Improving Postoperative Nasal Airway Patency in Le Fort-Based, Maxillofacial Trauma Patients Via a Modified Nasal Packing Technique

Introduction: Combined mid-face and nasal apparatus trauma injuries pose a significant challenge to airway patency (AW), in the immediate postoperative setting following fracture reduction. As such, the authors describe a modified technique with the goal of maintaining a patent nasal AW, while at the same time, minimizing nasopharyngeal bleeding and nasal AW edema—which can complicate patients requiring intermaxillary fixation (IMF) in the setting of pan-facial trauma. Methods: A modified technique was devised to assist the reconstruction surgeon in avoiding the risks associated with tracheostomy placement. In an effort to avoid surgical AW complications and improve nasal AW patency in the setting of concurrent IMF and nasal trauma, the authors developed a 2-stage technique drawing upon knowledge from the literature and the authors' own experiences. Technique: Following safe extubation, the authors insert open lumen nasal splints in both the nostrils, and suture them together to the nasal septum. If additional inner nasal support is required, polyvinyl alcohol nonabsorbable nasal packing dressing is covered with antibiotic ointment, and then placed within the nasal cavity lateral to the open lumen splints—as a way to further bolster the internal valve and mid-vault anatomy. Discussion: Given the fact that traditional nasal packing with merocele/gauze dressing in concomitant to IMF reduced patients ability to ventilate, the authors felt that a modified technique should be applied. The authors' preferred materials in such patients are open lumen splint, which provides nasal AW patency along with some septum support accompanied by merocele dressing. The authors feel that by applying this technique they achieve dual objectives by supporting the traumatized nose and maintaining nasal AW patency. Address correspondence and reprint requests to Chad R. Gordon, DO, FACS, Associate Professor of Plastic Surgery and Neurosurgery, Johns Hopkins University School of Medicine, 601 North Caroline St, JHOC 8th floor, Baltimore, MD 21287; E-mail: cgordon@jhmi.edu Received 11 January, 2018 Accepted 29 January, 2018 The authors report no conflicts of interest. © 2018 by Mutaz B. Habal, MD.

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