Our recommendation for postoperative care in patients that have been operated with minimally invasive techniques is to always keep the tissue surrounding the operative area healthy, especially during the procedure itself. This is obtained with fine and atraumatic movements that minimize bleeding. Bloody and eroded zones invariably cause synechia (Fig. 1) that collapse and obstruct drainage sites and in turn will guarantee recurrent sinus disease. We can thus deduce that good aeration of the middle meatus is crucial to avoid synechias and retention of secretions. We have learned from our patients through the years that medializing the middle turbinate with a suture stitch, described by us, is the cornerstone for starting and maintaining the success in postoperative care. Control of transoperative bleeding in patients with simple, yet consistent and systematic methods permits us to complete clean procedures in a nearly bloodless field. If the bleeding is kept scarce, then there is no need to place nasal packing after the procedure. On the other hand we consider that when one places nasal packings, no matter what it is made of, we will cause a local inflammatory reaction that paralyzes the mucociliary transport. This in turn causes bacterial infestation in bloody zones due to retention and accumulation of the secretions around it. We should also not forget that upon removal of the gauzes of the packing, we erode the irritated and denuded walls due to friction; and nasal epithelium that was at one time healed can become bloody again. This slows the healing process by keeping surgical zones compressed by the packing and causing even more paralysis of the mucociliary system in several places in the nasal cavity.
KeywordsNasal Cavity Postoperative Care Toxic Shock Syndrome Middle Turbinate Nasal Packing
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