A nasal splint is a support that holds the nose in its new shape while it heals after surgery or an injury. The same name covers two quite different things: a stiff shield taped over the outside of the nose, and thin soft sheets that sit hidden inside it.1CASRAI. Nasal Splint Types: Internal vs External, Doyle Which one you get depends mostly on whether your surgery changed the outside shape of your nose or the inside wall that divides the airway. For many patients, splints have replaced the bulky packing that once filled the nose after surgery.
Internal and External Splints Look and Work Differently
An external splint is a small, firm shield of thermoplastic, metal, or plastic that is molded over the bridge of the nose and taped down. After rhinoplasty, it helps hold the reshaped cartilage and repositioned nasal bones in place.2PubMed. Role of External Nasal Splinting Following Rhinoplasty: Is It Really Important? A Comprehensive Systematic Review of Literature It steadies the bony and cartilage framework and presses gently on the nose, which limits swelling and helps recovery go faster.3The American Journal of Cosmetic Surgery. A Novel External Nasal Splint Some newer splints are custom 3D-printed to press on the areas where bones were cut and around the eyes, to reduce swelling and bruising.4PubMed. The Effect of 3D-Printed Custom External Nasal Splint on Edema and Ecchymosis After Rhinoplasty External splints are also routinely used while a broken nose heals after it has been set.5The American Journal of Cosmetic Surgery. A Novel External Nasal Splint
The splint is held on with adhesive tape or strips over the skin rather than pressed onto the bone like a hard cast, and it should sit snugly without digging in. Leave it where it is. If it loosens, lifts at the edges, or gets knocked, call your surgeon’s office instead of re-taping it.
The septum is the wall of cartilage and bone that divides the left and right sides of your nose. Septoplasty is surgery to straighten a crooked septum, usually so you can breathe better. Internal splints, such as the common Doyle-style splints, are thin plastic or silicone sheets placed against each side of the septum after this surgery.6CASRAI. Nasal Splint Types: Internal vs External, Doyle They keep the rebuilt parts of the septum from shifting and help prevent blood from collecting along it.7Plastic Surgery Key. Postoperative Care and Management Many are made of soft medical silicone because it bends easily, is well tolerated by the body, and holds up for the days it stays in.8International Journal of Innovative Research in Medical Science. Liquid Silicone Injection Moulding: Revolutionizing Nasal Splint Development for Improved Patient Outcomes Some include a small built-in airway tube so air can pass through even while the nose is swollen.
The two splints are often joined by a stitch through the septum so they sit as a matched set. An external splint cannot reach the inner wall, which is why a surgeon who needs to support both the outside shape and the septum may use separate devices for each job.
After combined procedures, some people wear both kinds at once. It is worth asking your surgeon before the operation what to expect.
Once you’re awake, internal splints may give you a feeling of fullness or a firm edge just inside each nostril. Breathing through the nose is often limited at first because of swelling, even with airway tubes. When they are held by a stitch through the septum, they shouldn’t move or fall out by themselves.
Why Surgeons Place Internal Splints
After septoplasty, raw surfaces inside the nose can heal together and form adhesions, which are bands of scar tissue that bridge the airway and can block breathing. A splint acts as a physical barrier, so the septum and the side wall of the nose can’t touch while they heal. In one comparison, 1 in 30 patients with splints developed adhesions, compared with 6 in 30 patients without splints.9Life and Science. Role of Nasal Splints in Prevention of Nasal Adhesions following Septal Surgery at CMH Lahore: A Comparative Cross-Sectional Study10Pakistan Armed Forces Medical Journal. Role of Intranasal Splints in Preventing Postoperative Nasal Mucosal Adhesions
An adhesion matters because it can leave one side of the nose feeling blocked after the surgery was meant to open it. Adhesions can keep forming during the weeks of healing after the splints are out, so a problem may only show up once the swelling has settled. The typical sign is one side that stays blocked or feels narrower than expected, rather than sudden pain. Ordinary swelling and crusting also block the nose in the early weeks, so the surgeon needs to look inside to tell the difference. Your follow-up visits include that check, and small adhesions are often cut free in a quick office procedure.
