Comparative Study of Septal Quilting Sutures, Nasal Packing, and Internal Nasal Splints in Septoplasty

Comparative Study of Septal Quilting Sutures, Nasal Packing, and Internal Nasal Splints in Septoplasty | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Comparative Study of Septal Quilting Sutures, Nasal Packing, and Internal Nasal Splints in Septoplasty Ahmed Abdoo Elzhzahy, Hossam El Sayed El sisi, Hazem Emam Amer, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7950312/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background Nasal septal deviation is a highly prevalent condition and represents a major contributor to nasal airway obstruction, with reported occurrence in up to 80% of individuals. Aim To compare the outcomes of septal quilting sutures, nasal packing, and internal nasal splints in septoplasty with respect to postoperative headache, pain, sleep disturbance, bleeding, hematoma, epiphora, synechia, and crusting. Patients and Methods This randomized prospective comparative clinical study included 60 patients with symptomatic deviated nasal septum causing persistent nasal obstruction. Patients were recruited from the Otorhinolaryngology Outpatient Clinic, Mansoura University Hospital, between November 2021 and November 2022. Participants were randomly assigned to undergo septoplasty with either quilting sutures, nasal packing, or internal nasal splints. Postoperative outcomes were assessed using the Visual Analogue Scale (VAS) on postoperative days (POD) 2 and 7. Results No significant differences were observed among the three groups regarding age or sex distribution ( P > 0.05). On the 2nd postoperative day, patients who underwent septoplasty with Merocel nasal packing (Group B) reported significantly higher pain, bleeding, headache, epiphora, and sleep disturbance scores compared with those managed with quilting sutures (Group A) or silicone nasal splints (Group C) ( P < 0.001). By the 21st postoperative day, Group B demonstrated the highest incidence of crustation and synechiae, whereas Group A showed the least postoperative morbidity. Conclusion Quilting sutures following septoplasty were associated with significantly lower postoperative pain, bleeding, and nasal complications compared with Merocel nasal packing or silicone splints. This technique offers superior patient comfort and promotes better mucosal healing, making it a preferable alternative to traditional nasal packing methods. Septal quilting sutures nasal packing internal nasal splint septoplasty 1. Introduction Septal deviation is one of the most common causes of nasal obstruction, reported in up to 80% of the general population. While many cases remain asymptomatic, the severity of the deviation does not always correlate with the degree of obstruction, creating a diagnostic dilemma for both patients and surgeons. Postoperative satisfaction following septoplasty has been reported to range between 65% and 80% [ 1 ]. Septoplasty is among the most frequently performed procedures in rhinology and facial plastic surgery. Its primary objective is to relieve nasal obstruction; however, it also provides a superior surgical corridor for endoscopic sinus and skull base surgery, and facilitates subsequent therapeutic interventions. Septal deviation may involve the bony septum, the cartilaginous septum, or both. The deviation can manifest as angulation, twisting, tilting, curvature, spur formation, or a combination of these patterns. Consequently, no single standardized surgical technique can address the full spectrum of anatomical variations encountered in clinical practice [ 2 ]. Despite its effectiveness, septoplasty may be associated with complications such as postoperative bleeding, septal perforation, synechia, and septal hematoma [ 3 ]. Traditionally, nasal packing has been employed to reduce these risks, and many surgeons continue to advocate its use [ 4 ]. Various packing materials have been described, including medicated or plain gauze, foam, cellulose, absorbable gelatin sponges, Merocel, internal nasal splints, and polyethylene oxide gel [ 5 ]. However, the evidence supporting routine postoperative nasal packing is limited, and removal is often associated with significant patient discomfort. As a result, many authors recommend avoiding nasal packs whenever possible, with septal quilting sutures proposed as an effective alternative for securing mucosal flaps [ 6 ]. Another substitute for nasal packing is the use of silicone septal splints, with or without an airway, which may help prevent synechia and maintain septal stability following surgery [ 7 ]. The aim of the present study was to compare septal quilting sutures, nasal packing, and internal nasal splints in septoplasty with respect to postoperative headache, pain, sleep disturbance, bleeding, hematoma, epiphora, synechia, and crusting. 2. Patients and methods 2.1. Study Design and Setting: This prospective, randomized, comparative clinical study included 60 patients presenting with symptomatic nasal septal deviation associated with ongoing nasal obstruction. Participants were enrolled from the Otorhinolaryngology outpatient clinic at Mansoura University Hospital, Egypt, over the period from November 2021 to November 2022. Ethical approval for the study was obtained from the Institutional Review Board of the Faculty of Medicine, Mansoura University. All patients provided written informed consent prior to participation, with strict measures taken to ensure data confidentiality. 2.2. Inclusion Criteria: Patients aged > 16 years with unilateral or bilateral nasal obstruction due to septal deviation and requiring septoplasty. 2.3. Exclusion Criteria: Patients aged < 16 years, with a history of previous nasal surgery, nasal or sinus pathology (e.g., polyposis, inferior turbinate hypertrophy, benign tumors), comorbidities (diabetes mellitus, systemic hypertension, cardiac disease), craniofacial anomalies, immunodeficiency disorders, or inability to provide informed consent. 2.4. Randomization and Groups: Eligible patients were randomly assigned into three equal groups (n = 20 each) using a computer-generated randomization list with simple random allocation. Group A underwent septoplasty with septal quilting sutures, Group B underwent septoplasty with bilateral intranasal packing using Merocel, and Group C underwent septoplasty with internal silicone nasal splints. 