Maxillary Antrostomy Patency Following Intraoperative Use of Spray Cryotherapy

Abstract

Objectives/Hypothesis: Stenosis of the middle meatus antrostomy (MMA) represents a major cause of recurrent disease following endoscopic sinus surgery (ESS). Various strategies have been developed to prevent the occurrence of MMA stenosis. The aim of the present study was to evaluate the effects of spray cryotherapy (SC) on nasal wound healing following ESS. Methods: This is a prospective within-subject, randomized, and controlled trial. Twenty-six patients submitted to bilateral ESS with chronic rhinosinusitis without polyps were included. Following surgery, patients were randomized to receive SC on one side and saline contralaterally. Outcomes were represented by MMA diameter and area, histology of nasal mucosa, and nasal symptoms. Variables were assessed at 3 and 12 months postoperatively. Results: The MMA size in the SC group at 3 and 12 months (area-0.578 ± 0.1025 cm 2 , diameter-0.645 ± 0.1024 cm; 0.605 ± 0.1891 cm 2 , 0.624 ± 0.0961 cm, respectively) was significantly larger (p = 0.000) than in the control group. Histology established that cell infiltration, goblet cells, edema, and epithelial hyperplasia were prominent and persistent in the control side compared to the SC side. Nasal obstruction and discharge were significantly improved in the SC group compared to the control group. Conclusion: SC is a promising therapy following ESS, since it precludes MMA stenosis and decreases inflammation, edema, and goblet cell hyperplasia.

Role of mitomycin-C to reduce post FESS adhesion and ostial stenosis

“…The use of stents have also been reported by some authors [11]. Veronica et al evaluated the use of cyrotherapy spray to maintain maxillary sinus Ostia patency post FESS and described it a promising therapy [12]. The mitomycin has been used as an agent to reduce the post ostial stenosis in a small group of patient showing promising results [13].…”

A prospective study of spray cryotherapy in patients with COPD

“…Moreover, SCT can be used in situations where other treatment methods may cause damage to stent materials. The treatment also provides a more uniform and linear distribution of the cryogenic effect, resulting in a more homogenous impact on the entire treated lesion 27,28 …”

“…The treatment also provides a more uniform and linear distribution of the cryogenic effect, resulting in a more homogenous impact on the entire treated lesion. 27,28 While SCT is a promising treatment option, it is essential to consider the potential risks associated with its clinical application. These risks include anaesthesia risks, bronchoscopy risks and adverse reactions caused by cryotherapy, such as bleeding, pneumothorax, pain (back pain, chest pain, headache, sore throat), infections, arrhythmias and other events such as anxiety, fatigue, vertigo and diarrhoea.…”

The safety and efficacy of spray cryotherapy after endoscopic sinus surgery in chronic rhinosinusitis: A systematic review of randomized controlled trials

“…According to Trombitaș et al, 20 the spray cryotherapy (SC) group significantly outperformed the control group in terms of nasal obstruction and discharge. Furthermore, the placebo side was linked to mononuclear cell infiltration, edema with collagen fiber dislocation, epithelial hyperplasia, goblet cells, and persistent squamous metaplasia on top of the epithelial hyperplasia, whereas the SC side was linked to superior collagen fiber organization.…”