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Displaced Nasal Pack Airway Obstruction — FRCA Final MCQ

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ModerateAirway ManagementDisplaced Nasal Pack Airway ObstructionFRCA Final

A 35-year-old man (ASA I) undergoes a nasal septoplasty. The surgeon uses a posterior nasal pack. Post-operatively the patient develops stridor and respiratory distress. The nasal packs are in situ bilaterally. What has likely happened?

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Correct answer: D — Laryngospasm

Posterior nasal pack displacement is a known cause of post-operative airway obstruction after nasal surgery. If the pack migrates posteriorly, it can obstruct the oropharynx/hypopharynx. The patient cannot breathe through either the nose (packs) or the mouth (displaced pack). This is a potentially fatal emergency. Management: immediately cut and remove the nasal pack sutures, remove the displaced pack, and secure the airway. All patients with nasal packs should be closely monitored for airway obstruction and have the pack securing strings clearly visible and accessible for emergency removal.

Reference: RCOA – 2023 – ENT anaesthesia; Association of Anaesthetists – 2020 – Post-operative airway complications