2.5. Surgical Technique: All procedures were performed under general anesthesia with bilateral submucosal infiltration of 1:100,000 epinephrine, followed by a caudal septal incision on the left side, elevation of mucoperiosteal and mucoperichondrial flaps, and correction of cartilaginous and bony deviations using chondrotomies as needed. In Group A (quilting sutures), the septal incision was closed and mucosal flaps were approximated using 4 − 0 Vicryl mattress quilting sutures placed from posterior to anterior, with the knot secured on the contralateral side. In Group B (nasal packing), closure of the hemitransfixion incision with 5 − 0 Vicryl was followed by the insertion of bilateral Merocel packs (8–10 cm, UNIPORE), which were removed after 48 hours. In Group C (internal nasal splints), after closure of the incision, bilateral silicone splints were inserted and fixed with a single trans-septal suture, and subsequently removed on postoperative day 7. 2.6. Postoperative Care and Follow-up: All patients received parenteral ceftriaxone (1 g) and analgesia according to pain severity immediately postoperatively, followed by oral antibiotics (amoxicillin-clavulanic acid 1 g twice daily for 8 days) and saline nasal irrigation. Follow-up assessments were scheduled on POD 2, 7, and 21: POD 2 : Removal of nasal packs (Group A), reassessment of pain using the Visual Analogue Scale (VAS), evaluation of bleeding, headache, epiphora, swallowing difficulty, and sleep disturbance. Patients in Groups B and C underwent local nasal examination to clear clots or crusts. POD 7 : Removal of silicone splints (Group C) and endoscopic examination to detect infection, septal hematoma, edema, crusting, or granulation. POD 21 : Final endoscopic evaluation for infection, hematoma, synechia, and granulation tissue. 2.7. Statistical Analysis Statistical analysis was performed using methods appropriate to the nature and distribution of the data. The normality of continuous variables was first evaluated using the Shapiro–Wilk test. Variables with normal distribution (such as age), expressed as mean ± standard deviation, were compared across the three groups using one-way analysis of variance (ANOVA). Categorical data, including sex and endoscopic findings, were analyzed using the chi-square test; Fisher’s exact test was utilized when expected frequencies were less than five. Non-normally distributed and ordinal variables—such as postoperative pain, bleeding, headache, epiphora, and sleep disturbance measured by the visual analogue scale (VAS)—were presented as median and interquartile range (IQR). Differences among groups for these variables were assessed using the Kruskal–Wallis test. When significant differences were detected, pairwise comparisons were performed using the Mann–Whitney U test with Bonferroni adjustment to control for multiple comparisons. A P value of less than 0.05 was considered indicative of statistical significance. 3. Results 3.1. Demographic Characteristics The baseline demographic characteristics of the study groups are summarized in Table 1 . No statistically significant differences were identified among the three groups with respect to age or sex (P > 0.05), confirming their comparability at baseline. 3.2. Postoperative Symptoms on the 2nd Postoperative Day The comparison of pain, bleeding, headache, epiphora, and sleep disturbance scores on the 2nd postoperative day (POD) is shown in Table 2 . Group B demonstrated significantly higher Visual Analogue Scale (VAS) scores for all assessed parameters compared with Groups A and C ( P < 0.001). Group C showed intermediate symptom severity, significantly lower than Group B but slightly higher than Group A for certain symptoms. These findings indicate that patients in Group B experienced more pronounced early postoperative discomfort and nasal symptoms. 3.3. Postoperative Symptoms on the 7th Postoperative Day As shown in Table 3 , all groups demonstrated substantial improvement in postoperative symptoms by the 7th POD. Pain and sleep disturbance remained significantly higher in Group B compared with the other groups ( P < 0.05). Group C reported mild residual bleeding, which was statistically higher than in Groups A and B ( P < 0.001). No significant differences were observed among the groups regarding headache or epiphora at this stage. 3.4. Endoscopic Findings Endoscopic examination findings at the 7th and 21st PODs are summarized in Table 4 . On the 7th POD, crustation was significantly more frequent in Groups B and C compared with Group A ( P = 0.001). No hematoma or synechia was detected in any group at this point. By the 21st POD, crustation had resolved in all patients; however, synechiae were significantly more frequent in Group B compared with Groups A and C ( P = 0.003). No cases of hematoma were observed during the follow-up period. 4. Discussion The present study demonstrated that postoperative morbidity following septoplasty varied significantly according to the nasal management technique. Patients in the Merocel nasal packing group (Group B) experienced higher pain, bleeding, headache, epiphora, and sleep disturbance scores during the early postoperative period compared with those managed with quilting sutures (Group A) or silicone nasal splints (Group C) . These findings are consistent with previous reports indicating that traditional nasal packing is often associated with increased discomfort, mucosal trauma, and impaired nasal breathing during the immediate postoperative phase. The marked reduction in symptoms observed in the quilting suture group may be attributed to the absence of intranasal foreign material and better stabilization of the septal flaps without excessive pressure on the mucosa. Our findings are consistent with those reported by Arora et al. [ 8 ]., who observed that all 20 patients (100%) who underwent anterior nasal packing experienced severe postoperative discomfort, primarily in the form of pain requiring parenteral analgesia (intramuscular Voveran). Many of these patients were unable to sleep comfortably due to persistent pain and also reported symptoms such as mouth dryness, unpleasant odor, profuse rhinorrhea, headache, and epiphora. In contrast, patients who underwent quilting suturing experienced no significant postoperative discomfort, while only four patients (10%) in the intranasal splint group reported mild pain that was effectively controlled with one or two oral analgesic tablets per day. By the 7th postoperative day , a notable improvement in all groups was observed, yet pain and sleep disturbance scores remained significantly higher among patients who had received Merocel packing. Mild residual bleeding in the silicone splint group may be related to mucosal irritation from the splint edges, although this was transient and self-limiting. These results highlight