Division of Rhinology, Department of Otolaryngology, Mayo Clinic in Arizona, Scottsdale, AZ, USA.
Mayo Clinic Alix School of Medicine, Scottsdale, AZ, USA.
Am J Rhinol Allergy. 2023 Nov;37(6):679-685. doi: 10.1177/19458924231186901. Epub 2023 Jul 5.
Mometasone-eluting poly-L-lactide-coglycolide (MPLG) is available commercially for frontal sinus ostium (FSO) stenting. An alternative chitosan polymer-based drug delivery microsponge is also available at a lower cost per unit.
To compare the outcomes of MPLG stents versus triamcinolone-impregnated chitosan polymer (TICP) microsponge in frontal sinus surgery.
Patients who underwent endoscopic sinus surgery from December 2018 to February 2022 were reviewed to identify those with the intraoperative placement of TICP microsponge or MPLG stent in the FSO. FSO patency was evaluated by endoscopy at follow-up. Twenty-two-item sinonasal outcome test (SNOT-22) was also recorded, and complications were noted.
A total of 68 subjects and 96 FSOs were treated. TICP was first used in August 2021 and MPLG in December 2018. MPLG placement in a Draf 3 cavity was excluded since TICP had not been used during Draf 3 procedure. Both cohorts (TICP 20 subjects, 35 FSOs; MPLG 26 subjects, 39 FSOs) had similar clinical characteristics. At a mean total follow-up of 249.2 days for TICP and 490.4 days for MPLG, FSO patency was 82.9% and 87.1%, respectively ( = .265). At an equivalent follow-up of 130.6 days in TICP and 154.0 days in MPLG, patency was 94.3% and 89.7%, respectively ( = .475). Both groups showed significant reductions in SNOT-22 ( < .001). MPLG demonstrated crusting within the FSO at 1 month (none in TICP).
FSO patency for both stents was similar, although TICP had significantly lower costs per unit. Additional comparative trials may be helpful for guiding clinicians on the appropriate clinical situations for the use of these devices.
莫米松洗脱聚 L-丙交酯-共乙交酯（MPLG）可商购用于额窦口（FSO）支架置入。另一种基于壳聚糖聚合物的药物输送微球也可提供更低的单位成本。
比较 MPLG 支架与曲安奈德浸渍壳聚糖聚合物（TICP）微球在鼻窦手术中的效果。
回顾 2018 年 12 月至 2022 年 2 月期间接受内镜鼻窦手术的患者，以确定术中在 FSO 中放置 TICP 微球或 MPLG 支架的患者。通过随访时的内镜评估 FSO 通畅性。还记录了 22 项鼻-鼻窦结局测试（SNOT-22），并注意到并发症。
共有 68 名患者和 96 个 FSO 接受了治疗。TICP 于 2021 年 8 月首次使用，MPLG 于 2018 年 12 月使用。由于 Draf 3 手术期间未使用 TICP，因此排除了在 Draf 3 腔中放置 MPLG 的情况。两个队列（TICP 20 名患者，35 个 FSO；MPLG 26 名患者，39 个 FSO）具有相似的临床特征。TICP 的平均总随访时间为 249.2 天，MPLG 的平均总随访时间为 490.4 天，FSO 通畅率分别为 82.9%和 87.1%（ = .265）。在 TICP 中等效的 130.6 天和 MPLG 中的 154.0 天的随访中，通畅率分别为 94.3%和 89.7%（ = .475）。两组 SNOT-22 均显著降低（ < .001）。MPLG 在 1 个月时在 FSO 内出现结痂（TICP 中无）。
两种支架的 FSO 通畅率相似，尽管 TICP 的单位成本明显较低。额外的对照试验可能有助于指导临床医生在适当的临床情况下使用这些器械。
