jr Journal of Rhinology J Rhinol 1229-1498 2384-4361 Journal of Rhinology 10.18787/jr.2018.25.2.86 jr-25-86 ORIGINAL ARTICLE Effectiveness of Polyvinyl Acetate Sheeted with Carboxymethyl Cellulose as a Packing Material after Septoplasty KimSung-DongMD KimDongwonMD KimDeok-SooMD KimJi-aMD LeeDong-JooMD ChoKyu-SupMD Department of Otorhinolaryngology-Head and Neck Surgery, Pusan National University School of Medicine, Pusan National University Hospital, Busan, Korea 교신저자：조규섭, 49241 부산광역시 서구 구덕로 179 부산대학교 의학전문대학원 부산대학교병원 이비인후과학교실 Tel: +82-51-240-7824, Fax: +82-51-246-8668, E-mail: choks@pusan.ac.kr 012018 19012018 25286 90 12022018 29052018 25082018 Copyright © 2018 Journal of Rhinology 2018 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. Background and Objectives:

Although polyvinyl acetate (Merocel®) has been widely used as a packing material after septoplasty, removable nasal packing can increase patient discomfort, local pain, and pressure. Furthermore, the removal of nasal packing has been described as the most uncomfortable and distressing feature associated with septoplasty. The purpose of this study was to investigate the efficacy of polyvinyl acetate with carboxymethyl cellulose sheet (Rhinocel®) nasal packing on patient subjective symptoms, degree of bleeding, hemostasis, and wound healing following septoplasty.

 Subjects and Method:

Forty patients with nasal septum deviation requiring septoplasty were included. Following surgery, one nasal cavity was packed with Rhinocel® and the other one with Merocel®. Patient subjective symptoms while the packing was in situ, hemostatic properties, pain on removal, degree of bleeding on removal, duration of hemostasis after removal, postoperative wound healing, and the cost of the pack were evaluated.

 Results:

Although the two types of packing materials were equally effective in controlling postoperative bleeding after septoplasty, Rhinocel® was significantly more comfortable while in situ and less painful on removal than Merocel®, which was associated with significantly more bleeding on removal and so more time was needed to control hemorrhage. There was no significant difference in postoperative wound healing or pack cost.

 Conclusion:

The use of Rhinocel® after septoplasty has less discomfort, greater patient satisfaction, and less bleeding on removal with no adverse reactions compared to Merocel® packing. Therefore, Rhinocel® may be a useful packing material after septoplasty.

 Carboxymethylcellulose sodium Biocompatible materials Nose Septoplasty Postoperative care Pain Polyvinyl acetate. REFERENCESWeber R Hochapfel F Draf W Packing and stents in endonasal surgery Rhinology 200038 4962 Ozcan C Vayisoglu Y Kilic S Gorur K Comparison of rapid rhino and merocel nasal packs in endonasal septal surgery J Otolaryngol Head Neck Surg 200837 82631 Chandra RK Kern RC Advantages and disadvantages of topical packing in endoscopic sinus surgery Curr Opin Otolaryngol Head Neck Surg 200412 216 von Schoenberg M Robinson P Ryan R Nasal packing after routine nasal surgery-is it justified? J Laryngol Otol 1993107 9025 Cho KS Shin SK Lee JH Kim JY Koo SK Kim YW The efficacy of Cutanplast nasal packing after endoscopic sinus surgery: a prospective, randomized, controlled trial Laryngoscope 2013123 5648 Hajosch R Suckfuell M Oesser S Ahlers M Flechsenhar K Schloss-hauer B A novel gelatin sponge for accelerated hemostasis J Biomed Mater Res B Appl Biomater 201094 3729 Cenni E Ciapetti G Stea S Corradini A Carozzi F Biocompatibility and performance in vitro of a hemostatic gelatin sponge J Biomater Sci Polym Ed 200011 68599 Cho KS Park CH Hong SL Kim MJ Kim JY Kim YW Comparative analysis of Cutanplast and Spongostan nasal packing after endoscopic sinus surgery: a prospective, randomized, multi-center study Eur Arch Otorhinolaryngol 2015272 1699705 Hong SL Cho KS Absorbable packing materials in the nasal cavity following sinonasal surgery J Rhinol 201421 8591 Banglawala SM Gill M Sommer DD Psaltis A Schlosser R Gupta M Is nasal packing necessary after septoplasty? A meta-analysis Int Forum Allergy Rhinol 20133 41824 Dubin MR Pletcher SD Postoperative packing after septoplasty: is it necessary? Otolaryngol Clin North Am 200942 27985 Mehta U Huber TC Sindwani R Patient expectations and recovery following endoscopic sinus surgery Otolaryngol Head Neck Surg 2006134 4837 Valentine R Wormald PJ Sindwani R Advances in absorbable biomaterials and nasal packing Otolaryngol Clin North Am 200942 81328 Wee JH Lee CH Rhee CS Kim JW Comparison between Gelfoam packing and no packing after endoscopic sinus surgery in the same patients Eur Arch Otorhinolaryngol 2012269 897903 Acioglu E Edizer DT Yigit O Onur F Alkan Z Nasal septal packing: which one? Eur Arch Otorhinolaryngol 2012269 177781 Chheda N Katz AE Gynizio L Singer AJ The pain of nasal tampon removal after nasal surgery: a randomized control trial Otolaryngol Head Neck Surg 2009140 2157 Weber RK Nasal packing and stenting GMS Curr Top Otorhinolar yngol Head Neck Surg 20098 Doc02 Ohta S Nishiyama T Sakoda M Machioka K Fuke M Ichimura S Development of carboxymethyl cellulose nonwoven sheet as a novel hemostatic agent J Biosci Bioeng 2015119 71823 Szczygielski K Rapiejko P Wojdas A Jurkiewicz D Use of CMC foam sinus dressing in FESS Eur Arch Otorhinolaryngol 2010267 53740 Tables

Analysis of postoperative outcomes between Merocel and Rhinocel packing

Parameter Type Mean±SD p-value
불편감(POD 0) Merocel 5.76±2.52 0.024
Rhinocel 5.33±2.79  
코막힘(POD 0) Merocel 7.21±2.21 0.038
Rhinocel 6.45±2.64  
불편감(POD 1) Merocel 4.91±2.22 0.027
Rhinocel 4.42±2.43  
코막힘(POD 1) Merocel 6.21±2.99 0.353
Rhinocel 5.91±2.88  
패킹 동안 출혈 Merocel 1.45±0.61 0.002
Rhinocel 1.09±0.52  
패킹 제거 시 통증 Merocel 6.30±2.33 <0.001
Rhinocel 4.21±2.38  
패킹 제거 후 출혈 Merocel 1.42±0.75 <0.001
Rhinocel 0.73±0.45  
패킹 제거 후 지혈시간 Merocel 1.21±0.92 0.001
Rhinocel 0.73±0.76  

Data are expressed ad the mean±SD. POD: postoperative day

Postoperative healing assessment between Merocel and Rhinocel packing

POD Type Mean±SD p-value
7 Merocel 1.81±0.52 0.714
Rhinocel 1.70±0.56  
14 Merocel 1.21±0.31 0.328
Rhinocel 1.02±0.24  
28 Merocel 1.00±0.00 1.000
Rhinocel 1.00±0.07  

Data are expressed as the mean±SD. POD: postoperative day