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 anesthesia.
Indications:
Post adenoidectomy bleeding.
Post angiofibroma excision bleeding from the nasopharyngeal area.
Epistaxis not controllable by anterior nasal packing.
Posterior nasal packing procedure:
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 the pack is removed after 48 hours once the bleeding has been under control.
A Foley's 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.
Removal of posterior nasal pack:
It can be done under local anesthesia or general anesthesia. However, to minimize the chances of aspiration, especially for post-operative cases, it can be removed under general anesthesia.
In spite of the above, if the bleeding is not controlled, the anterior ethmoidal or internal maxillary artery is ligated.
