  of  the  two  aforementioned  methods  in  an  Indian  population.Materials and Methods  A  prospective  randomized  comparative  study  was  done  for  30  patients  between  18-50  years  undergoing  septoplasty,  while  excluding  those  requiring  additional  surgical  interventions.  Trans-septal  suturing  was  done  for  15  patients  and  polyvinyl alcohol  nasal  packing  for  the  rest.  Visual  Analogue  Scale  was  used  to  record  discomfort  levels  1  day  post-operatively.  A  vast  multitude  of  symptoms  were  assessed  during  regular  visits  for  3  months  after  surgery.  Results Post-operatively,  nasal  pain,  headache,  dyspnoea,  sleep  disturbance,  post-nasal  drip,  crusting,  and  epiphora  were  found  to  be   reduced  i

Introduction  Following  septoplasty,  the  usual  norm  is  to  pack  the  nose  using polyvinyl alcohol or  white petroleum  jelly impregnated gauze. But  due  to  side  effects  like  pain,  respiratory  problems, headache  or  pain  during  pack  removal,  trans-septal  suturing  is  recommended  as  it  provides  stability  and  prevents  septal  hematoma  formation  without  causing  the  above mentioned  complaints.  This  study  aims  to  conduct  an  in-depth  comparison  of  the  outcomes  of  the  two  aforementioned  methods  in  an  Indian  population.Materials and Methods  A  prospective  randomized  comparative  study  was  done  for  30  patients  between  18-50  years  undergoing  septoplasty,  while  excluding  those  requiring  additional  surgical  interventions.  Trans-septal  suturing  was  done  for  15  patients  and  polyvinyl alcohol  nasal  packing  for  the  rest.  Visual  Analogue  Scale  was  used  to  record  discomfort  levels  1  day  post-operatively.  A  vast  multitude  of  symptoms  were  assessed  during  regular  visits  for  3  months  after  surgery.  Results Post-operatively,  nasal  pain,  headache,  dyspnoea,  sleep  disturbance,  post-nasal  drip,  crusting,  and  epiphora  were  found  to  be   reduced  i

Introduction  Following  septoplasty,  the  usual  norm  is  to  pack  the  nose  using polyvinyl alcohol or  white petroleum  jelly impregnated gauze. But  due  to  side  effects  like  pain,  respiratory  problems, headache  or  pain  during  pack  removal,  trans-septal  suturing  is  recommended  as  it  provides  stability  and  prevents  septal  hematoma  formation  without  causing  the  above mentioned  complaints.  This  study  aims  to  conduct  an  in-depth  comparison  of  the  outcomes  of  the  two  aforementioned  methods  in  an  Indian  population.Materials and Methods  A  prospective  randomized  comparative  study  was  done  for  30  patients  between  18-50  years  undergoing  septoplasty,  while  excluding  those  requiring  additional  surgical  interventions.  Trans-septal  suturing  was  done  for  15  patients  and  polyvinyl alcohol  nasal  packing  for  the  rest.  Visual  Analogue  Scale  was  used  to  record  discomfort  levels  1  day  post-operatively.  A  vast  multitude  of  symptoms  were  assessed  during  regular  visits  for  3  months  after  surgery.  Results Post-operatively,  nasal  pain,  headache,  dyspnoea,  sleep  disturbance,  post-nasal  drip,  crusting,  and  epiphora  were  found  to  be   reduced  i

Introduction In an effort to find a comparable but less expensive nasal pack with the qualities of MerocelR,this study was aimed at comparing the clinical efficacy and patient comfort level, while simultaneously using MerocelR and commercially available sponge as packing material in the same patient. Materials and Methods This study included those patients who underwent septoplasty, turbinoplasty or FESS and nasal packing was done randomly with MerocelR and commercially available sponge (polyurethane foam) on the same patient. Patients shared their experience on the symptom questionnaire on the first post-operative day and they underwent sequential diagnostic nasal endoscopy to assess the endoscopic status of the nasal cavity, which were documented meticulously.   Result The post-operative bleeding control, pain during pack removal, general satisfaction, willingness to reuse and post-operative adhesion were same for both MerocelR and sponge.   Conclusion The innovative technique of using a commonly available, commercially prepared sponge which is as good as MerocelR is well supported due to its efficacy in hemostasis, less mucosal trauma and less pain during pack removal. So it may be used in developing countries where cost is a factor for compliance of patients for undergoing surgeries without compromising on quality.