the importance of selecting a postoperative technique that minimizes trauma and optimizes patient comfort during the early recovery period. Our results align with those reported by Arora et al. [ 8 ], who observed that six patients (30%) who underwent anterior nasal packing developed postoperative crust formation. In contrast, no crusting was noted in patients managed with quilting sutures or nasal splints. Additionally, two patients (10%) in the anterior nasal packing group developed postoperative synechiae, while none of the patients in the quilting or splint groups experienced this complication. Similar trends were described by Ramalingam et al. [ 9 ], who documented a high incidence of crusting among patients receiving nasal packing, particularly during the early postoperative days, whereas the quilting group showed markedly lower rates. Furthermore, synechiae were absent in patients treated with quilting sutures but were relatively common in those undergoing nasal packing. These findings are consistent with those of Thapa et al. [ 6 ], who also reported significantly greater crusting in patients managed with nasal packing. However, it is noteworthy that their study utilized medicated gauze packing rather than Merocel. Nasal packing, regardless of the material used, can cause mucosal trauma, which predisposes to crust formation and, subsequently, the development of synechiae. In line with this, Krishna Prakash et al. [ 10 ]. found that crusting was more prevalent and persisted for an average of two weeks in the nasal packing group. In contrast, quilting of the nasal septum significantly reduced the incidence of these complications, promoting smoother postoperative recovery. Similarly, Joshi et al. [ 11 ] reported a greater incidence of synechiae in the nasal packing group compared with the quilting group, along with additional complications such as dry mouth, sore throat, and vestibulitis, which were confined to patients receiving nasal packing. Importantly, neither group demonstrated significant postoperative bleeding or septal hematoma. In another study by Majeed and Saeed [ 12 ], no major postoperative hemorrhage was observed in either group, and minor bleeding occurred only in a small proportion of patients undergoing nasal packing. No cases of infection or hematoma were reported during early follow-up, and long-term outcomes, including crusting, adhesions, and septal perforation, did not differ significantly between groups. The present study provides a direct, head-to-head comparison of three commonly used postoperative techniques following septoplasty—quilting sutures, Merocel nasal packing, and silicone nasal splints—under standardized surgical conditions. Unlike most previous studies that compared only two modalities, this research offers a comprehensive, three-arm evaluation encompassing both subjective (VAS-based symptom scores) and objective (endoscopic) postoperative outcomes. The study highlights the superior comfort and mucosal healing associated with quilting sutures, emphasizing their potential to replace traditional nasal packing as a standard practice. Furthermore, the inclusion of silicone splints as a third arm adds practical clinical insight, clarifying their intermediate position between comfort and complication rates. This multifaceted approach enhances the clinical relevance and external validity of the findings, providing surgeons with evidence-based guidance for optimizing postoperative care after septoplasty. Nevertheless, several limitations should be considered. The relatively small sample size may restrict the generalizability of the findings, despite achieving adequate statistical power. Second, the study was conducted at a single tertiary center, and all procedures were performed by the same surgical team; while this minimizes technique variability, it may introduce selection or performance bias. Third, the follow-up period was limited to three weeks, focusing primarily on short-term morbidity and healing; long-term outcomes such as septal stability, mucosal remodeling, or recurrence of deviation were not assessed. Finally, VAS scoring relied on patient-reported outcomes, which, although valuable, are inherently subjective and may be influenced by individual pain tolerance and expectations. Future multicenter randomized studies with larger cohorts and extended follow-up are warranted to confirm these findings and evaluate long-term functional outcomes. Conclusion Quilting sutures appear to be a preferable technique at the end of septal surgery, as they are consistently available, quick to perform, and associated with fewer postoperative symptoms compared with nasal packing or intranasal splints. In contrast, nasal packing and silicone splints may not always be readily accessible and are frequently linked to patient discomfort and other adverse effects. Abbreviations Abbreviation Full Term ANOVA Analysis of Variance ENT Ear, Nose, and Throat I/M Intramuscular IRB Institutional Review Board IQR Interquartile Range POD Postoperative Day SD Standard Deviation SPSS Statistical Package for the Social Sciences VAS Visual Analogue Scale Declarations Acknowledgements and conflict of interest statement: i) Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. ii) Conflict of Interest: The authors declare that they have no conflict of interest. iii) The study obtained a Mansoura Faculty of Medicine Institutional Research Board (MFM-IRB) approval. iv) Informed consent: Written informed consent was obtained from all participants enrolled in the study. v) The datasets used and/or analyzed during the current study are saved with the primary investigator to protect confidentiality of participants and available upon reasonable request. vi) Acknowledgement: none Author Contribution A.A.E. and M.E.A. wrote the main manuscript text .H.E.A. and H.E.E. prepared a statistical analysis.All authors reviewed the manuscript. Data Availability The datasets used and/or analyzed during the current study are saved with the primary investigator to protect confidentiality of participants and available upon reasonable request. References Wang W, Lee T, Kohlert S, Kadakia S, Ducic Y (2019) Nasal fractures: the role of primary reduction and secondary revision. Facial Plast Surg 35(6):590–601. 