Influence of Chitosan-Based Dressing on Prevention of Synechia and Wound Healing after Endoscopic Sinus Surgery: A Meta-Analysis

Liu, Jie; Zeng, Quan; Xia, Ke; Yang, Yucheng; Hu, Guohua; Zhang, Xuan

doi:10.2500/ajra.2017.31.4469

Cited by 8 publications

(12 citation statements)

References 44 publications

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“…14,15 In this study, the follow-up period was purposely limited to 2 weeks because this is the time when early synechia formation between turbinates and septal tissues can be detected and treated; longer observations may confirm mature synechia. 16 In our experience, the NAG greatly facilitates rapid passage of instruments through the nasal cavity, increasing the efficiency of surgery. It protects the nasal aperture from burn injuries from powered instrumentation such as drills and ultrasonic aspirators.…”

Section: Discussionmentioning

confidence: 98%

Utility of Nasal Access Guides in Endoscopic Endonasal Skull Base Surgery: Assessment of Use during Cadaveric Dissection and Workflow Analysis in Surgery

Velasquez

Ahmed

Lavigne

et al. 2020

J Neurol Surg B Skull Base

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Background A nasal access guide (NAG) for endoscopic endonasal approaches (EEAs) to the skull-base has been developed and approved for clinical use but its utility has not been formally investigated. Objectives The study aims to assess the effect of a NAG on endoscopic visualization during cadaveric dissection and to perform a workflow analysis with process-based performance measures in the operating room and their effect on clinical outcomes. Methods Skull-base course participants were observed during hands-on cadaveric dissection with and without NAG. Instances of endoscope withdrawal for lens cleaning and inadequate visualization due to lens soiling were tabulated. Participants completed a Likert-scale survey examining the NAG utility and provided an overall grading. Surgical workflow and process-based performance on patients undergoing EEA to the skull-base was analyzed. Passage of powered and dissecting instruments, removal of endoscopes for cleaning, and dislodgment or migration of the device were reviewed. Postoperative assessments included mucosal trauma and synechiae formation. Results Instances of endoscope soiling and manual cleaning were significantly reduced by 40% and 61% with the NAG during cadaveric dissection. The overall grading of the device was 2.75/3. Surgical workflow was observed in 35 patients. Average number of passes of endoscopes, instruments, and powered tools during a 10-minute observation period were 3,17, and 5 during the surgical approach, and 3, 18, and 1 during tumor dissection. Dislodgement of the device occurred in 25.7% and migration of the device in 2.8% of cases. Postoperative synechiae, exposed cartilage or septal perforation was not observed in follow up. Conclusion NAG can significantly reduce inadequate visualization during EEA to the skull-base and has the potential to reduce instances of nasal trauma. Participants assessed its overall utility as being “excellent.”

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Section: Discussionmentioning

confidence: 98%

Utility of Nasal Access Guides in Endoscopic Endonasal Skull Base Surgery: Assessment of Use during Cadaveric Dissection and Workflow Analysis in Surgery

Velasquez

Ahmed

Lavigne

et al. 2020

J Neurol Surg B Skull Base

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“…They reportedly reduce incidence of abovementioned morbidities but often without reducing the risk of granulation reactions, infection, and synechiae. 11 Chitosan is a bioresorbable, nontoxic chitin-derived complex carbohydrate used widely in the nutrition, agriculture, cosmetic, and textile industries for its antimicrobial, hydrating, and other properties. 12 Induction of endothelin production and promotion of red blood cell and platelet adhesion contribute to barrier formation and wound sealing in the surgical setting.…”

Section: Introductionmentioning

confidence: 99%

Postoperative Bioresorbable Chitosan-Based Dressing for Endoscopic Middle Meatal Dacryocystorhinostomy With Balloon Dilation

et al. 2019

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Purpose: To evaluate the improvement in epiphora and need for surgical revision in patients with acquired nasolacrimal duct obstruction following balloon-assisted, middle meatal endoscopic dacryocystorhinostomy with chitosan-based dressing versus bioresorbable polyurethane packing versus no packing. Patients and Methods: This was a retrospective study of consecutive adult patients seen from 2015 to 2018 with follow-up evaluation of epiphora at least 3 months after balloon-assisted, middle meatal endoscopic dacryocystorhinostomy. Patients with a history of prior punctoplasty, septoplasty, sinus surgery, or dacryocystorhinostomy of any kind were excluded. Those meeting criteria were stratified by postoperative hemostatic intervention: no packing, bioresorbable packing, and chitosan-based dressing (groups 1, 2, and 3, respectively). Procedural outcomes were graded as successes or failures based on subjective report and anatomical findings at most recent visit within an 18-month postoperative window. Instances of recommendation for revision surgery were also recorded. Results: Forty-three cases (36 patients) met the abovementioned criteria. Groups 1, 2, and 3 comprised 12, 17, and 14 cases each, respectively. Average patient age was 55.3 years old, and average duration of follow-up was 6.7 months. Significant variation in outcomes was detected across the 3 groups ( P = .0495), particularly between groups 1 and 3 ( P = .033). Use of chitosan-based dressing trended toward reduced rates of recommendation for surgical revision ( P = .203, P = .113). Conclusions: Use of chitosan-based dressing after endoscopic dacryocystorhinostomy was associated with improved subjective and anatomical outcomes. It may also contribute to less frequent need for revision surgery. Further study in a larger prospective trial is recommended.

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“…Ancak burun içine yapılan bu müdahaleler, nadir olmayan şekilde çeşitli komplikasyonlarla sonuçlanabilmektedir. 1,2 Nazal septum veya endoskopik sinüs cerrahisinde başarılı sonuçlar elde etmek için cerrahi prosedürün doğru uygulanması ve düzgün yara iyileşmesinin sağlanması önemlidir. Cerrahi alanda düzgün yara iyileşmesi sağlanamazsa, revizyon ameliyatları gerektirebilecek mukozal yapışıklıklar ve anatomik kusurlar ortaya çıkabilir.…”

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Retrospective Clinical Analysis in Patients with Nazal Synechia

Özer¹,

Özer²,

Erkan³

2021

KBB ve BBC Dergisi

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Kronik rinosinüzit, septal deviasyon ve konka hipertrofisi, kulak-burun-boğaz (KBB) kliniğinde sık görülen patolojilerdir. Etkilenen hastalarda burun tıkanıklığına ve önemli ölçüde azalmış yaşam kalite-sine neden olabilirler. Ayrıca anosmi, baş ağrısı, baş dönmesi ve uykusuzluğa da sebep olabilirler. 1 KBB hekimleri, bu sorunların tedavisi için sıklıkla endoskopik sinüs cerrahisi, septoplasti, septorinoplasti ve

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Influence of Chitosan-Based Dressing on Prevention of Synechia and Wound Healing after Endoscopic Sinus Surgery: A Meta-Analysis

Abstract: Compared with control intervention, chitosan-based dressing was associated with significantly reduced synechia and with increased granulations and hemostasis but showed no influence on crusting and infection after ESS.

Cited by 8 publications

References 44 publications

Utility of Nasal Access Guides in Endoscopic Endonasal Skull Base Surgery: Assessment of Use during Cadaveric Dissection and Workflow Analysis in Surgery

Utility of Nasal Access Guides in Endoscopic Endonasal Skull Base Surgery: Assessment of Use during Cadaveric Dissection and Workflow Analysis in Surgery

Postoperative Bioresorbable Chitosan-Based Dressing for Endoscopic Middle Meatal Dacryocystorhinostomy With Balloon Dilation

Retrospective Clinical Analysis in Patients with Nazal Synechia

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