Department of Otolaryngology Head and Neck Surgery, Peking University Third Hospital, Beijing, PR China.
Department of Medicine, Peking University, Beijing, PR China.
J Otolaryngol Head Neck Surg. 2024 Jan-Dec;53:19160216241269375. doi: 10.1177/19160216241269375.
The frontal sinus remains a challenging site for irrigation due to its position relative to the nostril and ethmoid sinus. This study aims to summarize the necessary factors for efficient irrigation of the frontal sinus after endoscopic sinus surgery (ESS) among patients with chronic rhinosinusitis (CRS).
Using Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines, a systematic literature review was conducted on PubMed, Scopus, and Cochrane databases to identify studies assessing the effect of frontal sinus irrigation in patients with CRS, cadaver models, or 3D-printed models of the sinonasal cavity after ESS.
Of the initial 206 abstracts reviewed, 18 full-text articles were included. The degree of the frontal sinus ostium opening after ESS was found to be associated with the efficacy of frontal sinus irrigation. More extensive frontal sinus surgeries tended to increase frontal sinus penetration. A Draf IIA procedure was identified as the minimum standard to achieve sufficient irrigation in the frontal sinus. Due to decreased backpressure in the nasal passage, increasing septectomy in Draf III did not significantly improve irrigation delivery. Squeeze bottles achieved significantly higher irrigation flow in the frontal sinus than syringes and pulsating devices. Large-volume irrigation devices provided better irrigation for the frontal sinus by entering or flushing the entire frontal sinus. The head position influenced the frontal sinus irrigation by altering the ostia position relative to fluid flow and vertical height of the frontal sinus during irrigation. While the vertex down head position was likely to enhance frontal sinus irrigation, the comfort of the head position and patient compliance should be considered.
Elements for optimization of frontal sinus irrigation are a minimum of a Draf IlA procedure for frontal sinus dissection, use of large-volume irrigation, and vertex down head positioning. Developing comfortable head positions with high frontal sinus irrigation efficiency would increase patient compliance and improve outcomes.
NA.
由于额窦相对于鼻腔和筛窦的位置，其冲洗仍然是一个具有挑战性的部位。本研究旨在总结慢性鼻-鼻窦炎（CRS）患者内镜鼻窦手术后（ESS）有效冲洗额窦的必要因素。
使用系统评价和荟萃分析的首选报告项目（PRISMA）指南，在 PubMed、Scopus 和 Cochrane 数据库中进行系统文献综述，以确定评估 ESS 后 CRS 患者、尸体模型或鼻窦腔 3D 打印模型中额窦冲洗效果的研究。
在最初审查的 206 篇摘要中，有 18 篇全文文章被纳入。ESS 后额窦口的张开程度与额窦冲洗的疗效有关。更广泛的额窦手术往往会增加额窦穿透。Draf IIA 手术被认为是在额窦中实现充分冲洗的最低标准。由于鼻腔内的背压降低，Draf III 中的鼻中隔切除术并不能显著改善冲洗的输送。挤压瓶在额窦中实现了明显更高的冲洗流量，而注射器和脉动装置则没有。大容量冲洗装置通过进入或冲洗整个额窦，为额窦提供更好的冲洗。头的位置通过改变相对于流体流动的窦口位置和冲洗时额窦的垂直高度来影响额窦冲洗。虽然头朝下的位置可能会增强额窦冲洗，但应考虑头的位置的舒适度和患者的依从性。
优化额窦冲洗的要素包括额窦切开术的最低限度的 Draf IlA 手术、使用大容量冲洗和头朝下的位置。开发具有高额窦冲洗效率的舒适头部位置将提高患者的依从性并改善结果。
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