10.1055/s-0039-1700801 Lin YT (2020) Septoplasty: endoscopic and open techniques. Sino-Nasal and Olfactory System Disorders. IntechOpen, London. doi: 10.5772/intechopen.91435 Ansari MA, Islam U, Hirani I, Khayani IAM, Kashmiri ZA (2013) Trans-septal suturing technique without intranasal packing in nasal septal surgery. Pak J Surg 29(2):123–126 Naghibzadeh B, Peyvandi AA, Naghibzadeh G (2011) Does post-septoplasty nasal packing reduce complications? Acta Med Iran 49(1):9–12 Killera S, Padmanabhan D, Viswanatha B (2018) Nasal septal suture technique versus nasal packing after septoplasty: a prospective comparative study. J Otolaryngol ENT Res 10(1):4–6 Thapa N, Pradhan B (2011) Postoperative complications of septal quilting and BIPP packing following septoplasty. J Nepal Health Res Counc 9(2):186–188. 10.33314/jnhrc.v0i0.268 Kim SJ, Chang DS, Choi MS, Lee HY, Pyo JS (2021) Efficacy of nasal septal splints for preventing complications after septoplasty: a meta-analysis. Am J Otolaryngol 42(3):102389. 10.1016/j.amjoto.2020.102389 Arora P, Munjal M, Khurana AS, Munjal S, Saggar T (2020) Comparative study of nasal packs, quilts and splints in septal surgery. Int J Otorhinolaryngol Head Neck Surg 6:1793–1798 Ramalingam V, Venkatesan R, Somasundaram S, Kandasamy K, Rajeswari M (2020) A comparative study between septal quilting sutures without nasal packing and only nasal packing post-septal correction. Indian J Otolaryngol Head Neck Surg 72(2):169–174. 10.1007/s12070-019-01730-x Krishna Prakash K et al (2023) A comparative study between septal quilting sutures without nasal packing and only nasal packing in postoperative septoplasty. IOSR J Dent Med Sci (IOSR-JDMS) 22(2):10–13 Joshi A, Virmani N, Priya R, Behera SK (2022) Trans-septal suturing as an alternative to nasal packing following septoplasty: a prospective study. Int J Pharm Clin Res 14(11):816–823 Majeed SA, Saeed BMN (2022) The efficacy of septal quilting sutures versus nasal packing in septoplasty. Indian J Otolaryngol Head Neck Surg 74(Suppl 2):1713–1717. 10.1007/s12070-021-02865-6 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 06 May, 2026 Reviewers agreed at journal 04 May, 2026 Reviews received at journal 30 Apr, 2026 Reviews received at journal 28 Apr, 2026 Reviewers agreed at journal 12 Apr, 2026 Reviewers agreed at journal 08 Apr, 2026 Reviewers invited by journal 07 Apr, 2026 Submission checks completed at journal 26 Mar, 2026 First submitted to journal 25 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7950312","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":621655185,"identity":"3f4a5b6e-1f28-47c6-9160-612b581713c6","order_by":0,"name":"Ahmed Abdoo Elzhzahy","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABEElEQVRIiWNgGAWjYDACCSDmYTjA2MDAwAZkHmDgB4kmFJCiRbIBpMWAFC0GB0DCeLTwz+5OfPCm5o5sP3v7s4c/au4kbj6/OvHDAwMGeX6xA9gtuXN2s+GcY8+MZ/YcSDeQOPYscduNt5slgA4znDk7Abs1N3K3SfOwHU7ccCPhmIQBkLHtxtkNIC0JBrexa5G/kbv9N88/kJbENokEIGPzjLObf+DTYgC0hZm3DaQlmU3iIIjB37sNry2GN3I3S87tA/nlGJtkY99h4xk3eLdZJBhI4PSL3I3cjR/efIOEmOSPb4dl+/vPbr75o8JGnl8ah/fRgWODBFilBHHKQcCegf8A8apHwSgYBaNgRAAAcrFziMeFTEMAAAAASUVORK5CYII=","orcid":"","institution":"Mansoura University","correspondingAuthor":true,"prefix":"","firstName":"Ahmed","middleName":"Abdoo","lastName":"Elzhzahy","suffix":""},{"id":621655186,"identity":"eed817ec-7106-4620-9ab3-7d28478bce85","order_by":1,"name":"Hossam El Sayed El sisi","email":"","orcid":"","institution":"Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Hossam","middleName":"El Sayed El","lastName":"sisi","suffix":""},{"id":621655187,"identity":"f3a7d8a7-4635-4999-bf41-e729ec92dc6f","order_by":2,"name":"Hazem Emam Amer","email":"","orcid":"","institution":"Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Hazem","middleName":"Emam","lastName":"Amer","suffix":""},{"id":621655193,"identity":"40af3dc2-5302-4cec-a039-a4a67cd88b27","order_by":3,"name":"Mohamad El Sayed Abd Elhady Awaad","email":"","orcid":"","institution":"Mansoura University","correspondingAuthor":false,"prefix":"","firstName":"Mohamad","middleName":"El Sayed Abd Elhady","lastName":"Awaad","suffix":""}],"badges":[],"createdAt":"2025-10-27 11:10:02","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7950312/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7950312/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":107005699,"identity":"d52b0634-4b4b-4035-a2bf-b22edabdd407","added_by":"auto","created_at":"2026-04-15 16:20:42","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":700394,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7950312/v1/b647b5aa-d853-414a-b3dd-190d29f4ecf6.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Comparative Study of Septal Quilting Sutures, Nasal Packing, and Internal Nasal Splints in Septoplasty","fulltext":[{"header":"1. Introduction","content":"\u003cp\u003eSeptal deviation is one of the most common causes of nasal obstruction, reported in up to 80% of the general population. While many cases remain asymptomatic, the severity of the deviation does not always correlate with the degree of obstruction, creating a diagnostic dilemma for both patients and surgeons. Postoperative satisfaction following septoplasty has been reported to range between 65% and 80% [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eSeptoplasty is among the most frequently performed procedures in rhinology and facial plastic surgery. Its primary objective is to relieve nasal obstruction; however, it also provides a superior surgical corridor for endoscopic sinus and skull base surgery, and facilitates subsequent therapeutic interventions. Septal deviation may involve the bony septum, the cartilaginous septum, or both. The deviation can manifest as angulation, twisting, tilting, curvature, spur formation, or a combination of these patterns. Consequently, no single standardized surgical technique can address the full spectrum of anatomical variations encountered in clinical practice [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eDespite its effectiveness, septoplasty may be associated with complications such as postoperative bleeding, septal perforation, synechia, and septal hematoma [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Traditionally, nasal packing has been employed to reduce these risks, and many surgeons continue to advocate its use [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Various packing materials have been described, including medicated or plain gauze, foam, cellulose, absorbable gelatin sponges, Merocel, internal nasal splints, and polyethylene oxide gel [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. However, the evidence supporting routine postoperative nasal packing is limited, and removal is often associated with significant patient discomfort. As a result, many authors recommend avoiding nasal packs whenever possible, with septal quilting sutures proposed as an effective alternative for securing mucosal flaps [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eAnother substitute for nasal packing is the use of silicone septal splints, with or without an airway, which may help prevent synechia and maintain septal stability following surgery [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe aim of the present study was to compare septal quilting sutures, nasal packing, and internal nasal splints in septoplasty with respect to postoperative headache, pain, sleep disturbance, bleeding, hematoma, epiphora, synechia, and crusting.