Introduction In an effort to find a comparable but less expensive nasal pack with the qualities of MerocelR,this study was aimed at comparing the clinical efficacy and patient comfort level, while simultaneously using MerocelR and commercially available sponge as packing material in the same patient. Materials and Methods This study included those patients who underwent septoplasty, turbinoplasty or FESS and nasal packing was done randomly with MerocelR and commercially available sponge (polyurethane foam) on the same patient. Patients shared their experience on the symptom questionnaire on the first post-operative day and they underwent sequential diagnostic nasal endoscopy to assess the endoscopic status of the nasal cavity, which were documented meticulously.   Result The post-operative bleeding control, pain during pack removal, general satisfaction, willingness to reuse and post-operative adhesion were same for both MerocelR and sponge.   Conclusion The innovative technique of using a commonly available, commercially prepared sponge which is as good as MerocelR is well supported due to its efficacy in hemostasis, less mucosal trauma and less pain during pack removal. So it may be used in developing countries where cost is a factor for compliance of patients for undergoing surgeries without compromising on quality.

Introduction In an effort to find a comparable but less expensive nasal pack with the qualities of MerocelR,this study was aimed at comparing the clinical efficacy and patient comfort level, while simultaneously using MerocelR and commercially available sponge as packing material in the same patient. Materials and Methods This study included those patients who underwent septoplasty, turbinoplasty or FESS and nasal packing was done randomly with MerocelR and commercially available sponge (polyurethane foam) on the same patient. Patients shared their experience on the symptom questionnaire on the first post-operative day and they underwent sequential diagnostic nasal endoscopy to assess the endoscopic status of the nasal cavity, which were documented meticulously.   Result The post-operative bleeding control, pain during pack removal, general satisfaction, willingness to reuse and post-operative adhesion were same for both MerocelR and sponge.   Conclusion The innovative technique of using a commonly available, commercially prepared sponge which is as good as MerocelR is well supported due to its efficacy in hemostasis, less mucosal trauma and less pain during pack removal. So it may be used in developing countries where cost is a factor for compliance of patients for undergoing surgeries without compromising on quality.

Purpose: Nasal bone fracture reduction surgery is normally followed by nasal packing to control bleeding. Yet, patients suffer from pain and require further analgesic treatments following nasal packing and removal. This study aimed to evaluate the effect of fentanyl-soaked packing as a method of controlling pain after nasal surgeries in a prospective, randomized, double-blind controlled trial. Methods: Sixty-five patients that have undergone closed nasal bone fracture reduction surgery were included in this study. Thirty-two patients were treated postoperatively with 50 mcg fentanyl-soaked Merocel ® , a biodegradable synthetic polyurethane foams packing, and the other 33 patients were treated with saline-soaked packings. To analyze the relative nasal pain control effect of fentanyl, Numeric Rating Scale, patient satisfaction and Ramsay Sedation Scale were used. Patients were closely monitored to record relevant cardiopulmonary indicators and degree of adverse symptoms such as headache or sore throat. Results: Fentanyl group had a significantly lower Numeric Rating Scale and higher patient satisfaction for most of the time periods after operation (p <.05). Symptoms of headache and sore throat were also significantly reduced. Ramsay Sedation Scale scores improved compared to the control group (p <.05). No significant differences in cardiopulmonary relevant indicators between the two experimental groups were observed (p >.05). Conclusion: Fentanyl-soaked packing significantly decreased postoperative pain with no observable adverse effects. Our results demonstrate that topical fentanyl application to nasal packing is an effective method of postoperative pain control after closed nasal bone fracture reduction surgery. © 2019, © 2019 Acta Chirurgica Scandinavica Society.

