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| Year : 1995 | Volume
: 41
| Issue : 3 | Page : 70-1 |
Septal splint with wax plates.
DR Nayak, KD Murty, R Balakrishna
Department of ENT, Kasturba Medical College Hospital, Manipal, Karnataka.
Correspondence Address:
D R Nayak
Department of ENT, Kasturba Medical College Hospital, Manipal, Karnataka.
 Source of Support: None, Conflict of Interest: None  | Check |
PMID: 0010707719 
To pack or not to pack, has always been a debate, especially after septal and functional endoscopic sinus surgery. The authors have studied the symptoms of packing versus not packing in their series of 100 patients having undergone nasal surgery. They advocate the use of dental wax for the fashioning of septal splints, since they are easy to introduce, cheap and malleable. The patients postoperative comfort is greatly enhanced with the use of dental wax plate splints instead of nasal packing.
Keywords: Comparative Study, Endoscopy, methods,Human, Nasal Septum, surgery,Paranasal Sinuses, physiopathology,surgery,Patient Satisfaction, Postoperative Care, instrumentation,methods,Sensitivity and Specificity, Splints, Waxes,
How to cite this article:
Nayak D R, Murty K D, Balakrishna R. Septal splint with wax plates. J Postgrad Med 1995;41:70 |
Surgeons have debated since decades on the efficacy or inefficacy of nasal packing. Many packing materials are in vogue namely - BIPP, paraffin gauze, Merocel. Teflon etc Studies have been done to compare packing materials with a view to patient compliance, bleeding and difficulty in removal[1]. The authors have been using dental utility wax for setal splinting after septal surgery, turbinectomy etc, with or without functional endoscopic sinus surgery.
The wax plates are fashioned from dental utility wax, which are sterilised by placing them in 2% glutaraldehyde for atleast 10 hours. The splints are fashioned appropriate to the nasal cavity after surgery [Figure - 1].
A single plate is inserted into each cavity with aid of a Killian's speculum and head light. The plates are coated with antibiotic cream before application. The anterior ends of the wax plates lie at the level of the columella. A catgut stitch is taken through both wax plates including the septum [Figure - 2] about 2.0 cms posterior to the caudal end of the septum using a needle holder as shown in [Figure - 3].
Before introduction of the wax plates, a stab incision is placed on the muco-periosteal flap, towards the floor of the nasal cavity to prevent hematoma formation between the perichondrium and the cartilage. Nasal decongestants are prescribed post operatively for about five days.
The authors have been employing this technique since the last one year as a routine post operative splint after any septal surgery Over 100 nasal surgeries have been performed, namely septoplasty with or without endoscopic sinus surgery, turbinectomy and incision and drainage of hematoma.
Follow up at one year after surgery of 100 patients did not reveal any abnormality in the septum. No synechiae were noted between the septum and the lateral nasal wall. [Table - 1] depicts the post-operative complaints of patients on using nasal pack and nasal wax splints. The only major post-operative problem encountered in this study with septal wax splint is a post-nasal drip. Headache is comparatively less. Post-operative feeling of “heaviness” which is commonly associated with nasal packing is not noted with the use of the splint. Headache was seen in 24 patients with wax splint-age. This is attributed to improper positioning of the wax plate and its intense contact with the middle turbinate at its attachment.
Wax splints should be fashioned appropriate to the nasal cavity. The splints should always be coated with antibiotic cream before introduction, which also helps in lubrication. The splints should slide along the floor of the nasal cavity and should never be forced, Care should be taken to see that the splint stays between the septum and the lateral nasal wall. However, wax splints can also be placed in the middle meatus postoperatively after endoscopic sinus surgery to prevent lateralisation of the middle turbinate, Septal splints should always be anchored together to prevent displacement and to provide adequate pressure on the septum.
Wax splints have the advantage that they do away with nasal packing altogether postoperatively. Hence patients do not face the discomfort of breathing through the mouth. Increased lacrimation, difficulty in swallowing and headache are unheard of with this technique. Nasal cleaning is possible with the wax plates in situ. Wax plate splints have the additional advantage of enabling septal correction and endoscopic sinus surgery to be performed at the same sitting since nasal packing is not required. Nasal packing after FESS may lead to the narrowing of the middle meatus and synechiae formation. Splints are normally removed on the second postoperative day. After wax splint removal, nasal cleaning and anterior rhinoscopy or endoscopy are mandatory to detect any wax debris and hematoma formation.
The utility wax plates are cheap, easily fashioned and malleable. The ease, effectiveness and safety of this technique in addition to the reduced post-operative morbidity, makes it a superior alternative to the nasal packing following septal surgery.
| :: References | |  |
| 1. |
Garth RA, Brightwell AP. A comparison of packing materials used in nasal surgery. Journal of Laryngology and Otology 1994; 108:564-566.  |
| 2. | Robert GC, Dental restoration materials 8th edition. St. Louis: CV Mosby company; 1989, pp 375-395.
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Figures
[Figure - 1], [Figure - 2], [Figure - 3] Tables
[Table - 1]
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| Nayak DR, Balakrishnan R, Hazarika P | | INTERNATIONAL JOURNAL OF PEDIATRIC OTORHINOLARYNGOLOGY. 1998; 46 (3): 171-178 | | [Pubmed] | |
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