\u003c/p\u003e"},{"header":"2. Patients and methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003e2.1. Study Design and Setting:\u003c/h2\u003e \u003cp\u003eThis prospective, randomized, comparative clinical study included 60 patients presenting with symptomatic nasal septal deviation associated with ongoing nasal obstruction. Participants were enrolled from the Otorhinolaryngology outpatient clinic at Mansoura University Hospital, Egypt, over the period from November 2021 to November 2022. Ethical approval for the study was obtained from the Institutional Review Board of the Faculty of Medicine, Mansoura University. All patients provided written informed consent prior to participation, with strict measures taken to ensure data confidentiality.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec4\" class=\"Section2\"\u003e \u003ch2\u003e2.2. Inclusion Criteria:\u003c/h2\u003e \u003cp\u003ePatients aged\u0026thinsp;\u0026gt;\u0026thinsp;16 years with unilateral or bilateral nasal obstruction due to septal deviation and requiring septoplasty.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec5\" class=\"Section2\"\u003e \u003ch2\u003e2.3. Exclusion Criteria:\u003c/h2\u003e \u003cp\u003ePatients aged\u0026thinsp;\u0026lt;\u0026thinsp;16 years, with a history of previous nasal surgery, nasal or sinus pathology (e.g., polyposis, inferior turbinate hypertrophy, benign tumors), comorbidities (diabetes mellitus, systemic hypertension, cardiac disease), craniofacial anomalies, immunodeficiency disorders, or inability to provide informed consent.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec6\" class=\"Section2\"\u003e \u003ch2\u003e2.4. Randomization and Groups:\u003c/h2\u003e \u003cp\u003eEligible patients were randomly assigned into three equal groups (n\u0026thinsp;=\u0026thinsp;20 each) using a computer-generated randomization list with simple random allocation. Group A underwent septoplasty with septal quilting sutures, Group B underwent septoplasty with bilateral intranasal packing using Merocel, and Group C underwent septoplasty with internal silicone nasal splints.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003e2.5. Surgical Technique:\u003c/h2\u003e \u003cp\u003eAll procedures were performed under general anesthesia with bilateral submucosal infiltration of 1:100,000 epinephrine, followed by a caudal septal incision on the left side, elevation of mucoperiosteal and mucoperichondrial flaps, and correction of cartilaginous and bony deviations using chondrotomies as needed. In Group A (quilting sutures), the septal incision was closed and mucosal flaps were approximated using 4\u0026thinsp;\u0026minus;\u0026thinsp;0 Vicryl mattress quilting sutures placed from posterior to anterior, with the knot secured on the contralateral side. In Group B (nasal packing), closure of the hemitransfixion incision with 5\u0026thinsp;\u0026minus;\u0026thinsp;0 Vicryl was followed by the insertion of bilateral Merocel packs (8\u0026ndash;10 cm, UNIPORE), which were removed after 48 hours. In Group C (internal nasal splints), after closure of the incision, bilateral silicone splints were inserted and fixed with a single trans-septal suture, and subsequently removed on postoperative day 7.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003e2.6. Postoperative Care and Follow-up:\u003c/h2\u003e \u003cp\u003eAll patients received parenteral ceftriaxone (1 g) and analgesia according to pain severity immediately postoperatively, followed by oral antibiotics (amoxicillin-clavulanic acid 1 g twice daily for 8 days) and saline nasal irrigation.\u003c/p\u003e \u003cp\u003eFollow-up assessments were scheduled on POD 2, 7, and 21:\u003c/p\u003e \u003cp\u003e\u003cul\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePOD 2\u003c/b\u003e: Removal of nasal packs (Group A), reassessment of pain using the Visual Analogue Scale (VAS), evaluation of bleeding, headache, epiphora, swallowing difficulty, and sleep disturbance. Patients in Groups B and C underwent local nasal examination to clear clots or crusts.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePOD 7\u003c/b\u003e: Removal of silicone splints (Group C) and endoscopic examination to detect infection, septal hematoma, edema, crusting, or granulation.\u003c/p\u003e\u003c/li\u003e\u003cli\u003e\u003cp\u003e\u003cb\u003ePOD 21\u003c/b\u003e: Final endoscopic evaluation for infection, hematoma, synechia, and granulation tissue.\u003c/p\u003e\u003c/li\u003e\u003c/ul\u003e\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003e2.7. Statistical Analysis\u003c/h2\u003e \u003cp\u003eStatistical analysis was performed using methods appropriate to the nature and distribution of the data. The normality of continuous variables was first evaluated using the Shapiro\u0026ndash;Wilk test. Variables with normal distribution (such as age), expressed as mean\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviation, were compared across the three groups using one-way analysis of variance (ANOVA). Categorical data, including sex and endoscopic findings, were analyzed using the chi-square test; Fisher\u0026rsquo;s exact test was utilized when expected frequencies were less than five. Non-normally distributed and ordinal variables\u0026mdash;such as postoperative pain, bleeding, headache, epiphora, and sleep disturbance measured by the visual analogue scale (VAS)\u0026mdash;were presented as median and interquartile range (IQR). Differences among groups for these variables were assessed using the Kruskal\u0026ndash;Wallis test. When significant differences were detected, pairwise comparisons were performed using the Mann\u0026ndash;Whitney U test with Bonferroni adjustment to control for multiple comparisons. A P value of less than 0.05 was considered indicative of statistical significance.\u003c/p\u003e \u003c/div\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003e3.1. Demographic Characteristics\u003c/h2\u003e \u003cp\u003eThe baseline demographic characteristics of the study groups are summarized in \u003cb\u003eTable\u0026nbsp;1\u003c/b\u003e. No statistically significant differences were identified among the three groups with respect to age or sex (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05), confirming their comparability at baseline.