Odat Haitham, Al-Qudah Mohannad, Alzoubi Firas, Bani-Ata Majid, Hamouri Shadi, Al-Alawneh Mohammad, Al-Ameri Mohammad, Al-Domaidat Derar, Tanash Mahmoud
Division of Otolaryngology, Department of Special Surgery, Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid, Jordan.
Department of Surgery, Faculty of Medicine, Jordan University of Science and Technology, PO Box 3030, Irbid, Jordan.
Ann Med Surg (Lond). 2020 Sep 6;58:172-176. doi: 10.1016/j.amsu.2020.08.047. eCollection 2020 Oct.
To investigate the efficacy of middle meatal silastic splint in preventing adhesions after bilateral endoscopic sinus surgery (ESS) for chronic rhinosinusitis with nasal polyps (CRSwNP), and to assess nasal symptoms and endoscopic findings in splinted and non-splinted sides.
After completion of ESS, silicon silastic splints were randomly inserted in the middle meatus of one nasal side, while no stent in the other side (control). The surgeon was blinded to the side selection, and splint insertion until removal after 1 week. Patients were followed -up after 1 week, 1 and 6 months. Each side of the nasal cavity was assessed for adhesions, crusting, pus, pain, nasal obstruction, and nasal discharge by endoscopic examination and visual analogue scale.
Forty-nine patients (98 nasal sides) were included. At the 1st week visit, there was no significant difference between the splinted and non-splinted sides for all investigated parameters.After 1- month, adhesions were seen in 10% of the splinted sides, while it was in 26% of the non-splinted sides (P = 0.037).At the 6 -month follow-up visit, the adhesions rate remained 10% in the splinted sides, however the rate increased to 32% in the non-splinted sides ( = 0.007). All other examined parameters remained statistically insignificant between both sides throughout the follow -up visits.
Middle meatal silastic splint is significantly reducing middle meatal adhesions with low complication rate in CRSwNP patients undergoing ESS. Our results support its usage when the middle turbinate is unstable or traumatized during surgery.
探讨中鼻道硅橡胶夹板在双侧鼻内镜鼻窦手术（ESS）治疗慢性鼻-鼻窦炎伴鼻息肉（CRSwNP）后预防粘连的疗效，并评估夹板侧和非夹板侧的鼻部症状及内镜检查结果。
ESS完成后，将硅橡胶夹板随机插入一侧鼻腔的中鼻道，另一侧不放置支架（对照）。手术医生对侧别选择不知情，夹板插入后1周取出。患者在术后1周、1个月和6个月进行随访。通过内镜检查和视觉模拟评分对鼻腔两侧的粘连、结痂、脓性分泌物、疼痛、鼻塞和鼻分泌物进行评估。
纳入49例患者（98侧鼻腔）。在第1周随访时，所有研究参数在夹板侧和非夹板侧之间无显著差异。1个月后，夹板侧有10%出现粘连，而非夹板侧为26%（P = 0.037）。在6个月随访时，夹板侧粘连率仍为10%，而非夹板侧升至32%（P = 0.007）。在整个随访期间，两侧所有其他检查参数在统计学上均无显著差异。
中鼻道硅橡胶夹板可显著降低ESS治疗的CRSwNP患者中鼻道粘连，并发症发生率低。我们的结果支持在手术中中鼻甲不稳定或受创伤时使用该夹板。
