Clinical utility of additional non-absorbable nasal packing after septoplasty: a systematic review and meta-analysis

This study evaluated the clinical utility of additional non-absorbable nasal packing when combined with transseptal suturing or septal splints.

A systematic review and meta-analysis was conducted using two analytical frameworks: septal suture plus non-absorbable packing versus septal suture alone or septal suture with absorbable packing, and septal splint plus non-absorbable packing versus septal splint alone or packing alone. Outcomes of interest included postoperative bleeding, septal hematoma, adhesion/synechia formation, postoperative pain, headache, and sleep disturbance.

In the suture-based analysis, additional non-absorbable packing did not significantly reduce postoperative bleeding or septal hematoma formation but was associated with higher rates of headache (odds ratio [OR]: 40.06, 95% confidence interval [CI]: 16.05-99.99) and synechia formation (OR: 2.79, 95% CI: 1.00-7.77). In the splint-based analysis, additional packing did not significantly reduce postoperative hemorrhage or overall adhesion rates. Although splint plus packing reduced adhesion formation compared with packing alone, no advantage was observed compared with splint-only treatment. Additional packing was also associated with significantly higher postoperative pain scores on postoperative days 1 and 7.

Additional non-absorbable nasal packing after septoplasty provides no consistent clinical benefit when effective septal stabilization has already been achieved and is associated with increased postoperative discomfort. These findings do not support the routine use of additional non-absorbable nasal packing following contemporary septoplasty.