Septoplasti sonrası nazal tampon veya dikiş tekniğinin sistemik oksijen satürasyonu ve hasta konforu üzerine etkisi

Amaç: Septoplasti sonrası konulan intranazal tampon veya tampon konulmaksızın sadece septuma dikiş atılmasının, sistemik oksijen satürasyonu ve hasta konforu üzerine olan etkileri araştırıldı.Hastalar ve Yöntemler: Çalışmaya, izole septum deviyasyonu tanısıyla septoplasti ameliyatı yapılan 37 hasta alındı. On sekiz hastaya intranazal tampon konulurken, 19 hastada septuma dikiş atıldı. Sistemik oksijen satürasyonunu değerlendirmek için, ameliyat öncesi ve sonrası dönemlerde puls oksimetri cihazı ile parsiyel oksijen satürasyonu ölçüldü. İki yöntemin hasta konforuna etkisi, ameliyattan önce, 48 saat sonra, tampon alındıktan beş gün sonra ve ameliyattan 30 gün sonra görsel analog skala ile değerlendirildi.Bulgular: İstatistiksel olarak anlamlı olmasa da, sistemik oksijen satürasyonu dikiş grubunda tampon grubuna göre daha yüksek bulundu p>0.05 . Tampon grubunda anlamlı derecede daha fazla burun tıkanıklığı izlendi p0.05 .Sonuç: Septoplasti ameliyatı sonrası kullanılan intranazal tamponun sistemik oksijen satürasyonunu anlamlı derecede olmasa da, dikiş kullanımından daha fazla düşürmesi ve hasta konforunu olumsuz etkilemesi nedeniyle, özellikle kronik sistemik rahatsızlıkları olan yaşlı hastalarda septuma dikiş atılması daha uygun olabilir

The effect of nasal packing and suture technique on systemic oxygen saturation and patient comfort after septoplasty

Objectives: We investigated the effect of intranasal packing placed after septoplasty or alternatively sutur- ing the septum vvithout inserting a packing on systemic oxygen saturation and patient comfort.Patients and Methods: The study involved 37 patients who undervvent septoplasty for isolated septum deviation.İntranasal packing was used in 18 patients 5 women, 13 men; mean age 30±10 years; range 18 to 47 years , while 19 patients 5 women, 14 men; mean age 31±12 years; range 18 to 54 years undervvent nasal septal suturing.To evaluate systemic oxygen saturations, partial oxygen saturations were measured pre- and postoperatively by pulse oximetry. The effect of intranasal packing and sutur­ ing on patient comfort was assessed by a visual analog scale before and 48 hours after surgery, five days after removal of nasal packing, and 30 days after surgery.Results: Postoperative systemic oxygen saturations exhibited higher levels in the sutured group, but this did not reach significance p>0.05 . The incidence of nasal obstruction was significantly higher with nasal packing p<0.05 . İn general, headache and facial pain were more common with nasal packing, while suturing was associ- ated with a higher frequency of nasal crusting, postnasal discharge, and reduced sense of smell p>0.05 .Conclusion: Considering that, albeit not significantly, intranasal packing used after septoplasty decreases systemic oxygen saturation more than suturing and thus, has more adverse effects on patient comfort, suturing the septum may be a better alternative, particularly in elderly patients with chronic systemic diseases.

___

  • Lee IN, Vukovic L. Hemostatic suture for septoplasty: how we do it. J Otolaryngol 1988;17:54-6.
  • Nunez DA, Martin FW. An evaluation of post-opera- tive packing in nasal septal surgery. Clin Otolaryngol Allied Sci 1991;16:549-50.
  • Thomas DM, Tierney PA, Samuel D, Patel KS. Audit of pain after nasal surgery. Ann R Coll Surg Engl 1996; 78:380-2.
  • Weber R, Keerl R, Hochapfel F, Draf W, Toffel PH. Packing in endonasal surgery. Am J Otolaryngol 2001; 22:306-20.
  • Weber R, Hochapfel F, Draf W. Packing and stents in endonasal surgery. Rhinology 2000;38:49-62.
  • Ogretmenoglu O, Yilmaz T, Rahimi K, Aksoyek S. The effect on arterial blood gases and heart rate of bilat- eral nasal packing. Eur Arch Otorhinolaryngol 2002; 259:63-6.
  • Gottschalk GH. An improved septoplasty: the micro- surgical suture technique. Ann Plast Surg 1978;1:30-3.
  • Reiter D, Alford E, Jabourian Z. Alternatives to pack- ing in septorhinoplasty. Arch Otolaryngol Head Neck Surg 1989;115:1203-5.
  • Jensen PF, Kristensen S, Juul A, Johannessen NW. Episodic nocturnal hypoxia and nasal packs. Clin Otolaryngol Allied Sci 1991;16:433-5.
  • Erpek G, Yorulmaz A. Burun tamponu ve nokturnal oksijen satürasyon ölçümü. KBB Baş Boyun Cerrahisi Dergisi 1997;5:209-11.
  • Yigit O, Cinar U, Uslu B, Akgul G, Topuz E, Dadas B. The effect of nasal packing with or without an air- way on arterial blood gases during sleep. [Article in Turkish] Kulak Burun Bogaz Ihtis Derg 2002;9:347-50.
  • von Schoenberg M, Robinson P, Ryan R. The morbid- ity from nasal splints in 105 patients. Clin Otolaryngol Allied Sci 1992;17:528-30.
  • Bhattacharyya N, Wenokur RK, Goodman ML. Endoscopic excision of a giant pyogenic granuloma of the nasal cavity caused by nasal packing. Rhinology 1997;35:44-5.
  • Sheen TS, Ko JY, Hsu YH. Pyogenic granuloma- an uncommon complication of nasal packing. Am J Rhinol 1997;11:225-7.
  • Yanagisawa E, Latorre R. Choking spells following septorhinoplasty secondary to displaced nasal pack- ing. Ear Nose Throat J 1995;74:744-6.
  • Thompson AC, Crowther JA. Effect of nasal packing on eustachian tube function. J Laryngol Otol 1991; 105:539-40.
  • Yildirim A, Yasar M, Bebek AI, Canbay E, Kunt T. Nasal septal suture technique versus nasal packing after septoplasty. Am J Rhinol 2005;19:599-602.
  • Younis RT, Lazar RH. Delayed toxic shock syn- drome after functional endonasal sinus surgery. Arch Otolaryngol Head Neck Surg 1996;122:83-5.
  • Sessions RB. Membrane approximation by continuous mattress sutures following septoplasty. Laryngoscope 1984;94:702-3.
  • Genc E, Ergin NT, Bilezikci B. Comparison of suture and nasal packing in rabbit noses. Laryngoscope 2004; 114:639-45.
  • Lemmens W, Lemkens P. Septal suturing following nasal septoplasty, a valid alternative for nasal pack- ing? Acta Otorhinolaryngol Belg 2001;55:215-21.
  • von Schoenberg M, Robinson P, Ryan R. Nasal packing after routine nasal surgery-is it justified? J Laryngol Otol 1993;107:902-5.
  • Samad I, Stevens HE, Maloney A. The efficacy of nasal septal surgery. J Otolaryngol 1992;21:88-91.