Mehmet Güven, Öznur Akıdil, Süleyman Cesur, Mahmut Sinan Yılmaz

Septoplasti Sonrası Uygulanan İki Farklı Nazal Tamponun Mukosiliyer Klirens Ve Ameliyat Sonrası Ağrı Üzerine Etkisi

Amaç: Bu çalışmanın amacı septoplasti ameliyatı sonrası kullanılan iki farklı nazal tamponun mukosiliyer aktivite ve vizüel analog skala (VAS) ile değerlendirilen ameliyat sonrası ağrı üzerine etkisinin değerlendirilmesidir. Gereç ve yöntem: Nazal septum deviyasyonu nedeniyle septoplasti ameliyatı uygulanan 39 hasta çalışmaya dahil edildi. Hastaların 20'sine çift taraflı anterior merosel tampon uygulanırken 19'una havayollu silikon nazal septal splint uygulandı. Bütün hastalara ameliyattan önce ve 6 hafta sonra sakkarin ile mukosiliyer klirens testi uygulandı. Ayrıca ameliyat sonrası 1. günde VAS ile burunlarında hissettikleri ağrı değerlendirmesi yapıldı. Bulgular: Merosel tampon uygulanan gruptaki hastaların preoperatif mukosiliyer klirens (MSK) süresi ortalama 13.05±2.9, postoperatif mukosilyer klirens süresi 11.65±2.5, VAS 3.5±1.3 olarak tespit edilmiştir. Mukosiliyer klirens açısından istatistiksel fark olmasa da mukosiliyer klirens zamanında azalma olduğu görülmüştür. Havayollu silikon nazal splint uygulanan gruptaki preoperatif mukosilyer klirens süresi ortalama 12.1±2.5, postoperatif mukosilyer klirens süresi 11.2±2.25, VAS 1.6±1.4 olarak tespit edilmiştir. Havayollu silikon nazal splint kullanılan grubun preoperatif mukosilyer klirens süresi ile postoperatif mukosilyer klirens süresi karşılaştırıldığında anlamlı bir fark saptanmadı. VAS açısından ise havayollu silikon nazal splint lehine istatistiksel olarak anlamlı bir fark bulunmuştur.Sonuç: Septoplasti ameliyatı sonrasında kullanılan anterior merosel tampon ya da havayollu silikon nazal septal splintin mukosiliyer klirensi etkilemediği görüldü. Havayollu nazal septal splintin anteriyor merosel tampona göre daha az ağrıya yol açtığı saptandı.

Anahtar Kelimeler:

Nazal septum deviyasyonu, Mukosiliyer klirens zamanı, Vizüel analog skala

The Effect Of Two Different Nasal Packings Applied After Septoplasty On Mucociliary Activity And The Pain Score

Objective: This study aims to evaluate the effect of two different nasal packings applied after septoplasty on mucociliary activity and the pain score evaluated by visual analog scale. Materials and methods: 39 consecutive patients who underwent septoplasty were randomized into two groups. After septoplasty bilateral anterior Merocel nasal packs were applied in one group, while silicon nasal septal splints were applied in the other group. All of the patients underwent mucociliary clearance test preoperatively and 6 weeks postoperatively with saccharine. Also they were asked to score the pain in their nose by using the visual analog scale at postoperative first day. Results: In Merocel packing group, the patients have had preoperative mucociliary clearance time approximately 13.05±2.9 minute, postoperative mucociliary clearance time 11.65±2.5 minute and visual analog score 3.5±1.3. Although there was no statistically significant difference on mucociliary clearance, decrease on mucociliary clearance time was seen. In silicone nasal splint group, the patients have had preoperative mucociliary clearance times approximately 12.1±2.5 minute, postoperative mucociliary clearance time 11.2±2.25 minute and visual analog score 1.6±1.4. There was no statistically significant difference on postoperative mucociliary clearance time compared to preoperative mucociliary clearance time in silicon nasal splint group. Besides, there was statistically significant difference on visual analog score in silicon nasal splint group.Conclusion: The nasal packing used after septoplasty, whether it is anterior Merocel packing or silicon nasal splint, has no effect on mucociliary clearance. Besides, silicon nasal splints cause lesser pain than Merocel nasal packs after septoplasty.

Keywords:

Nasal septum deviation, Mucociliary clearance time, Visual analog scala.,

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Lale AM, Mason JD, Jones NS: Mucociliary transport and its assessment: a review. Clin Otolaryngol 1998;23: 388-96
Kleinschmidt EG, Witt G: Evaluation of nasal mucociliary clearance with a modified saccharin test, Laryngorhinootologie. 1995;74:286-8
Armengot M, Basterra J, Garín L: Normal values of nasal mucociliary clearance. Comparison of various techniques and substances. Acta Otorrinolaringol Esp. 1990;41:333-6.
Jang YJ, Myong NH, Park KH, Koo TW, Kim HG: Mucociliary transport and histologic characteristics of the mucosa of deviated nasal septum. Arch Otolaryngol Head Neck Surg. 2002;128:421-4
Shaw CL, Dymock RB, Cowin A, Wormald PJ: Effect of packing on nasal mucosa of sheep. J Laryngol Otol. 2000;114:506-9.
Toskala E, Nuutinen J, Rautiainen M, Torkkeli T: The correlation of mucociliary transport and scanning electron microscopy of nasal mucosa, Acta Otolaryngol. 1995;115:61-5
Ginzel A, Illum P: Nasal mucoliliary clearance in patients with septal deviation. Rhinology 1980;18:177-81.
Inagi K: Histological study of mucous membranes in the human nasal septum. Nippon Jibiikoka Gakkai Kaiho 1992;95:1174-89.
Nunez DA, Martin FW: An evaluation of post-operative packing in nasal septal surgery. Clin Otolaryngol Allied Sci 1991;16:549-50.
Bajaj Y, Kanatas AN, Carr S, Sethi N, Kelly G: Is nasal packing really required after septoplasty? Int J Clin Pract. 2009;63:757-9.
Ohashi Y, Nakai Y, Ikeoka H, Furuya H: Regeneration of nasal mucosa following mechanical injury. Acta Otolaryngol Suppl 1991;486:193-201.
Kula M, Yuce I, Unlu Y, Tutus A, Cagli S, Ketenci I: Effect of nasal packing and haemostatic septal suture on mucociliary activity after septoplasty: an assessment by rhinoscintigraphy. Eur Arch Otorhinolaryngol 2010;267:541-6.
Nunez DA, Martin FW: An evaluation of post-operative packing in nasal septal surgery. Clin otolaryngology 1991:16: 549–50.
Ardehali MM, Bastaninejad S: Use of nasal packs and intranasal septal splints following septoplasty. Int J Oral Maxillofac Surg. 2009;38:1022–4.