Procedures Surgeries - Posterior Nasal Packing

What is posterior nasal packing?

Posterior nasal packing is a procedure that is helpful in those cases of nasal bleeding where anterior nasal packing alone has failed to control the bleeding. It is normally done under general anaesthesia.

What are the indications for posterior nasal packing?

  • Post adenoidectomy bleeding
  • Post angiofibroma excision bleeding from the nasopharyngeal area
  • Epistaxis not controllable by anterior nasal packing

How is posterior nasal packing done?

Procedure of posterior nasal packing:

  • Two thin red rubber catheters are passed one from each nostril, from anteriorly backwards into the oropharynx. They are drawn through the mouth and tied to two tapes secured to a pack
  • The post nasal pack is soaked in antibiotic ointment and a thread is attached to it
  • The catheter and attached tapes are then pulled forward through the nose and tied across a bolster which protects the columella
  • The thread attached to the pack is brought out through the mouth and attached to the cheek by adhesive tape. This thread helps in per-oral removal of the pack
  • Usually, anterior nasal packing is also done with vaseline gauze
  • The patient is kept on broad spectrum antibiotics and pack is removed after 48 hours once the bleeding has been under control
  • A foleys catheter may also be used instead of a post nasal pack. It is introduced along the floor of one nasal cavity into the nasopharynx. It is then inflated with air and the other end of the catheter pulled through the nostril. However, this procedure may not give adequate pressure in the nasopharynx

How is posterior nasal packing removed?

Removal of pack: It can be done under local anaesthesia. However, to minimize the chances of bleeding and aspiration, especially for post operative cases it can be removed under general anaesthesia. In spite of the above, if the bleeding is not controlled, the anterior ethmoidal or internal maxillary artery is ligated.

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