Nasal dressings after endoscopic sinus surgery: what and why?

Abstract

The sinus surgeon must be aware of the potential advantages and limitations of currently available nasal dressings. The area of wound healing and adhesion prevention remains an area of active research and more prospective controlled trials are needed to define any benefits biomaterials may have.

Avoiding Complications in Endoscopic Sinus Surgery

“…Although packing is not necessary to prevent postoperative hemorrhage, biomaterials such as chitosan and microporous polysaccharide hemospheres (potato starch) can be placed electively to promote hemostasis. [37][38][39] Postoperative instructions to avoid nose blowing and nasal manipulation are provided in written format. The patient is encouraged to perform open mouth sneezing and refrain from vigorous activity or lifting greater than 10 lb (w5 kg) until the first postoperative office visit.…”

Post-FESS Middle Meatal Dressings

“…Epistaxis severe enough to require clinical attention has been estimated to occur in 1% to 6% of cases across studies. 3 …”

“…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. Precise rates of turbinate lateralization are difficult to estimate because turbinate position remains a subjective assessment with only fair interrater reliability.…”

Hepatocyte Growth Factor Gene-Modified Mesenchymal Stem Cells Augment Sinonasal Wound Healing

“…Although symptomatic and medical results have been extensively described after FESS [2,3], the formation of adhesions and the scarring of the nasal cavity and sinuses are common [4]. Recurrence or surgical failure has been a postoperative problem in some cases because of adhesion and scar formation after surgery [4]. The postoperative management of the FESS cavity remains an area of active research and ongoing debate in the otolaryngologic literature.…”

“…Both conservative and surgical therapies aim at restoring respiratory function, especially ciliated epithelial function. Although symptomatic and medical results have been extensively described after FESS [2,3], the formation of adhesions and the scarring of the nasal cavity and sinuses are common [4]. Recurrence or surgical failure has been a postoperative problem in some cases because of adhesion and scar formation after surgery [4].…”