Manji Jamil, Habib Al-Rahim R, Macias-Valle Luis, Finkelstein Andres, Alsaleh Saad, Dadgostar Anali, Al-Asousi Fahad, Okpaleke Christopher, Javer Amin R
St. Paul's Sinus Centre, Vancouver, BC, Canada.
Hospital Español de México, Facultad Mexicana de Medicina Universidad La Salle, Mexico City, Mexico.
Int Forum Allergy Rhinol. 2018 Mar 30. doi: 10.1002/alr.22119.
Spacers are inserted into the middle meatal space (MMS) following functional endoscopic sinus surgery (FESS) to prevent lateralization of the middle turbinate, scarring, and synechiae. Our objective was to determine if the incidence of postoperative synechiae, facial pain/discomfort, pain during spacer removal, scarring, and discharge differed between nasal cavities receiving Silastic or gloved-Merocel (GM) spacers following FESS.
A double-blind, randomized controlled trial (RCT) was conducted in adults requiring bilateral FESS for chronic rhinosinusitis (CRS) ± nasal polyposis. Participants served as their own controls, with each subject receiving both a Silastic and GM spacer. Spacers were inserted into the MMS during FESS and left in situ for 6 days. Participants were reviewed at 6 days, 5 weeks, and 12 weeks postoperatively. The presence of synechiae and scarring were evaluated endoscopically. Inflammation, discharge, and pain during spacer removal were assessed using a visual analogue scale (VAS).
Forty-eight participants (96 nasal cavities) were recruited. Preoperatively, Lund-Mackay computed tomography (CT) scores were similar between Silastic-treated and GM-treated cavities (6.38 ± 2.35 vs 6.18 ± 2.17). The incidence of synechiae and scarring did not differ significantly between spacers up to 12 weeks postoperatively. Pain during spacer removal was significantly greater for Silastic than GM spacers (2.13 ± 1.34 vs 1.51 ± 1.23, p = 0.020). Facial pain prior to removal and extent of discharge did not differ significantly between spacers.
Following FESS, patients report less pain during removal of GM than Silastic spacers. However, the likelihood of synechiae and scarring did not differ between either of the spacers.
在功能性鼻内镜鼻窦手术（FESS）后，将间隔物插入中鼻道间隙（MMS）以防止中鼻甲侧化、瘢痕形成和粘连。我们的目的是确定在FESS后接受硅橡胶或戴手套的美罗赛（GM）间隔物的鼻腔之间，术后粘连、面部疼痛/不适、取出间隔物时的疼痛、瘢痕形成和分泌物的发生率是否存在差异。
对因慢性鼻窦炎（CRS）±鼻息肉而需要双侧FESS的成年人进行了一项双盲、随机对照试验（RCT）。参与者作为自身对照，每个受试者同时接受硅橡胶和GM间隔物。在FESS期间将间隔物插入MMS并原位留置6天。在术后6天、5周和12周对参与者进行复查。通过内镜评估粘连和瘢痕形成的情况。使用视觉模拟量表（VAS）评估取出间隔物时的炎症、分泌物和疼痛情况。
招募了48名参与者（96个鼻腔）。术前，硅橡胶治疗组和GM治疗组的鼻腔Lund-Mackay计算机断层扫描（CT）评分相似（6.38±2.35对6.18±2.17）。术后长达12周，间隔物之间粘连和瘢痕形成的发生率无显著差异。取出硅橡胶间隔物时的疼痛明显大于GM间隔物（2.13±1.34对1.51±1.23，p = 0.020）。取出间隔物前的面部疼痛和分泌物程度在间隔物之间无显著差异。
FESS后，患者报告取出GM间隔物时的疼痛比硅橡胶间隔物少。然而，两种间隔物之间粘连和瘢痕形成的可能性没有差异。