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e3.2. Postoperative Symptoms on the 2nd Postoperative Day\u003c/h2\u003e \u003cp\u003eThe comparison of pain, bleeding, headache, epiphora, and sleep disturbance scores on the 2nd postoperative day (POD) is shown in \u003cb\u003eTable\u0026nbsp;2\u003c/b\u003e. Group B demonstrated significantly higher Visual Analogue Scale (VAS) scores for all assessed parameters compared with Groups A and C (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Group C showed intermediate symptom severity, significantly lower than Group B but slightly higher than Group A for certain symptoms. These findings indicate that patients in Group B experienced more pronounced early postoperative discomfort and nasal symptoms.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003e3.3. Postoperative Symptoms on the 7th Postoperative Day\u003c/h2\u003e \u003cp\u003eAs shown in \u003cb\u003eTable\u0026nbsp;3\u003c/b\u003e, all groups demonstrated substantial improvement in postoperative symptoms by the 7th POD. Pain and sleep disturbance remained significantly higher in Group B compared with the other groups (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Group C reported mild residual bleeding, which was statistically higher than in Groups A and B (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). No significant differences were observed among the groups regarding headache or epiphora at this stage.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003e3.4. Endoscopic Findings\u003c/h2\u003e \u003cp\u003eEndoscopic examination findings at the 7th and 21st PODs are summarized in \u003cb\u003eTable\u0026nbsp;4\u003c/b\u003e. On the 7th POD, crustation was significantly more frequent in Groups B and C compared with Group A (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.001). No hematoma or synechia was detected in any group at this point. By the 21st POD, crustation had resolved in all patients; however, synechiae were significantly more frequent in Group B compared with Groups A and C (\u003cem\u003eP\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003). No cases of hematoma were observed during the follow-up period.\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003e The present study demonstrated that postoperative morbidity following septoplasty varied significantly according to the nasal management technique. Patients in the \u003cb\u003eMerocel nasal packing group (Group B)\u003c/b\u003e experienced higher pain, bleeding, headache, epiphora, and sleep disturbance scores during the early postoperative period compared with those managed with \u003cb\u003equilting sutures (Group A)\u003c/b\u003e or \u003cb\u003esilicone nasal splints (Group C)\u003c/b\u003e. These findings are consistent with previous reports indicating that traditional nasal packing is often associated with increased discomfort, mucosal trauma, and impaired nasal breathing during the immediate postoperative phase. The marked reduction in symptoms observed in the quilting suture group may be attributed to the absence of intranasal foreign material and better stabilization of the septal flaps without excessive pressure on the mucosa.\u003c/p\u003e \u003cp\u003eOur findings are consistent with those reported by \u003cb\u003eArora et al.\u003c/b\u003e [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]., who observed that all 20 patients (100%) who underwent anterior nasal packing experienced severe postoperative discomfort, primarily in the form of pain requiring parenteral analgesia (intramuscular Voveran). Many of these patients were unable to sleep comfortably due to persistent pain and also reported symptoms such as mouth dryness, unpleasant odor, profuse rhinorrhea, headache, and epiphora. In contrast, patients who underwent \u003cb\u003equilting suturing\u003c/b\u003e experienced no significant postoperative discomfort, while only four patients (10%) in the \u003cb\u003eintranasal splint\u003c/b\u003e group reported mild pain that was effectively controlled with one or two oral analgesic tablets per day.\u003c/p\u003e \u003cp\u003eBy the \u003cb\u003e7th postoperative day\u003c/b\u003e, a notable improvement in all groups was observed, yet pain and sleep disturbance scores remained significantly higher among patients who had received Merocel packing. Mild residual bleeding in the silicone splint group may be related to mucosal irritation from the splint edges, although this was transient and self-limiting. These results highlight the importance of selecting a postoperative technique that minimizes trauma and optimizes patient comfort during the early recovery period.\u003c/p\u003e \u003cp\u003eOur results align with those reported by \u003cb\u003eArora et al.\u003c/b\u003e [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e], who observed that six patients (30%) who underwent anterior nasal packing developed postoperative crust formation. In contrast, no crusting was noted in patients managed with quilting sutures or nasal splints. Additionally, two patients (10%) in the anterior nasal packing group developed postoperative synechiae, while none of the patients in the quilting or splint groups experienced this complication.\u003c/p\u003e \u003cp\u003eSimilar trends were described by \u003cb\u003eRamalingam et al.\u003c/b\u003e [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], who documented a high incidence of crusting among patients receiving nasal packing, particularly during the early postoperative days, whereas the quilting group showed markedly lower rates. Furthermore, synechiae were absent in patients treated with quilting sutures but were relatively common in those undergoing nasal packing.\u003c/p\u003e \u003cp\u003eThese findings are consistent with those of \u003cb\u003eThapa et al.\u003c/b\u003e [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], who also reported significantly greater crusting in patients managed with nasal packing. However, it is noteworthy that their study utilized medicated gauze packing rather than Merocel. Nasal packing, regardless of the material used, can cause mucosal trauma, which predisposes to crust formation and, subsequently, the development of synechiae. In line with this, \u003cb\u003eKrishna Prakash et al.