Nowadays there is not exhaustive consensus regarding posterior epistaxis management and different factors may vary the applied treatment. Method: 72 patients who were admitted to our center with a discharge diagnosis of posterior epistaxis between 2010 and 2015 were selected. The types of nasal packing, the invasive tratment needed, personal history associated with increase in incidence and/or mangement diffculties, age and gender were analyzed after applying the exclusion criteria. Results: The average age was 62 years old. 78% were men. 55.6% had a hypertension diagnosis, while 22.2% were diagnosed at admission. 31.9% were in oral anticoagulant therapy and 11.1% antiplatelet therapy. Bibalonated catheter was used in 60 patients (85.7%) as first nasal packing, anteroposterior nasal packing in 6 patients (8.6%). The mean time of the first tamponade was 3.74 days. 15 patients (20.8%) needed a second nasal packing and one patient needed the placement of a 3rd nasal packing. During admission, 5 patients (6.9%) required invasive treatment, in 2 of them without previous nasal packing. In 4 patients a surgical treatment was performed, and interventional treatment was performed in 2 patients. Conclusions: The bibalonated catheter is the first choice in our hospital. The nasal packing duration is lightly higher than described in the literature. After an exhaustive research about this topic, we can conclude that the therapeutic management of epistaxis is still a controversial point in Otorhinolaryngology., Actualmente no existe un consenso detallado respecto al manejo de la epistaxis posterior, influyendo diversos factores en el tratamiento aplicado. Material y método: Se seleccionaron 72 pacientes ingresados en nuestro centro con diagnóstico al alta de epistaxis posterior entre los años 2010 y 2015. Tras aplicar los criterios de exclusión fueron analizados los tipos de taponamientos que portaron, los tratamientos invasivos que precisaron, así como los antecedentes personales hematológicos o cardiovasculares, además de la edad y el sexo. Resultados: La edad media fue de 62 años. El 78% fueron hombres. Un 55,6% eran hipertensos, mientras que un 22,2% debutaron en su ingreso. El 31,9% tomaba anticoagulantes orales y el 11,1% antiagregantes. Como primer taponamiento se empleó la sonda de doble balón en 60 pacientes (85,7%), un taponamiento anteroposterior con gasa en 6 pacientes (8,6%). El tiempo medio de mantenimiento del primer taponamiento fue de 3,74 días. Quince pacientes (20,8%) precisaron la colocación de un segundo taponamiento y un paciente precisó un 3º taponamiento. Durante el ingreso 5 pacientes (6,9%) precisaron un tratamiento invasivo, realizándose en 2 de ellos sin mantener taponamiento previo. En 4 pacientes se realizó tratamiento quirúrgico y en 2 intervencionista. Conclusiones: La sonda de doble balón es el taponamiento de elección para la epistaxis posterior en nuestro centro. El tiempo de mantenimiento de los taponamientos es algo superior al descrito en la literatura. Tras la revisión bibliográfica, encontramos gran variabilidad el manejo terapéutico de la epistaxis.

Purpose: Nasal bone fracture reduction surgery is normally followed by nasal packing to control bleeding. Yet, patients suffer from pain and require further analgesic treatments following nasal packing and removal. This study aimed to evaluate the effect of fentanyl-soaked packing as a method of controlling pain after nasal surgeries in a prospective, randomized, double-blind controlled trial. Methods: Sixty-five patients that have undergone closed nasal bone fracture reduction surgery were included in this study. Thirty-two patients were treated postoperatively with 50 mcg fentanyl-soaked Merocel ® , a biodegradable synthetic polyurethane foams packing, and the other 33 patients were treated with saline-soaked packings. To analyze the relative nasal pain control effect of fentanyl, Numeric Rating Scale, patient satisfaction and Ramsay Sedation Scale were used. Patients were closely monitored to record relevant cardiopulmonary indicators and degree of adverse symptoms such as headache or sore throat. Results: Fentanyl group had a significantly lower Numeric Rating Scale and higher patient satisfaction for most of the time periods after operation (p <.05). Symptoms of headache and sore throat were also significantly reduced. Ramsay Sedation Scale scores improved compared to the control group (p <.05). No significant differences in cardiopulmonary relevant indicators between the two experimental groups were observed (p >.05). Conclusion: Fentanyl-soaked packing significantly decreased postoperative pain with no observable adverse effects. Our results demonstrate that topical fentanyl application to nasal packing is an effective method of postoperative pain control after closed nasal bone fracture reduction surgery. © 2019, © 2019 Acta Chirurgica Scandinavica Society.

