To Place or Not To Place A Tampon in The Nose After Rhinoplasty, That Is (Not) The Question!!!
3 December 2019 onur
The subject of tampons is perhaps one of the most frightening issues for rhinoplasty candidates. The basis of this fear is the “former” cloth packings that have left their mark on an era and are driven deep into our collective memory like nails. In the past, cloth tampons at a total length of almost 1 meter, three on the right and left each, were placed inside the nose. It was very difficult to have and remove these packings. Cloth packings absorb blood, harden over time, adhere to clots and often make the nose bleed quite a lot when removed. It was impossible for patients to breathe through those packings. If it was kept in place too long, it would cause both malodor and infection.
Now relax: We don’t use those anymore.
Different types of tampons are temporarily placed in the nose in modern nose jobs.
The most common one is publicly called a “silicone tampon”. In medical terminology, it’s called a “Doyle Splint”. This is a product having the form of an elliptical plate. It has an air channel inside. It is made of soft silicone, is very flexible and slippery, and does not adhere to tissues in any way whatsoever. It is placed and taken off quite effortlessly. We do not place these splints to prevent bleeding in the nose but to provide structural support during the healing process. The plates of the silicone tampon support the cartilage wall (septum) in the medial of the nose from both sides, preventing this structure from bending during the early healing process. In addition, it forms some volume between the septum and the nasal bones and acts as a barrier against the unwanted internal migration of bones. Since silicone tampons are non-adhesive, they are used to prevent possible adhesions between the inner and outer walls in patients who are treated simultaneously on the inner and outer surfaces of nostrils. Silicone tampons do not absorb blood and do not constitute a source of infection. If necessary, they can stay in the nose for even 3-4 weeks without any issues. Since silicone tampons do not absorb water, they can be washed and cleaned with water after intranasal surgery.
It is not required to insert silicone tampons after rhinoplasty, but it is necessary to anticipate the problems that may emerge when nothing is placed. If nothing is placed in the nose after surgery to fill in the volume, it is likely that the mucous layer on the inner surface of the nose will become edematous, swell and completely close the airway. As I mentioned above, there are additional risks such as adhesions in the nose, accumulation of blood under the septal mucosa, and deterioration of the surgically-corrected septum.
If I were a patient, I would not want to take any of these risks just because I was not willing to accept a temporary decrease in comfort. Small details are very important in rhinoplasty, and that’s why I use silicone tampons in almost 95% of my patients. In some surgeries, the risk factors I mentioned above may not occur, and it may not be required to place tampons in such patients. For instance, if we are only doing nasal tip rhinoplasty and we have not done anything inside of the nose, we will definitely not place tampons. As a basic principle, nasal tampons are placed not for the pleasure of surgeons, but as a medical requirement. If you see ads talking of rhinoplasty without tampons, please remember this principle.
When I am performing rhinoplasty, in addition to silicone splints, I place a second tampon called xeroform, only to support the tip of the nose and the wings, to fine-tune this area and shape it like a play dough. I keep this tampon in place for about 48 hours. This second tampon prevents any adhesions at the junction of the nose wing and the nasal tip as well as any notching of this area. It keeps the wings equal for the first 48 hours when they’re at their weakest. These are very fine details but are extremely important to me. I can never find it reasonable to accept a deformity that will catch your eye for the next 50 years, even if it is small, just to make sure you feel comfortable in the first 48 hours after the operation.
In addition to these, I also place a drain that takes out the blood between the bone structure and the skin. Think of it like a thin, soft, plastic discharge canal. This drain is very effective in preventing excessive bruising and long-lasting nasal floor edema after surgery.
During examination, patients are surprised and worried when they find out that 3 different apparatus will be placed in their nose. But believe me, you will never feel them in your nose. On Instagram or other social media platforms, you can reach out to my patients that I have operated and ask them about their post-operative experience as well as their memories about tampons. Rest assured, no fearful dream awaits you.
These are the tampons I prefer in my practice. Apart from these, there are many other products designed for use in nasal surgeries. There are so many because there is a medical need for these products. In addition, every doctor has a unique style. Having read this article, I hope you have realized that the term “tampon-free rhinoplasty” is a marketing strategy fueled by the fears of prospective patients rather than medical and technological innovation.
For more detailed information about tampons, please feel free to contact me.
Take good care…
… of yourself and your beauty.
Assoc. Prof. Ozan Bitik