\u003c/b\u003e [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. found that crusting was more prevalent and persisted for an average of two weeks in the nasal packing group. In contrast, quilting of the nasal septum significantly reduced the incidence of these complications, promoting smoother postoperative recovery.\u003c/p\u003e \u003cp\u003eSimilarly, \u003cb\u003eJoshi et al.\u003c/b\u003e [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e] reported a greater incidence of synechiae in the nasal packing group compared with the quilting group, along with additional complications such as dry mouth, sore throat, and vestibulitis, which were confined to patients receiving nasal packing. Importantly, neither group demonstrated significant postoperative bleeding or septal hematoma. In another study by \u003cb\u003eMajeed and Saeed\u003c/b\u003e [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e], no major postoperative hemorrhage was observed in either group, and minor bleeding occurred only in a small proportion of patients undergoing nasal packing. No cases of infection or hematoma were reported during early follow-up, and long-term outcomes, including crusting, adhesions, and septal perforation, did not differ significantly between groups.\u003c/p\u003e \u003cp\u003eThe present study provides a direct, head-to-head comparison of three commonly used postoperative techniques following septoplasty\u0026mdash;quilting sutures, Merocel nasal packing, and silicone nasal splints\u0026mdash;under standardized surgical conditions. Unlike most previous studies that compared only two modalities, this research offers a comprehensive, three-arm evaluation encompassing both subjective (VAS-based symptom scores) and objective (endoscopic) postoperative outcomes. The study highlights the superior comfort and mucosal healing associated with quilting sutures, emphasizing their potential to replace traditional nasal packing as a standard practice. Furthermore, the inclusion of silicone splints as a third arm adds practical clinical insight, clarifying their intermediate position between comfort and complication rates. This multifaceted approach enhances the clinical relevance and external validity of the findings, providing surgeons with evidence-based guidance for optimizing postoperative care after septoplasty.\u003c/p\u003e \u003cp\u003eNevertheless, several limitations should be considered. The relatively small sample size may restrict the generalizability of the findings, despite achieving adequate statistical power. Second, the study was conducted at a single tertiary center, and all procedures were performed by the same surgical team; while this minimizes technique variability, it may introduce selection or performance bias. Third, the follow-up period was limited to three weeks, focusing primarily on short-term morbidity and healing; long-term outcomes such as septal stability, mucosal remodeling, or recurrence of deviation were not assessed. Finally, VAS scoring relied on patient-reported outcomes, which, although valuable, are inherently subjective and may be influenced by individual pain tolerance and expectations. Future multicenter randomized studies with larger cohorts and extended follow-up are warranted to confirm these findings and evaluate long-term functional outcomes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eQuilting sutures appear to be a preferable technique at the end of septal surgery, as they are consistently available, quick to perform, and associated with fewer postoperative symptoms compared with nasal packing or intranasal splints. In contrast, nasal packing and silicone splints may not always be readily accessible and are frequently linked to patient discomfort and other adverse effects.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAbbreviation\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFull Term\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eANOVA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eAnalysis of Variance\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eENT\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEar, Nose, and Throat\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eI/M\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eIntramuscular\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIRB\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eInstitutional Review Board\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eIQR\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eInterquartile Range\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003ePOD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePostoperative Day\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSD\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eStandard Deviation\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSPSS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eStatistical Package for the Social Sciences\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eVAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eVisual Analogue Scale\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements and conflict of interest statement:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ei) Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003c/p\u003e\n\u003cp\u003eii) Conflict of Interest: The authors declare that they have no conflict of interest.\u003c/p\u003e\n\u003cp\u003eiii) The study obtained a Mansoura Faculty of Medicine Institutional Research Board (MFM-IRB) approval.\u003c/p\u003e\n\u003cp\u003eiv) Informed consent: Written informed consent was obtained from all participants enrolled in the study.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003ev) The datasets used and/or analyzed during the current study are saved with the primary investigator to protect confidentiality of participants and available upon reasonable request.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003evi) Acknowledgement: none\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eA.A.E. and M.E.A. wrote the main manuscript text .H.E.A. and H.E.E. prepared a statistical analysis.All authors reviewed the manuscript.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThe datasets used and/or analyzed during the current study are saved with the primary investigator to protect confidentiality of participants and available upon reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWang W, Lee T, Kohlert S, Kadakia S, Ducic Y (2019) Nasal fractures: the role of primary reduction and secondary revision. 