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Original Investigation
Jan/Feb 2019

Evaluation of Safety and Efficacy for an Intranasal Airway Device in Nasal Surgery

Author Affiliations
  • 1Otolaryngology–Head and Neck Surgery, University of California Irvine, Orange, California
  • 2University of California Irvine School of Medicine, Irvine, California
  • 3The Beckman Laser Institute and Medical Clinic, Irvine, California
JAMA Facial Plast Surg. 2019;21(1):38-43. doi:10.1001/jamafacial.2018.0955
Key Points

Question  Is an intranasal airway (IA) safe postoperatively, and does it help patients with comfort and breathing in the immediate postoperative period?

Findings  This review of medical records of 302 patients undergoing nasal surgery with insertion of IA and subsequent survey of 59 such patients shows that use of the IA in rhinoplasty and other nasal surgeries does not increase risk of postoperative complications compared with accepted rates in the literature and is overall well tolerated by patients.

Meanings  Use of an easily placed IA may help assist patients with breathing postoperatively without increasing postoperative wound breakdown, bleeding, or infection.

Abstract

Importance  Postoperative packing in nasal surgery often results in nasal obstruction and discomfort. Commercially available silicone intranasal airways (IAs) serve as dual-nasal airway tubes aimed at alleviating this process, but the safety and efficacy of these devices are unknown.

Objective  To evaluate the safety and efficacy of an intraoperatively placed IA device in rhinoplasty and nasal surgery.

Design, Setting, and Participants  In this retrospective record review, the medical records of patients undergoing nasal surgery with insertion of the IA at a single institution from 2012 to 2017 were reviewed. After review of over 200 patients, a questionnaire was developed to assess device efficacy.

Exposures  Use of the IA device. The IA 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. Placed intraoperatively, the device aims to support air flow postoperatively in the face of edema, hemorrhage, and packing.

Results  A total of 302 operations in 300 patients were analyzed, including primary and revision septorhinoplasty. A total of 24 (7.9%) patients self-removed or inadvertently dislodged the IA. Minor acute postoperative complications not unique to airway insertion included cellulitis in 4 (1.3%) participants and epistaxis in 6 (2%). Postoperatively, 1 (0.3%) patient developed dehiscence along transcolumellar incisions. A total of 59 patients (100% compliance) completed the efficacy questionnaire. The mean breathing score was between good and average (2.9 of 5), comfort scores 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 (76%) particpiants had full patency or only partial obstruction, compared with 13 (24%) patients with total obstruction. In all patients, with or without obstruction, the effect lasted an average of 4 days.

Conclusions and Relevance  The device is safe and well-tolerated for maintaining patency of the nasal airway in patients undergoing rhinoplasty and nasal reconstruction without increased risk of incisional dehiscence.

Level of Evidence  4.

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