Some experts still debate how much splints help, even though they are widely used.11PubMed. Efficacy of nasal septal splints for preventing complications after septoplasty: A meta-analysis A review of six trials found that conventional thick splints added pain without clearly lowering the risk of adhesions.12PubMed Central. Intranasal Synechiae as Complications of Rhinosurgical Treatment—A Review of Current Knowledge Thinner, softer silicone splints did better in that review, with less discomfort and less damage to the nose lining.13PubMed Central. Intranasal Synechiae as Complications of Rhinosurgical Treatment—A Review of Current Knowledge Many surgeons choose thin silicone splints, and your surgeon’s choice may reflect this kind of trade-off.
How Splints Compare With Nasal Packing
Nasal packing fills the nose with sponge or gauze to control bleeding, which blocks breathing through the nose completely. It is pressed in to push on the lining and stop oozing. A splint sits flat against the septum and leaves space for some air. Because splints don’t press on the lining to control bleeding in the same way, they suit cases where the surgeon expects modest bleeding or has controlled it during the operation. Because sponge or gauze blocks both sides, people often describe pressure across the face and forehead and are forced to breathe through the mouth.
In one study, people with splints had less pain at 24 and 48 hours, along with less bleeding, facial swelling, watery eyes, and difficulty eating.14PubMed. Comparative study of intranasal septal splints and nasal packs in patients undergoing nasal septal surgery People with splints also reported easier sleeping and less blocked breathing than those with sponge packs.15PubMed Central. Comparison of Early-period Results of Nasal Splint and Merocel Nasal Packs in Septoplasty Even so, you will likely breathe partly through your mouth, which dries it out. Sleeping with your head raised and keeping water nearby helps.
Removal hurt much less with splints than with packing.16PubMed Central. Comparison of Early-period Results of Nasal Splint and Merocel Nasal Packs in Septoplasty Packing can stick to the lining as blood dries in it, so pulling it out can tug on healing tissue and may restart bleeding. A splint is smooth plastic or silicone, so after the holding stitch is cut it usually slides out without grabbing the tissue. Patients with tight sponge packing were about 3.6 times more likely to have breathing trouble while waking from anesthesia.17PubMed. Comparison of totally occlusive nasal pack, internal nasal splint, and transseptal suture technique after septoplasty in terms of immediate respiratory distress related to anesthesia and surgical complications
At six weeks in one study, about 1 in 15 splint patients had a remaining crookedness, compared with about 1 in 4 packing patients.18PubMed. Comparative study of intranasal septal splints and nasal packs in patients undergoing nasal septal surgery In that same study, no splint patients developed adhesions, compared with about 13% of packing patients.19PubMed. Comparative study of intranasal septal splints and nasal packs in patients undergoing nasal septal surgery
How Long Splints Stay In and What Removal Is Like
Internal splints are usually removed in the office somewhere between 2 and 14 days after surgery.20PubMed Central. Pediatric Septoplasty: Benefits, Challenges, and Clinical Recommendations—Comprehensive Review of Young ESPO Within the first week, the exact day of removal makes little difference to pain.21PubMed Central. Timing of Nasal Splint Removal After Septoplasty and Its Effects on Postoperative Functional Outcomes and Complications: A Systematic Review and Meta-Analysis External splints usually come off around a week after rhinoplasty. If your splints are causing real trouble, such as severe pain or signs of infection, call the office instead of waiting for the planned date.
At the removal visit, the doctor cuts the holding stitch and slides each splint out in a few seconds. You’ll feel pressure and a strange pulling sensation, and your eyes may water. Most people can breathe more freely right away, though some stuffiness lasts for weeks. A little bleeding afterward is common and usually settles quickly.
Don’t take internal splints out yourself. Many are held by a stitch through the septum, so pulling on one at home can tear the tissue and cause bleeding. If a splint seems loose or slides down toward the nostril opening, call your surgeon instead of tugging it out. The surgeon also uses the visit to look inside for blood collections and early adhesions, which you can’t check on your own.
After an external splint comes off, the nose will still look swollen, and that is expected. Avoid glasses resting on the bridge of the nose until your surgeon says it’s okay. The skin under the tape may be oily or flaky, so clean it gently.
