External nasal splinting is performed routinely after nasal bone fracture reductions, osteotomies, and rhinoplasties. Materials commonly used include plaster of Paris (POP), thermoplastic splints, self-adhesive padded aluminium splints, and Orthoplast, among many others. The disadvantages of these materials are described in this paper, and polyvinyl siloxane is recommended as an effective and more readily available alternative material to counter these pitfalls.
External nasal splinting is an essential adjuvant after nasal surgery, including nasal bone fractures treated by closed reduction, osteotomies of the nasal bones, and rhinoplasties, which may require dorsal augmentation with grafts. The primary use of nasal splints in the authors’ practice is related to trauma and reconstructive nasal surgeries. Materials commonly used include plaster of Paris (POP), thermoplastic splints, self-adhesive padded aluminium splints, and Orthoplast, among many others.
In many parts of the world, POP is favoured because it is inexpensive, readily available, and easy to use. However, it is a cumbersome dressing, requiring time to attain rigidity. The setting reaction is exothermic making it unsuitable for application over wounds. Additionally, dry debris from the plaster can irritate the eyes. Prefabricated thermoplastic splints are available in fixed sizes; they are cumbersome, time-consuming, and they need to be heated to provide adaptability. Additionally, these splints are currently a rare and ‘luxury’ commodity in the developing world.
With the intention of circumventing these disadvantages, the authors introduced the use of polyvinyl siloxane ‘putty’ for the fabrication of external nasal splints into their practice. This material has been in use for over 2 years now, with favourable outcomes.
Technique and case presentation
Polyvinyl siloxane is used routinely in dentistry for impression-making. It is supplied as a set of two pastes: base and catalyst. The base paste consists of polymethyl hydrogen siloxane, while the accelerator contains divinyl polysiloxane. Equal amounts of material from both tubes are mixed to form a putty-like paste, which takes about 5 to 9 min to set into a semi-rigid mass in the shape to which it was originally adapted.
In the case of a compound comminuted nasal fracture ( Fig. 1 A), the sutured laceration ( Fig. 1 B) was dressed with antiseptic gauze (Bactigras; Smith & Nephew) and the putty was then adapted to the nose and held in place until set ( Fig. 2 A). After this, it was cut into shape using a No. 15 blade, and the fabricated splint was reapplied ( Fig. 2 B) and secured using adhesive tape ( Fig. 3 ) (elastic or non-elastic tape may be used). The splint was worn day and night for the first week and only during the night for the second and third weeks.