A Scientific Review of Middle Meatal Packing/stents

Abstract

The most effective hemostatic agent currently available is FloSeal; however, this product causes an increase in adhesion formation. For the purpose of preventing adhesions, resorbable packs appear to have no benefit over either nonresorbables or no packing. If the middle turbinate is unstable at the conclusion of surgery, suturing it to the septum may reduce adhesions. Although mitomycin C, hyaluronic acid, and retinoic acid all have shown potential in these roles, to date, none have shown to be useful in the post-ESS chronic sinusitis human patient.

International Consensus Statement on Allergy and Rhinology: Rhinosinusitis

“…However, there has been conflicting evidence on their effectiveness. 1305,1309 Controversy remains regarding their effectiveness, when they should be placed, duration of placement, and type of stent employed. 1308 Silastic stents have been associated with biofilm formation postoperatively, which maybe counterproductive in the treatment of CRS.…”

“…Postoperative failures may be caused by synechiae formation, ostial stenosis, osteoneogeneiss, MT lateralization, and recurrent polyposis. [1302][1303][1304][1305][1306] These complications are currently mitigated by saline irrigations to reduce crusting, postoperative debridement, adhesion lysis, and topical and systemic corticosteroids. Postoperative debridement can be painful and the use of systemic corticosteroids carries potential side effects.…”

Middle turbinate medialization for improved access during endoscopic sinus surgery

“…They also recommend suturing the septum to the middle turbinate if it is unstable at the conclusion of surgery and suggest that this technique may reduce adhesion formation. 11 Though most literature published on the medialization of the middle turbinate focuses on preventing lateral adhesions, these techniques can seemingly benefit the surgeon during the operation in addition to the postoperative period. Success in endoscopic surgery of the sinuses relies strongly upon visualization of key anatomic structures.…”

Post-FESS Middle Meatal Dressings

“…Synechiae formation in the middle meatus is estimated to occur in 0% to 40% of cases, with most authors reporting rates greater than 15%. 2 It remains a commonly held belief that scarring negatively impacts outcomes of surgery and predicts need for future revision procedures. 3 Lateralization of the middle turbinate is another undesired outcome of surgery because it may increase synechiae formation and limits access into the middle meatus for endoscopic visualization and topical delivery of medications.…”