Background: Indications for treatment and outcomes after endovascular management of carotid blowout syndrome for patients with head and neck cancer are not well defined. We investigated the safety and effectiveness of endovascular embolization and stent-graft reconstruction. Method(s): A literature review was performed for studies published between 2001 and 2015 with relevance to treatment outcomes. Our institutional database was examined to identify patients treated with endovascular techniques. Result(s): A total of 266 patients were included. Rates of procedural stroke were higher after embolization of internal carotid artery (ICA)/common carotid artery (CCA) compared to stent graft (embolization 10.3%; stent graft 2.5%; P <.02). Stent graft of ICA/CCA was associated with higher rates of recurrent bleeding (embolization 9.1%; stent graft 31.9%; P <.01). Conclusion(s): Both embolization and stent grafts are safe therapeutic options for acute carotid blowout syndrome. Embolization for ICA/CCA carotid blowout syndrome was associated with higher risks of procedural stroke and lower recurrent bleeding compared to stent grafts.Copyright © 2017 Wiley Periodicals, Inc.

Background: Indications for treatment and outcomes after endovascular management of carotid blowout syndrome for patients with head and neck cancer are not well defined. We investigated the safety and effectiveness of endovascular embolization and stent-graft reconstruction. Method(s): A literature review was performed for studies published between 2001 and 2015 with relevance to treatment outcomes. Our institutional database was examined to identify patients treated with endovascular techniques. Result(s): A total of 266 patients were included. Rates of procedural stroke were higher after embolization of internal carotid artery (ICA)/common carotid artery (CCA) compared to stent graft (embolization 10.3%; stent graft 2.5%; P <.02). Stent graft of ICA/CCA was associated with higher rates of recurrent bleeding (embolization 9.1%; stent graft 31.9%; P <.01). Conclusion(s): Both embolization and stent grafts are safe therapeutic options for acute carotid blowout syndrome. Embolization for ICA/CCA carotid blowout syndrome was associated with higher risks of procedural stroke and lower recurrent bleeding compared to stent grafts.Copyright © 2017 Wiley Periodicals, Inc.

Object The gold-standard surgical approach to the odontoid is via the transoral route. This approach necessitates opening of the oropharynx and is associated with risks of infection, and swallowing and breathing complications. The endoscopic endonasal approach has the potential to reduce these complications as the oral cavity is avoided. There are fewer than 25 such cases reported to date. The authors present a consecutive, single-institution series of 9 patients who underwent the endonasal endoscopic approach to the odontoid. Methods The charts of 9 patients who underwent endonasal endoscopic surgery to the odontoid between January 2005 and August 2013 were reviewed. The clinical presentation, radiographic findings, surgical management, complications, and outcome, particularly with respect to time to extubation and feeding, were analyzed. Radiographic measurements of the distance between the back of the odontoid and the front of the cervicomedullary junction (CMJ) were calculated, as well as the location of any residual bone fragments. Results There were 7 adult and 2 pediatric patients in this series. The mean age of the adults was 54.8 years; the pediatric patients were 7 and 14 years. There were 5 females and 4 males. The mean follow-up was 42.9 months. Symptoms were resolved or improved in all but 1 patient, who had concurrent polyneuropathy. The distance between the odontoid and CMJ increased by 2.34 +/- 0.43 mm (p = 0.03). A small, clinically insignificant fragment remained after surgery, always on the left side, in 57% of patients. Mean times to extubation and oral feeding were on postoperative Days 0.3 and 1, respectively. There was one posterior cervical wound infection; there were 2 cases of epistaxis requiring repacking of the nose and no instances of breathing or swallowing complications or velopharyngeal insufficiency. Con clusions This series of 9 cases of endonasal endoscopic odontoidectomy highlights the advantages of the approach in permitting earl

