Prevention of Middle Meatal Synechia Formation after Endoscopic Sinus Surgery with Different Packing Materials Dawood S Hasan* FICMS, Munthir K Ali* DLO, Ali S Fadhil* DLO, Mohammed R Taha* MBChB
Background: One of the primary goals of functional endoscopic sinus surgery for treatment of chronic rhinosinusitis is to create patent paranasal sinus ostia, but formation of synechiae between the middle turbinate and lateral nasal wall can obstruct sinus outflow leading to persistence or recurrence of symptoms. Numerous techniques have been used to prevent postoperative synechiae formation.
Objectives: To evaluate the effect of three different materials (Mitomycin C, Merocel, and Nasopore) on the prevention of synechiae and excessive granulation tissue in the middle meatus with relation of pain and discomfort in patients undergone functional endoscopic sinus surgery.
Methods: An interventional study of (32) selected adult patients with signs and symptoms of chronic rhinosinusitis were seen in otorhinolaryngology department at Al-Imamain Alkadhimain medical city over a period of 12 months (from May 2017 to April 2018). They were divided into three groups depending on type of middle meatal packing used following functional endoscopic sinus surgery; Group I: (12) patients were packed using Merocel, Group II: (12) patients were using Mitomycin C and Group III: (8) patients were packed using Nasopore. Consent was taken from all patients underwent functional endoscopic sinus surgery for treating their chronic rhinosinusitis and classified into specific group according to type of packing materials. Postoperatively, all patients received I.V. antibiotics for 72 hours then changed to oral for 11 days, given instructions on how to use nasal irrigations using isotonic saline with analgesia as indicated and with systemic or local steroid for all patients. Merocel packing was removed after 48 hr. postoperatively. Patients were seen 7-10 days postoperatively, then every 1 week in the first month, every 2 weeks in the second month, then 1 visit in the third month.
Results: Eighteen patients (56.25%) were males and 14 patients (43.75%) were females. Ages of patients ranged from 20 to 49 years and the mean age ± standard deviation (SD) was 34.3 ± 8.4 years. The most common clinical presentations were nasal obstruction (86.7%) and nasal discharge (76.7%). The stages of rhinosinusitis (Lund and Mackay CT staging system) were ranging from 10 to 20 for both sides, the mean stage ± SD was 14.4 ± 3. Discomfort due to middle meatal packing and pain caused by packing removal were significantly associated with Merocel packing compared to Nasopore as the P values were 0.027 and 0.009 respectively. The rates of development of middle meatal synechia and granulation tissues associated with different packing materials were as follow: Merocel (16.7% and 25%), Mitomycin C (25% and 33.3%) and Nasopore (12.5% and 12.5%), respectively. No significant difference has been obtained between different packing materials in preventing the development of middle meatal synechia and granulation tissue following functional endoscopic sinus surgery.
Conclusions: Although each type of middle meatal packing has its specific advantages and disadvantages, no one has been shown to have a superior role than others in preventing the development of middle meatal synchiae following functional endoscopic sinus surgery
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