The role of different materials for prevention of synechiae following endoscopic sinus surgery

Comparison between the endoscopic scores of bolgerization versus partial resection of the middle turbinate for management of the postoperative lateralization in the early follow-up period after endoscopic frontal sinusotomy: A randomized controlled study

BACKGROUND

Frontal sinusotomy is a challenging procedure that needs meticulous handling due to its unique anatomical position. Postoperative middle turbinate lateralization is critical comorbidity for the success rate, and many techniques are adopted to prevent it. The study aimed to compare the effect of middle turbinate bolgerization and partial resection on the postoperative endoscopic scores and assess their impact on the middle meatus and the frontal recess outcome.

PATIENT AND METHODS

This prospective study was conducted on forty-one patients undergoing bilateral frontal sinusotomy for chronic frontal sinusitis. Nasal cavities were randomized so that partial middle turbinate resection technique was done alternately with bolgerization approach in every patient. Each participant acted as their control. Both sides were compared using Lund Kennedy Endoscopic Score (LKES) and Perioperative Sinus Endoscopy Score (POSE) at the baseline, 1st, 3rd, and 12th-month intervals postoperatively. Also, middle turbinate status was assessed at the end of the 12th-month interval using POSE score.

RESULTS

The total frontal sinus patency rate was 82.9% (63/76 operated sinus). Baseline scores, LKES (3.79 ± 0.777 vs 4.05 ± 0.769, p = 0.142, for the side of resection and the side for bolgerization respectively) and POSE (1.79 ± 0.413 vs 1.82 ± 0.393, p = 0.777, for the side of resection and the side for bolgerization respectively). Regarding LKES, the differences between both operated sides were fluctuating with p values: 0.001*, 0.171, and 0.044* for the 1st, 3rd, and 12th months follow-up intervals, respectively. Regarding the POSE score of the frontal sinus, the difference between both groups was steadily increasing with p values: 0.318, 0.119, and 0.017* for the 1st, 3rd^, and 12th months follow-up intervals. The middle turbinate's POSE score at the 12th month was significantly higher in the side allocated for bolgerization (p-value = 0.008*).

CONCLUSION

Partial middle turbinate resection showed favorable endoscopic outcomes than bolgerization at the 12th month follow up period in patients undergoing primary ESS for chronic frontal sinusitis.

The impact of bolgerization versus partial resection of the middle turbinate on frontal sinusotomy patency outcome: A randomised controlled study

OBJECTIVES

This study aimed to compare the effects of middle turbinate resection vs bolgerization on the incidence of middle meatus synechia and their prognostic value on the patency outcomes after frontal sinusotomy.

DESIGN

A randomised controlled study.

SETTING

Tertiary centre hospital.

MAIN OUTCOME MEASURES

Thirty-eight patients undergoing bilateral frontal sinusotomy for chronic frontal sinusitis were included. Partial middle turbinate resection was alternated with bolgerization in both nasal cavities of every patient. The Lund-Kennedy endoscopic scores (LKESs) for both sides were compared at the first, third and sixth months postoperatively. Middle meatus synechia was assessed using the visual analogue score (VAS). Sinus patency was assessed at the end of the sixth month using a 70° nasal endoscope.

RESULTS

The sinus patency outcome was significantly higher in the resected group (34\38) than the bolgerized group (26\38), (P = .047*). The VAS scores suggested that the middle turbinate bolgerization group showed a significantly higher incidence of middle meatal synechia than the partial middle turbinate resection group (4.47 ± 2.617 vs 3.29 ± 2.301; P = .040*).

CONCLUSION

Middle turbinate resection showed more favourable results than bolgerization concerning the sinus patency outcome after frontal sinusotomy. It also showed a lower incidence of middle meatus synechia postoperatively.

Effects of Silver Nitrate Cauterization on Middle Turbinate Synechia after Endoscopic Sinus Surgery

Objective This study aimed to examine the efficacy of silver nitrate cauterization of the middle turbinate (MT) for hindering postoperative middle meatal synechia formation after endoscopic sinus surgery (ESS). Study Design Prospective, controlled, and single-blinded. Settings Tertiary referral center. Subjects and Methods For this study, 38 patients undergoing bilateral ESS due to nasal polyposis were recruited. Following ESS, silver nitrate cauterization of the lateral side of the left MT was performed in all cases. The noncauterized opposite right sides served as controls. All patients received the standard ESS protocol, intraoperative middle meatal packing, and postoperative management. The main outcome measured was the formation of partial or complete MT synechia at the end of 6-month assessment, performed by a blinded observer. Results At the end of the 6-month follow-up period, MT synechia formation was observed in 7 of the right sides (7 of 38, 18.4%) and none in any left sides. The rate of synechia formation was significantly higher in the controls when compared with the silver nitrate-cauterized sides ( P < .001). Conclusion The results of this study suggest that silver nitrate cauterization of the MT is a practical and efficient method to eliminate middle meatal synechia after ESS.