Outcomes of Septal Surgery with Nasal Packing Versus Quilting Sutures

Abstract

Background: Septoplasty is a common surgical procedure used to correct a deviated nasal septum, which can cause nasal obstruction and impact respiratory function. Postoperative management traditionally includes nasal packing to prevent complications such as bleeding and hematoma, although it can be associated with discomfort and other complications. Quilting sutures have been proposed as an alternative technique to reduce these issues.

Objective: To compare the postoperative outcomes of nasal packing versus quilting sutures in patients undergoing septoplasty.

Methods: This prospective comparative cross-sectional study was conducted at the ENT unit of Combined Military Hospital Rawalpindi, Pakistan, after obtaining ethical approval. The sample size comprised 384 patients, with 192 in the nasal packing group and 192 in the quilting sutures group. Inclusion criteria included patients aged 18 to 70 years undergoing elective nasal septoplasty. Exclusion criteria were patients with nasal polyps, allergic rhinitis, diabetes, coagulation disorders, septal flap tears, those unfit for surgery, and those undergoing combined septoplasty and turbinate intervention. Patients were randomly assigned to either nasal packing or quilting sutures groups. Baseline characteristics, including age, gender, and BMI, were documented. Postoperative assessments were conducted at 48 hours, 1 week, and 3 months, evaluating pain using a visual analogue scale (VAS), bleeding, epiphora, dyspnea, hematoma, and adhesions. Data analysis was performed using SPSS version 26.0, with quantitative data represented as mean ± standard deviation and qualitative data as percentages and frequencies. Statistical significance was determined using chi-square and unpaired two-tailed Student’s t-tests, with p < 0.05 considered significant.

Results: The mean age of participants was 34.37 ± 6.95 years. Gender distribution included 256 males (66.7%) and 128 females (33.3%). At 48 hours postoperatively, the nasal packing group had a higher mean pain score (5.96 ± 1.39) compared to the quilting sutures group (2.03 ± 1.05) (p < 0.001). Bleeding was more significant in the quilting sutures group (1.82 ± 0.60) than in the nasal packing group (1.27 ± 0.45) (p < 0.001). Epiphora and dyspnea were more common in the nasal packing group, with 48 patients (25%) and 81 patients (42.2%), respectively, compared to 8 patients (4.2%) and 6 patients (3.1%) in the quilting sutures group (p < 0.001). Hematoma occurrence was low and not significantly different between the groups. After 1 week, pain scores remained higher in the nasal packing group (1.45 ± 1.12) compared to the quilting sutures group (0.58 ± 0.79) (p < 0.001). At 3 months, pain scores were still higher in the nasal packing group (1.45 ± 1.12) compared to the quilting sutures group (0.58 ± 0.80) (p < 0.001), with no significant difference in adhesion formation.

Conclusion: Quilting sutures resulted in lower postoperative pain and fewer complications compared to nasal packing in patients undergoing septoplasty, despite a slightly higher risk of bleeding. These findings suggest that quilting sutures may be a preferable alternative to nasal packing for postoperative management in septoplasty.