An intraoperatively placed airway device is well tolerated and maintains nasal patency after rhinoplasty and nasal reconstruction without increasing the risk of incisional dehiscence, researchers in California say.

Postoperative packing in nasal surgery often results in nasal obstruction and discomfort, note Dr. Brian J. F. Wong of the University of California Irvine and colleagues. Commercially available silicone intranasal airways (IAs) are aimed at alleviating these problems, but the safety and efficacy of the devices had not been tested.

To evaluate one such device, the Kotler Nasal Airway, the researchers studied more than 200 patients who underwent nasal surgery at the university with the device inserted from 2012 to 2017 and created a questionnaire to assess patients' breathing and comfort.

The device is 12 cm long, anchored across the columella, extends distally along the nasal floor, and has a proximal external portion used for cleaning and maintaining patency.

As reported online September 6 in JAMA Facial Plastic Surgery, 302 operations in 300 patients were analyzed. Operations included rhinoplasty (249 patients; 186 with primary open septorhinoplasty and 63 with revision septorhinoplasty).

And repair of vestibular stenosis (5); endonasal septorhinoplasty (3); closed reduction of nasal bone fracture (24); excision of intranasal lesion, including the vestibule and nasal sill (5); isolated turbinate reduction (5); isolated septoplasty (4); repair of Naso-orbito-ethmoid fracture (2); removal of dorsal nasal implant (3); lateral rhinotomy with skin graft (1); and excision of supernumerary tooth (1).

Postoperative complications

Twenty-four (7.9%) patients self-removed or inadvertently dislodged the device. Minor acute postoperative complications included cellulitis in four participants (1.3%) and epistaxis in six (2%). Postoperatively, one patient (0.3%) developed dehiscence along transcolumellar incisions.

Fifty-nine patients completed the questionnaire. The mean breathing score was between good and average (2.9 of 5); comfort scores were between comfortable and average (2.9 of 5); and mean ease of irrigation score was between very easy and easy (1.96 of 5).

The device was irrigated on average 3.57 times per day. A total of 43 participants (76%) had full patency or only partial obstruction; 13 (24%) had a total obstruction. In all patients, with or without obstruction, the effect lasted an average of four days.

"The airway device is simple and provides a conduit for airflow during the acute recovery period. It adds to patient comfort, in my opinion," Dr. Wong told Reuters Health by email. "I think the greatest value is in the first few days, and it is of exceptional value during extubation of the patient, as it provides an airway when the endotracheal tube is removed."

"The design can always be refined to improve and optimize flow and also reduce the collection of secretions that tend to accumulate with(in) the lumen," he added.