3.5\ Nasal Packing Material

3.5.1\ Discussion

Nasal packs are routinely used in sinonasal surgery in order to apply pressure, fill preformed spaces, create moist environments to facilitate physiological processes, function as a barrier, and induce physiological hemostatic and reparative processes. Nasal packings, including Merocel and MeroGel packs, and alginate strips

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have a tendency to imbibe blood products in the early perioperative period, which is reflected in the appearance on imaging (Fig. 3.9). Bismuth and iodoform paraffin paste using some packing material displays high CT attenuation that results in severe image degradation. Aqueous Betadine gauze also displays high attenuation on CT. Myospherulosis, a foreign body-type granulomatous reaction to lipid-containing material, has a characteristic fat-attenuation appearance on CT.

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Fig. 3.9  Nasal packing. Coronal CT image (a) shows opacification of the right nasal cavity and paranasal sinuses. Coronal T1-weighted MRI (b) shows that the nasal packing material is very hypointense (arrow). The

T1-weighted (c) and fat-suppressed post-contrast T1-weighted (d) MR images show that the nasal packing (arrows) is mildly T1 hyperintense and does not enhance, unlike the surrounding mucosa