Packing and stents in endonasal surgery.

Nasal packing is used primarily to control bleeding in epistaxis and after surgical procedures to the nose such as septoplasty, turbinate and paranasal sinus surgery. It is also used for internal stabilisation after operations involving the cartilaginous-bony skeleton of the nose. Apart from haemostasis, packing is used to prevent synechiae or restenosis, particularly after surgery. Generally accepted standards regarding the materials which should be used for packing, how long the packing should be left in place or the indications for nasal packing are lacking (Egelund and Jeppessen, 1992; Hosemann, 1996; Weber et al., 1996b). For example, many authors do not use packing at all provided that there is no heavy bleeding during or after the operation. Of those who use packing, some remove it on the day of the operation, others up to 5 days postoperatively (for overview see Weber et al., 1996b). Most publications describe experience with packing materials developed or preferred by the authors. Results of comparative studies on the nature and duration of packing are listed in Table 1. The currently available materials are reviewed and their respective properties, indications and risks are outlined.