JIIMC March 2016.cdr


ORIGINAL ARTICLE

ABSTRACT
Objective: To determine the efficacy of nasal splints in preventing adhesion formation in patients undergoing 
septoplasty for deviated nasal septum (DNS).
Study Design: Quasi experimental study.
Place and Duration of Study: The study was carried out at ENT department, Holy Family Hospital, Rawalpindi 
from January 2010 to January 2011.
Materials and Methods: Two hundred and sixty patients with DNS requiring septoplasty were included in this 
study. They were divided in two groups A and B with each group consisting of 130 patients. In group A splints 
were used postoperatively after septoplasty while in group B no splints were used. In group A nasal splints were 
removed on 14th postoperative day. All patients in group A and B were followed up regularly in OPD for six 
weeks for development of adhesions to determine efficacy of nasal splints in prevention of adhesions.
Results: In group A average age was 29.13 years+10.11SD while it was 27.6 years+ 9.5SD in group B. Male to 
female ratio was 1.15:1.  There was no statistically significant difference in the incidence of adhesion formation 
between two groups with p-value of 0.734.
Conclusion: There is no significant advantage of routinely using intranasal splints in septoplasty patients for 
prevention of adhesion formation.

Key Words: Nasal Splints, Septoplasty, DNS.

done worldwide over the years to determine the 
efficacy of intranasal splints in prevention of 

6, 7, 8
intranasal adhesions to justify their use.
Although many surgeons insert nasal splints 
routinely, no well-designed trials exist to support 

3
their use.  The nasal splint increases the post-

6,7
operative pain and discomfort. Although splints are 
in common practice but their use has shown limited 
benefit in terms of prevention of adhesions when 

6
compared withseptoplasty patients without splints.  
So in this study we tried to find out efficacy of nasal 
splints in prevention of nasal adhesions to justify 
their routine use in patients undergoing septoplasty 
in our set up.

Materials and Methods
It is a quasi experimental study carried out in 
department of Ear, Nose and Throat of Holy Family 
Hospital, Rawalpindi from January 2010 to January 
2011. Patient coming in outpatient department in 
age group of 16 to 50 years who were diagnosed with 
deviated nasal septum by anterior rhinoscopy were 
included in the study. Patients with turbinate 
hypertrophy, nasal polyps, previous surgeries or 
requiring other lateral wall nasal procedures or 
having comorbids like diabetes or hypertension were 
not included.
Two hundered and sixty patients with DNS requiring 

Introduction
Deviated nasal septum is one of the most common 
ENT complaints and is treated by performing 

1
septoplasty.  Formation of intranasal adhesions is an 
i m p o r t a n t  p o s t o p e r a t i v e  c o m p l i c a t i o n  o f  

1,2,3
septoplasty with an incidence of 10-36%.  
Rhinologists all over the world routinely use 
intranasal splints after nasal septal surgery to 
prevent the adhesions and also tomaintain nasal 
stability and improve the results of septoplasty. This 
use of intranasal splints is not evidence based and 
splints are associated with increased pain and 

3,4,5
discomfort to patient.  Many studies have been 

Efficacy of Nasal Splints in Reducing the Incidence of Intranasal
Adhesions Following Septoplasty

1 2 3 4
Kashif Mahmood , Mirza Nasheed Baig , Nayyer Ayub , Tabassum Aziz

Efficacy of Nasal Splints following SeptoplastyJIIMC 2016 Vol. 11, No.1  

Correspondence:
Dr. Mirza Nasheed Baig
Assistant Professor, Otorhinolaryngology
Fouji Foundation Hospital
Foundation University Medical College, Islamabad
Email: drnasheed@hotmail.com

1
ENT Department

Aziz Bhatti Shaheed Teaching Hospital, Gujrat
2
ENT Department

Fouji Foundation Hospital
Foundation University Medical College, Islamabad 
3
ENT Department

Islamic International Medical College
Riphah International University, Islamabad
4
ENT Department

Holy Family Hospital, Rawalpindi

Funding Source: NIL ; Conflict of Interest: NIL
Received: November 20, 2015; Accepted: January 10, 2016

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septoplasty were admitted in the ward. The purpose 
and benefits of the study was explained to patients 
and a written informed consent was obtained. All 
patients were worked up with detailed history and 
clinical examination followed by routine pre 
operative investigations. The patients were 
randomly allocated in two groups by convenient 
sampling technique. Patients in group A were 
subjected to use of splints after septoplasty and in 
patients in group B no splints were used after 
septoplasty. 
All patients were operated by the same ENT surgeon 
having five years of experience in nasal surgery. After 
surgery nasal packing was removed after 24 hours 
and patients were discharged on 2nd postoperative 
day. Patients in both groups were given same oral 
antibiotic and analgesic for one week. Both groups 
were advised saline nasal douches three times a day 
for two weeks. In group A nasal splints were removed 
on 14 postoperative day. All patients in group A and B 
were followed up weekly in OPD till 6th week post 
operatively to determine intervention efficacy in 
terms of absence of adhesions.
All the above mentioned data was collected using 
performa. Data was analyzed by using SPSS version 
20. Mean and standard deviation were calculated for 
age. Frequencies and percentages were calculated 
for gender and efficacy. Chi square test was used to 
compare the efficacy in both the groups. P value of 
<0.05 was considered significant.

