Nareseal Internal Silicone Nasal Splints

What it is

Nareseal internal silicone nasal splints are thin, flat medical-grade silicone sheets placed inside the nasal cavity on either side of the nasal septum following septoplasty. They are soft, flexible, and transparent, conforming to the contours of the septal mucosa and nasal floor. The 'with airway' variant incorporates an integral silicone breathing tube running through the splint, allowing the patient to breathe through the nose while the splints are in situ. They are secured with a single suture through the columella or a transseptal suture.

When & how it's used

Used following septoplasty to support the repositioned septal cartilage and mucoperiosteal flaps while they heal, to prevent haematoma formation between the flaps and the cartilage, and to prevent synechiae (adhesions) between the septal mucosa and the lateral nasal wall (inferior turbinate). The 'without airway' variant is used where nasal breathing through the splints is not required; the 'with airway' variant is used when the surgeon wants the patient to have nasal airway access during the packing period — typically 7–14 days post-operatively.

Internal nasal splinting following septoplasty is used across many rhinological surgery centres as an alternative or adjunct to nasal packing. The primary purpose of the splints is septal support — maintaining apposition of the mucoperiosteal flaps to the underlying cartilage and bone graft while the flaps heal, preventing the dead space in which haematoma can accumulate. A secondary and equally important function is prevention of synechiae: if the raw septal mucosa contacts the raw or abraded lateral nasal wall during healing, the two surfaces can adhere, forming bands of scar tissue (synechiae) that reduce the nasal airway and may require surgical division.

The silicone material is chosen for its softness and biocompatibility. Unlike rigid septal splints or nasal packing, silicone splints do not exert significant pressure on the mucosa, reducing the risk of pressure necrosis and making them comfortable enough to wear for up to two weeks. Transparency allows post-operative endoscopic inspection without splint removal. The ‘with airway’ variant is particularly valued by patients who find complete nasal obstruction (as occurs with solid splints or nasal packing) significantly distressing: the integral breathing tube maintains a patent nasal airway lumen, allowing nasal breathing and reducing the discomfort of the post-operative period. Splints are removed at 1–2 weeks at the post-operative review, typically with topical anaesthesia.

Design features

• Medical-grade silicone: Soft, flexible, and biocompatible; does not cause pressure necrosis or foreign body reaction during the wearing period.
• Flat sheet profile: Thin enough to sit comfortably within the nasal cavity alongside the septum without distorting nasal anatomy.
• Transparent: Allows endoscopic visualisation of the septum through the splint without removal.
• With airway variant: Integral silicone breathing tube (airway lumen) running through the splint body allows nasal airflow during the splinting period.
• Suture fixation: Secured with a transseptal suture or columellar suture to prevent migration during the healing period.

Frequently Asked Questions

What is the difference between internal silicone splints and nasal packing (e.g., Merocel)? Nasal packing (Merocel, ribbon gauze) fills the nasal cavity with compressive material to achieve haemostasis and is removed at 24–72 hours. Internal silicone splints are thin sheets placed beside the septum for structural support and synechiae prevention, worn for 1–2 weeks. They provide less compressive haemostasis but more sustained structural support and do not obstruct the airway (especially the ‘with airway’ variant). Some surgeons use both: packing for the first 24–48 hours, then splints for the subsequent week.

How painful is removal of internal silicone splints? Removal is generally well tolerated when performed with topical anaesthesia (e.g., lidocaine spray into the nostril 10 minutes before removal). The silicone surface does not adhere to the mucosa, so removal is smooth. Patients typically describe it as uncomfortable rather than painful, and the discomfort is brief (seconds per splint).

Do silicone nasal splints affect breathing during the post-operative period? The ‘without airway’ variant results in complete nasal obstruction, requiring mouth breathing. The ‘with airway’ variant maintains a nasal airway lumen, allowing nasal breathing. For patients with significant mouth breathing difficulty (e.g., those with obstructive sleep apnoea or dental appliances), the ‘with airway’ variant is strongly preferred.

How are the splints fixed in position after insertion? Most surgeons pass a single absorbable or non-absorbable suture through both splints and the nasal septum (transseptal suture), tying it on one side with the knot buried. An alternative is a single suture through the columella. The suture is removed with the splints at the post-operative review.