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Modified nasal vestibule packing with airway preservation.

Although well-known textbooks on rhinoplasty1,2 describe internal nasal splinting as a routine procedure, the literature lacks overall consensus concerning whether nasal splinting is appropriate after septorhinoplasty.3,4 Malki et al5 concluded that intranasal splinting may be indicated for enhancing the septum's stability following septoplasty. It also has been demonstrated that Doyle intranasal splints (Medtronic, Minneapolis, Minnesota) with an airflow tube influence neither the incidence of postoperative complications nor patient comfort or breathing ability compared with intranasal packing6; in fact, we have been using these paired devices routinely for severe septal deviation and reconstruction.

We have found, however, that Doyle splints are usually ineffective at the level of the nasal vestibule when lower alar cartilages are transposed or reconstructed with grafts. In such situations, the vestibular skin is undermined—usually partially and sometimes almost completely—from the lower lateral cartilages (LLC) during open septorhinoplasty (Figures 1 and 2). At the surgery's conclusion, good contact between the LLC and underlying skin must be ensured for smooth adherence and prevention of dead spaces at the level of the soft-tissue triangle. This cannot be guaranteed solely by placing separate sutures along the alar rim and columella. A potential solution would be additionally packing the vestibule over the intranasal …