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Int J Otorhinolaryngol Head Neck Surg 6:1793\u0026ndash;1798\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRamalingam V, Venkatesan R, Somasundaram S, Kandasamy K, Rajeswari M (2020) A comparative study between septal quilting sutures without nasal packing and only nasal packing post-septal correction. Indian J Otolaryngol Head Neck Surg 72(2):169\u0026ndash;174. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s12070-019-01730-x\u003c/span\u003e\u003cspan address=\"10.1007/s12070-019-01730-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKrishna Prakash K et al (2023) A comparative study between septal quilting sutures without nasal packing and only nasal packing in postoperative septoplasty. IOSR J Dent Med Sci (IOSR-JDMS) 22(2):10\u0026ndash;13\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJoshi A, Virmani N, Priya R, Behera SK (2022) Trans-septal suturing as an alternative to nasal packing following septoplasty: a prospective study. Int J Pharm Clin Res 14(11):816\u0026ndash;823\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMajeed SA, Saeed BMN (2022) The efficacy of septal quilting sutures versus nasal packing in septoplasty. Indian J Otolaryngol Head Neck Surg 74(Suppl 2):1713\u0026ndash;1717. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s12070-021-02865-6\u003c/span\u003e\u003cspan address=\"10.1007/s12070-021-02865-6\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"the-egyptian-journal-of-otolaryngology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [The Egyptian Journal of Otolaryngology](https://ejo.springeropen.com/)","snPcode":"43163","submissionUrl":"https://submission.springernature.com/new-submission/43163/3","title":"The Egyptian Journal of Otolaryngology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Septal quilting sutures, nasal packing, internal nasal splint, septoplasty","lastPublishedDoi":"10.21203/rs.3.rs-7950312/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7950312/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNasal septal deviation is a highly prevalent condition and represents a major contributor to nasal airway obstruction, with reported occurrence in up to 80% of individuals.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAim\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo compare the outcomes of septal quilting sutures, nasal packing, and internal nasal splints in septoplasty with respect to postoperative headache, pain, sleep disturbance, bleeding, hematoma, epiphora, synechia, and crusting.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePatients and Methods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis randomized prospective comparative clinical study included 60 patients with symptomatic deviated nasal septum causing persistent nasal obstruction. Patients were recruited from the Otorhinolaryngology Outpatient Clinic, Mansoura University Hospital, between November 2021 and November 2022. Participants were randomly assigned to undergo septoplasty with either quilting sutures, nasal packing, or internal nasal splints. Postoperative outcomes were assessed using the Visual Analogue Scale (VAS) on postoperative days (POD) 2 and 7.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo significant differences were observed among the three groups regarding age or sex distribution (\u003cem\u003eP\u003c/em\u003e \u0026gt; 0.05). On the 2nd postoperative day, patients who underwent septoplasty with Merocel nasal packing (Group B) reported significantly higher pain, bleeding, headache, epiphora, and sleep disturbance scores compared with those managed with quilting sutures (Group A) or silicone nasal splints (Group C) (\u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001). By the 21st postoperative day, \u003cstrong\u003eGroup B\u003c/strong\u003e demonstrated the highest incidence of crustation and synechiae, whereas \u003cstrong\u003eGroup A\u003c/strong\u003e showed the least postoperative morbidity.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eQuilting sutures following septoplasty were associated with significantly lower postoperative pain, bleeding, and nasal complications compared with Merocel nasal packing or silicone splints. This technique offers superior patient comfort and promotes better mucosal healing, making it a preferable alternative to traditional nasal packing methods.\u003c/p\u003e","manuscriptTitle":"Comparative Study of Septal Quilting Sutures, Nasal Packing, and Internal Nasal Splints in Septoplasty","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-04-15 16:20:25","doi":"10.21203/rs.3.rs-7950312/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"51000642376389660684147137174905402596","date":"2026-05-06T12:32:07+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"261170417378173167462357721685271276946","date":"2026-05-04T13:38:34+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-30T09:14:41+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-28T06:51:50+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"274456319862531914573350405614320058602","date":"2026-04-12T10:26:52+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"142806844287571942112524878868319152343","date":"2026-04-08T11:51:25+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-07T23:50:47+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-27T03:54:48+00:00","index":"","fulltext":""},{"type":"submitted","content":"The Egyptian Journal of Otolaryngology","date":"2026-03-25T11:54:49+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"the-egyptian-journal-of-otolaryngology","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [The Egyptian Journal of Otolaryngology](https://ejo.springeropen.com/)","snPcode":"43163","submissionUrl":"https://submission.springernature.com/new-submission/43163/3","title":"The Egyptian Journal of Otolaryngology","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Springer Open","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"41e1469f-2b52-4fbd-a0d2-49b0a6a7ad1e","owner":[],"postedDate":"April 15th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"51000642376389660684147137174905402596","date":"2026-05-06T12:32:07+00:00","index":27,"fulltext":""},{"type":"reviewerAgreed","content":"261170417378173167462357721685271276946","date":"2026-05-04T13:38:34+00:00","index":26,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-30T09:14:41+00:00","index":25,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-04-15T16:20:25+00:00","versionOfRecord":[],"versionCreatedAt":"2026-04-15 16:20:25","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7950312","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7950312","identity":"rs-7950312","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}