[Comparative analysis of different types of tampons used after septoplasty, conchotomy of the inferior turbinates].

Abstract

In otorhinolaryngology, the question of improving the tactics of early postoperative management in patients who have undergone surgery on the structures of the nasal cavity remains open. The timing of rehabilitation, the possible outcome of postoperative inflammation of the mucous membrane and the patient's ability to work depend on the choice of tactics. The nasal cavity differs from other anatomical areas in its rich blood supply, and therefore the problem of adequate hemostasis in the early stages after undergoing surgical treatment is still extremely relevant.

Objective: To study the methods of postoperative hemostasis and the degree of traumatization of the nasal mucosa when using various types of tamponade in patients who underwent septoplasty and sparing lower conchotomy.

Material and methods: We operated on and examined 40 patients. The patients were divided into four groups: in patients of group 1 (n=10), the operation was completed with nasal cavity tamponade with gauze swabs; in patients of group 2 (n=10), nasal cavity tamponade was performed with Merocel tampons (Medtronic Xomed, Inc., USA); in patients of group 3 (n=10) tamponade was performed with elastic finger tampons; for patients of group 4 (n=10) tamponade was performed with filling hydrotampons. In the postoperative period, the severity of pain during nasal tamponade was assessed using a visual analogue scale (VAS), the volume of nasal blood loss during tampon removal, depending on the type of tamponade, the presence/absence of recurrent nosebleeds in the early postoperative period. To objectively assess the severity of the inflammatory reaction of the nasal mucosa against the background of tamponade, a cytological examination of smear prints from the surface of the tampon was performed.

Results: The severity of pain was insignificant in patients of all four groups. The average VAS score in patients of group 1 (gauze tampons) was 0.94±0.16 points; group 2 (Merocel tampons) - 0.92±0.14 points; group 3 (elastic tampons) - 0.72±0.09 points; group 4 (filling hydrotampons) - 0.96±0.13 points (p<0.05). The volume of blood loss after evacuation of gauze tampons and Merocel tampons was 114.3±35.1 ml and 140.1±22.2 ml, respectively, which exceeded the volume of blood loss when removing elastic tampons (30.4±13.1 ml) and hydrotampons (23.1±11.0 ml) by more than 80%; patients with intranasal elastic tampons and original hydrotampons with internal gluings had no recurrence of bleeding in the early postoperative period, unlike patients with tamponade with gauze turunds and Merocel; according to the results of cytological examination, more pronounced destructive changes in the ciliated epithelium were noted when using gauze turunds and Merocel tampons.

Conclusions: In the first 24 hours after surgery, regardless of the type of tampons used, there was consistent hemostasis and mild pain syndrome - less than 1.0 on a visual analogue scale. The maximum amount of blood loss after evacuation of tampons was noted when using Merocel tampons and gauze turundas, the minimum amount of blood loss was after removal of hydrotampons with internal gluings. The proportion of patients with recurrent bleeding in the early postoperative period after gauze tamponade and Merocel tampons was 10% and 20%, respectively, whereas recurrence of bleeding in patients with original tampons with internal gluings and elastic tampons was not observed.