Results
Average age was 27.6 years+ 9.5SD in group A while 
in group B it was 29.13 years +10.11SD. The age 
distribution among the groups was insignificant with 
p-value 0.860.  Further demographic characteristics 
of both groups A and B are shown in table I and II.
In group A adhesions were seen in four patients 
(3.1%) and in group B five patients developed 
adhesion (3.8%). This difference between two 
groups was insignificant with p-vale of 0.734 (Table 
III).

Discussion
In our study although there is higher incidence of 
adhesions in the non splinted group (Group B) but in 
comparison of the both groups statistically this 
difference was not significant and this may be due to 
intra operative surgical technique and postoperative 
nasal douching with normal saline to prevent crust 
formation and thus formation of adhesions. 
Similar findings were seen in studies of some other 
authors. Tang and Kacker concluded that nasal 
splints cause significantly increased postoperative 
pain and there is not sufficient evidence that they are 
effective in decreasing the incidence of intranasal 

6
adhesions.  Von Schoenberg and Robinson found out 
on three months postoperative follow up  that the 
splinted and non splinted groups had the same low 
rate of adhesion formation of 2% which in their 
opinion was because of early outpatient review with 

8
careful nasal toilet on weekly basis. Cook et al 
showed a failure of intranasal splints in preventing 
intranasal adhesion(6.5% in splinted vs. 7.0% in non 
splinted group) and concluded that there is no clear 
advantage of using intranasal splints and they should 
therefore be used sparingly and  recommended  use 

9
of nasal toilet after septal surgery.  Pringle et al 
carried out a survey of 440 consultants and found 
that 33% of them never or rarely used intranasal 
splints and reported an adhesion rate of 5.2% in non 
splinted patients vs. 3.9% in the splinted patients,  

5
which is not statistically significant. Like wise the 
results of the study done by Malki et al showed no 
statistically significant difference in the incidence of 
adhesions between the splinted and non-splinted 

10
patients. Study of Almoflehi also concluded that the 
intranasal splints are not of significant value in 
preventing nasal adhesion(10% in splinted vs. 21% in 
non splinted group) and recommendation was that 
the use of intranasal splints in septal surgery has to 
be individualized. They stressed on Nasal irrigation 
using saline to prevent crusting and minimizing 

Table I: Age Wise Distribu�on in Group 'A' and 'B'

(P value= 0.860)

Table II: Gender Wise Comparison in Group 'A' and 'B'

(p value=0.901)

Table III:  Adhesion Forma�on in Groups 'A' and 'B'

(p value = 0.734)

Efficacy of Nasal Splints following SeptoplastyJIIMC 2016 Vol. 11, No.1  

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occurrence of adhesion. Almazrou and Zakzouk in 
their study found no significant difference in 
incidence of adhesion formation between splinted 
and non splinted groups (2% in splinted vs. 10% in 

12
non splinted group).
On the other hand contrary to our results Deniz M et 
al. suggested that nasal splints were effective in 

13
reducing the incidence of nasal synechia formation.  
Schoenberg et al. found a low incidence of adhesions 
in the first week post operatively when intranasal 
splints were used and found that the highest 
incidence of intranasal adhesions occurred in non 
splinted patients who had surgery to both walls of 
nasal cavity (3.6% in splinted vs. 31.6% in non 

8
splinted).  Campbell et al. inserted a nasals plint into 
one side of the nose of 106 patients undergoing a 
variety of intranasal procedures. All adhesions 
occurred on the non splinted side and were more 
common when bilateral nasal wall procedures had 
been performed (8% in splinted versus 26% in non 

14
splinted).  They concluded that splints were justified 
for bilateral wall procedures but their increased 
morbidity did not justify their use in single wall 

14
procedures.  Roberto et al. found nasal splints very 
effective inpreventing adhesion formation in 
patients under going septoplasty with turbinectomy 

15
(0% in splinted vs.10.6% in non splinted group).  
Nabil-ur-Rahman concluded that complications 
were related to the type of procedure being 
p e r fo r m e d  a n d  a d h e s i o n s  w e r e  c o m m o n  

16
complication if intranasal splint were not provided.  
The routine use of nasal splints in septoplasty 
patients is still a matter of debate. Splints 
addsignificantly to post operative pain and 
discomfort. It is recommended that their use should 
be individualized depending upon procedure being 
performed. They are more justified when surgical 
procedures are performed on both medial and 
lateral walls of nose simultaneously. Alternati 
velysaline nasal douching and regular outpatient 
follow up with suction toilet are very effective in 
preventing intranasal crusting and thus adhesion 
formation.

Conclusion
There is no significant advantage of using intranasal 
splints routinely in patients undergoing septoplasty 
for prevention of adhesions provided patients are 
closely followed up with saline nasal douches and 
regular nasal toilets.

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