Effects of nasopore packing on dacryocystorhinostomy

Nasal packing after dacryocystorhinostomy (DCR) is an optional procedure to prevent nasal bleeding [1,2]. Although improvements in surgical technique have reduced the need for this practice, nasal packing is still needed more for Asians than for Caucasians due to anatomical differences. Compared to Caucasians, Asians have a thicker lacrimal bone, a thicker frontal process of the maxilla, and a narrower nasal passage [3-5]. In addition, the proportion of the maxilla to the lacrimal bone in the lacrimal sac fossa is greater than in Caucasians [4]. Such anatomical differences make osteotomy more difficult and prone to nasal bleeding in Asians when performing DCR. Postoperative nasal bleeding is unpleasant for patients and can be severe in certain cases [2,6]. It can potentially affect the mucosal healing process and can cause fibrosis and induce scarring at the newly formed rhinostomy site, all of which could result in an impairment of ostial patency [7]. Therefore, the minimization of intra- and postoperative bleeding is important to consider in an attempt to achieve successful surgical results. The effects of nasal packing are not limited to hemostasis, as it also directly affects wound healing [8-14]. In the field of endoscopic sinus surgery, a number of papers have investigated whether or not nasal packing, both in general and in regard to the type used, affected nasal mucosal re-epitheliazation, fibrous tissue proliferation, granulation, and synechiae formation [8,11-13]. More recently, the effects of nasal packing materials after DCR have started to draw attention [10], but there are no well-established conclusions due to the scarcity of reports. Furthermore, the lack of standardization in the measurement of DCR surgical outcomes makes it difficult to compare and interpret the results of previous studies [15]. Packing materials are broadly divided into non-absorbable and absorbable materials. Non-absorbable materials include Vaseline gauze strips and Merocel, which inhibit bleeding through a compression mechanism [8]. Absorbable materials such as Gelfoam [1,9] and MeroGel [10] have been reported to be successful as packing materials after DCR. Nasopore, a bioresorbable dressing for the nasal cavity, is composed of fully synthetic biodegradable, fragmentable foam that absorbs fluids while supporting and providing pressure against the surrounding tissue. As such, it could potentially prevent undesired postoperative adhesions [13]. To investigate the effects of postoperative packing with Nasopore, we placed Nasopore at the anastomosis site of newly formed anterior mucosal flaps. Patients who had their nasal cavities packed with Merocel packing were recruited as a control group. Merocel, due to its non-absorbable character, is supposed to be removed within 2 to 3 days after its application. We investigated the degree of postoperative re-bleeding and the level of patient discomfort and compared the anatomical and functional success rate 3 months post-surgery between Nasopore and Merocel. To our knowledge, this is the first report to investigate the effect of Nasopore on the surgical outcome of DCR.