Object The gold-standard surgical approach to the odontoid is via the transoral route. This approach necessitates opening of the oropharynx and is associated with risks of infection, and swallowing and breathing complications. The endoscopic endonasal approach has the potential to reduce these complications as the oral cavity is avoided. There are fewer than 25 such cases reported to date. The authors present a consecutive, single-institution series of 9 patients who underwent the endonasal endoscopic approach to the odontoid. Methods The charts of 9 patients who underwent endonasal endoscopic surgery to the odontoid between January 2005 and August 2013 were reviewed. The clinical presentation, radiographic findings, surgical management, complications, and outcome, particularly with respect to time to extubation and feeding, were analyzed. Radiographic measurements of the distance between the back of the odontoid and the front of the cervicomedullary junction (CMJ) were calculated, as well as the location of any residual bone fragments. Results There were 7 adult and 2 pediatric patients in this series. The mean age of the adults was 54.8 years; the pediatric patients were 7 and 14 years. There were 5 females and 4 males. The mean follow-up was 42.9 months. Symptoms were resolved or improved in all but 1 patient, who had concurrent polyneuropathy. The distance between the odontoid and CMJ increased by 2.34 +/- 0.43 mm (p = 0.03). A small, clinically insignificant fragment remained after surgery, always on the left side, in 57% of patients. Mean times to extubation and oral feeding were on postoperative Days 0.3 and 1, respectively. There was one posterior cervical wound infection; there were 2 cases of epistaxis requiring repacking of the nose and no instances of breathing or swallowing complications or velopharyngeal insufficiency. Con clusions This series of 9 cases of endonasal endoscopic odontoidectomy highlights the advantages of the approach in permitting earl

Endonasal endoscopic sinus surgery is the standard procedure for surgery of most paranasal sinus diseases. Appropriate frame conditions provided, the respective procedures are safe and successful.These prerequisites encompass appropriate technical equipment, anatomical oriented surgical technique, proper patient selection, and individually adapted extent of surgery. The range of endonasal sinus operations has dramatically increased during the last 20 years and reaches from partial uncinectomy to pansinus surgery with extended surgery of the frontal (Draf type III), maxillary (grade 3-4, medial maxillectomy, prelacrimal approach) and sphenoid sinus.In addition there are operations outside and beyond the paranasal sinuses. The development of surgical technique is still constantly evolving. This article gives a comprehensive review on the most recent state of the art in endoscopic sinus surgery according to the literature with the following aspects: principles and fundamentals, surgical techniques, indications, outcome, postoperative care, nasal packing and stents, technical equipment.

AimTo describe the prevalence, diagnosis, treatment, and outcomes of end stage liver disease (ESLD) patients with severe epistaxis thought to be severe upper gastrointestinal hemorrhage (UGIH).MethodsThis observational single center study included all consecutive patients with ESLD and epistaxis identified from consecutive subjects hospitalized with suspected UGIH and prospectively enrolled in our databases of severe UGIH between 1998 and 2011.ResultsA total of 1249 patients were registered for severe UGIH in the data basis, 461 (36.9%) were cirrhotics. Epistaxis rather than UGIH was the bleeding source in 20 patients. All patients had severe coagulopathy. Epistaxis was initially controlled in all cases. Fifteen (75%) subjects required posterior nasal packing and 2 (10%) embolization in addition to correction of coagulopathy. Five (25%) patients died in the hospital, 12 (60%) received orthotopic liver transplantation (OLT), and 3 (15%) were discharged without OLT. The mortality rate was 63% in patients without OLT.ConclusionSevere epistaxis in patients with ESLD is (1) a diagnosis of exclusion that requires upper endoscopy to exclude severe UGIH; and (2) associated with a high mortality rate in patients not receiving OLT.

Nasal packs are indispensable in ENT practice. This study reviews current indications, effectiveness and risks of nasal packs and stents. In endoscopic surgery, nasal packs should always have smooth surfaces to minimize mucosal damage, improve wound healing and increase patient comfort. Functional endoscopic endonasal sinus surgery allows the use of modern nasal packs, since pressure is no longer required. So called hemostatic/resorbable materials are a first step in this direction. However, they may lead to adhesions and foreign body reactions in mucosal membranes. Simple occlusion is an effective method for creating a moist milieu for improved wound healing and avoiding dryness. Stenting of the frontal sinus is recommended if surgery fails to produce a wide, physiologically shaped drainage path that is sufficiently covered by intact tissue.