Tilley Nasal Packing Forceps

What it is

Tilley nasal packing forceps are long-handled stainless steel forceps with a bayonet (angled offset) shaft profile and serrated jaws. The bayonet offset positions the jaws clear of the clinician's line of sight when the handle is held horizontally, allowing direct visualisation of the nasal cavity during introduction and removal of packing. The serrated jaws grip ribbon gauze, Merocel sponge, BIPP, and other packing materials securely without cutting or tearing.

When & how it's used

Used for introducing nasal packing into the anterior and middle nasal cavity in patients with epistaxis and post-operatively following septoplasty and FESS. Also used for removing nasal packing at the post-operative review. The long handle allows the posterior nasal cavity to be reached in adults, and the bayonet profile enables controlled placement of packing under direct or endoscopic vision.

Tilley nasal packing forceps are a fundamental instrument in any ENT tray set up for nasal procedures. The bayonet profile is the design feature that distinguishes them from standard haemostatic forceps: by offsetting the jaws laterally from the long axis of the handle, the instrument allows the operator to hold the handle in a comfortable horizontal or slightly angled grip while the jaws travel along the floor of the nasal cavity without the handle obstructing the view through the nasal introitus. This is critical when placing packing under headlight illumination or endoscopic guidance.

The serrated jaws grip packing materials firmly without the risk of the material slipping off during insertion, which is particularly important when placing Merocel packs that must be positioned accurately before they begin to expand on contact with mucosal secretions. For ribbon gauze or BIPP packing, the forceps are used in a concertina technique — repeatedly grasping successive loops of gauze and tucking them into the cavity — to achieve layered, space-filling packing. At removal, the same forceps grasp the leading edge of the pack and draw it out of the nasal cavity.

Design features

• Bayonet (angled offset) shaft: Positions the jaws clear of the handle axis, maintaining the operator’s line of sight into the nasal cavity during introduction and removal.
• Serrated jaws: Horizontal serrations on the jaw faces provide secure grip on Merocel sponge, ribbon gauze, and BIPP without tearing the material.
• Long handle: Provides reach to the posterior nasal cavity in adult patients.
• Box joint or ring handle: Standard ring handle with ratchet for maintained grip during packing manipulation.
• Stainless steel, autoclavable: Fully reusable; maintains jaw alignment and serration integrity across repeated sterilisation cycles.

Frequently Asked Questions

What is the difference between Tilley forceps and standard haemostatic forceps for nasal packing? The bayonet profile of Tilley forceps is designed specifically for nasal access, keeping the handle out of the line of sight during insertion. Standard straight haemostatic forceps would block the operator’s view of the nasal cavity when inserted in the same working axis, making accurate packing placement much more difficult.

Can Tilley forceps be used to remove Merocel nasal packs? Yes. After pre-soaking the Merocel with saline to soften it, the forceps grasp the anterior aspect of the pack and withdraw it smoothly in the long axis of the nasal cavity. The serrated jaws provide secure grip on the softened sponge without tearing it.

Are Tilley forceps suitable for posterior nasal packing? Tilley forceps are designed for anterior and middle nasal cavity packing. True posterior nasal packing — for posterior epistaxis — typically requires a posterior pack passed via a catheter technique rather than direct forceps placement, as the posterior choana is beyond the reach of forceps under direct vision.

How are Tilley forceps sterilised? By standard steam autoclave sterilisation. The jaws should be inspected before autoclaving to ensure the serrations are clean and the ratchet mechanism is functional. The instrument should be autoclaved in the open (unlocked) position to allow steam penetration between the jaws.