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Simple fractures of the nasal pyramid without significant septal deformity may be reduced as effectively under local as under general anaesthesia. Currently, the former may involve regional nerve blockade by intranasal infiltration and is often unpleasant. We have attempted to find a more acceptable method. Fifty consecutive, adult patients with clinically displaced nasal fractures were randomized to receive either blocks of the infraorbital, infratrochlear and external nasal nerves by intranasal infiltration or generalized infiltration of the nasal dorsum by an external route. All patients received intranasal cocaine. Following manipulation, each patient recorded their overall discomfort level and subjective nasal airway patency. The surgeon recorded the cosmetic result. Analysis revealed the internal route to be significantly more painful (P less than 0.001) and with no advantage to the patient with respect to post-operative airway patency or cosmesis. We recommend the technically easier external method for this procedure.

Intranasal splints have been used to maintain septal stability and prevent intranasal adhesions following septal surgery. However, their efficacy and attendant morbidity have received surprisingly little attention. Our prospective study of 100 adults was divided into patients undergoing septoplasty or submucous resection of the nasal septum alone (n = 50) and those undergoing combined septal and inferior turbinate surgery (n = 50). All patients were randomized to have paired silicon rubber splints inserted for 7 days or not at all. All noses were additionally packed with 2 pieces of Jelonet for 12-20 h and examined and cleaned at 1 and 6 weeks post-operatively. The position of the septum, patency of the airways, presence of adhesions and degree of discomfort were recorded. Statistical analysis of the 89 complete sets of results obtained indicated splints added significantly to post-operative discomfort in both groups, with no demonstrable benefit to the patient.

Traditionally, soft cold foods have been recommended after tonsillectomy to aid comfort and haemostasis but, more recently, rougher foods have been advocated to promote physiologically normal deglutition. This trial was designed to discover whether post-tonsillectomy dietary advice has any influence on recovery. 150 patients due to undergo tonsillectomy were prospectively randomized to 1 of 3 diets: mainly rough food, mainly soft food, and no advice except to eat regularly. Food consumption, analgesia intake and pain levels were recorded daily by each patient. Tonsillar fossa slough and secondary haemorrhage were evaluated 1 and 2 weeks after surgery. Results of 137 patients were obtained. There were no significant differences between the diets regarding post-operative pain, analgesic required, healing rates or secondary haemorrhage. Specific post-tonsillectomy dietary advice need not be given, other than to encourage regular eating.