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Silastic splints reduce middle meatal adhesions after endoscopic sinus surgery

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Abstract:

Background:

Adhesions frequently form between the middle turbinate and lateral nasal wall after endoscopic sinus surgery (ESS) and are a possible cause for surgical failure. Many absorbable and nonabsorbable spacers have been tried to improve healing. This study was designed to ascertain whether placement of a thin silastic splint into the middle meatus after sinus surgery for 2 weeks reduces adhesion formation and whether a reduction in the adhesion rate improves patient outcomes in the early postoperative phase.

Methods:

Forty-two patients who were scheduled to undergo ESS for chronic rhinosinusitis were randomized to have a silastic splint placed into the middle meatus on one side of the nose but not the other at the completion of surgery. Splints were removed 2 weeks postoperatively. Symptom scores were recorded for each side of the nose up to 12 weeks after surgery and ethmoid cavities were graded at the 6- and 12-week visits along with assessment of adhesions. Patients were blinded to which side was splinted as was the surgeon assessing ethmoid cavities at 6 and 12 weeks.

Results:

Thirty-three patients completed 12 weeks of follow-up. Nasal obstruction and facial pain/discomfort were significantly higher on splinted sides for the first 2 weeks. More interventions were performed to debride adhesions in nonsplinted sides. Endoscopy revealed no adhesions at 12 weeks for sides treated with a splint whereas 9 of 33 nonsplinted sides had persistent adhesions. There were no significant differences in symptom or ethmoid cavity scores at 6 or 12 weeks between sides treated with splints versus sides treated without splints or between sides with adhesions versus without adhesions.

Conclusion:

Middle meatal silastic splints reduce adhesions after ESS but increase early nasal obstruction and discomfort. Their use did not significantly change symptom or ethmoid cavity scores at 12 weeks.

Keywords: Adhesion; chronic rhinosinusitis; endoscopic sinus surgery; healing; outcome; packing; scarring; spacer; synechiae

Document Type: Research Article

DOI: https://doi.org/10.2500/ajra.2012.26.3810

Affiliations: North Shore Hospital, and the Department of Surgery, The University of Auckland, Auckland, New Zealand

Publication date: 2012-09-01

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