Nasal Adhesions – A New Perspective

Abstract

Objective: The objective of the study is to explore various causes of adhesions or faults what different surgeons commonly do and how to combat this problem. Study design: Randomized Control Trial. Settings: ENT Unit-I, Allied Hospital, Faisalabad. Duration: July, 2016 to June, 2018. Methodology: 500 patients undergoing septoplasty and SMR, over a period of 2 years were included in this study. Those requiring combination procedures were excluded. The study involved 400 males and 100 females. The age range was 15-75 years with a mean age of 34 years. All patients had a pre-operative nasal packing by undertraining medical officers using a roll gauze soaked in 4% Xylocaine with Topical Adrenaline 1:1000 in a ratio of 50:50 half an hour before surgery. 300 cases were operated under local anesthesia with no intravenous supplement and the remaining 200 under General Anesthesia. Results: 20 patients (04%) presented with adhesions out of which 15 were operated under General Anesthesia and 5 under local anesthesia. All these patients belonged to the non-splinted group. 07 patients (1.4%) complained of slight discomfort due to splints particularly those made of the cut drips. 03 patients (0.6%) complained of the unsightly look of the anterior ends of the splints as they were secured with stitches over the columella. Crust formation was the main problem encountered during the splinting period. Conclusion: Splints have been found to be very effective in preventing adhesion formation which are sometimes very troublesome. However, because of the very low incidence, (04%) in our studies compared to (8.1%) in other series after a single procedure on the nose, one must be very cautious in placing splints and should be placed where the surgeon strongly fears the formation of adhesions, such as in difficult cases. Suggestions: Prevention from unwanted adhesions is the best strategy to avoid adhesions.