Caring for Your Nose While Wearing Splints
Rinsing the nose matters because it keeps crusts from building up around the splints.22Saudi Medical Journal. The impact of using intranasal splints on morbidity and prevalence of adhesions Salt-water rinses that are saltier than normal (hypertonic) reduced crusting more than other rinse types.23PubMed Central. The effect of different nasal irrigation solutions following septoplasty and concha radiofrequency: a prospective randomized study Use the rinse your surgeon recommends, as often as they advise.
Aim the bottle or syringe gently along the side of the nose, not straight up, and avoid forceful squirting. Lean over a sink and let the water run out of the nostrils. Use distilled, sterile, or boiled and cooled water, because untreated tap water can carry rare but serious infections.
Dried blood and mucus form crusts around the splints, and left alone they can harden and make the nose feel more blocked. Don’t pick at them or push a cotton swab up the nose, because that can move a splint or reopen healing tissue. Rinsing softens crusts so they loosen on their own, and your surgeon may add a lubricating ointment at the nostril opening.
Day to day, don’t blow your nose; dab drainage gently and sneeze with your mouth open. Avoid heavy lifting and bending forward for about the first week. Expect blood-tinged drainage in the first days, but tell your surgeon about steady bleeding. Keep an external splint dry when showering, because water can loosen the tape.
Splints did not increase bacterial infections in one study.24PubMed Central. The effects of the time of intranasal splinting on bacterial colonization, postoperative complications, and patient discomfort after septoplasty operations Toxic shock syndrome, a rare but serious infection, has been reported with silicone splints.25PubMed. Toxic shock syndrome in a patient using bilateral silicone nasal splints It comes from bacterial toxins entering the bloodstream and can develop quickly. Call your surgeon right away for a sudden high fever, a sunburn-like rash, vomiting, or dizziness. Ordinary stuffiness, mild soreness, and blood-tinged drainage are expected, so the thing to watch for is a sudden, sick-feeling change.
Septoplasty Without Splints
Some surgeons skip splints and instead sew the two layers of the septum lining together with quilting stitches.26PubMed Central. Pediatric Septoplasty: Benefits, Challenges, and Clinical Recommendations—Comprehensive Review of Young ESPO After the septum is straightened, the lining on one side is sewn to the lining on the other in a pattern across the septum, which closes the space between them. That space is where blood could collect, so the stitches do the job of keeping the layers together that a splint does from outside. They are usually dissolvable, so there is generally nothing to remove and no removal visit.
Combined results show complication rates are similar with this stitching method and with splints.27PubMed. Comparison on the Effectiveness and Safety of Transseptal Suturing Versus Intranasal Splints After Septoplasty: A Systematic Review and Meta-analysis Another study found both methods were equally effective at preventing complications.28International Journal of Otorhinolaryngology and Head and Neck Surgery. Trans-septal quilting suture versus intranasal silicone splint for preventing complications post endoscopic septoplasty Minor bleeding was more common with stitches alone in one study.29PubMed. Comparison of totally occlusive nasal pack, internal nasal splint, and transseptal suture technique after septoplasty in terms of immediate respiratory distress related to anesthesia and surgical complications
With no splints, there is no foreign object in the nose, so you may avoid the fullness and firm edge that splints can cause. You’ll still have swelling, so the nose may feel blocked for some time, and rinses and care instructions still apply. You may also see more drainage in the early days, which is expected and not by itself a sign of a problem.
Splints for Babies With Cleft Lip
Some babies with cleft lip have a flattened nostril, and nostril splinting before surgery can help reshape it.30BC Children’s Hospital. Nostril Splinting before Surgery for Newborns with Cleft Lip Nasal Deformity On the cleft side, the nostril is pulled flat or wide because the cartilage underneath isn’t held in a normal shape. Babies’ cartilage is soft and bends easily early in life, which is why gentle shaping works and is started early. It also gives the surgeon a better starting point, so the nose needs less correction during repair.
The nostril retainer is a small soft stent or tube that sits in the nostril and holds it open in a rounder shape. It is often connected by a bridge or held with tape across the lip, so it stays in as the baby moves. Unlike the sheets used after septoplasty, it is shaped for a small baby’s nostril and made to be worn for months. Parents clean it and put it back in at home.
Wearing it consistently matters most for results. Babies who wore a nostril retainer consistently for at least 6 months after repair had noticeably better nose shape.31PubMed. The use of nasal splints in the primary management of unilateral cleft nasal deformity