Sinonasal debridement versus no debridement for the postoperative care of patients undergoing endoscopic sinus surgery

Tzelnick, Sharon; Alkan, Uri; Leshno, Moshe; Hwang, Peter H.; Soudry, Ethan

doi:10.1002/14651858.cd011988.pub2

Cited by 11 publications

(3 citation statements)

References 22 publications

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“…Understanding the normal peri-operative time toward healing can better guide clinical decisions as to the frequency and length of follow-up needed in the immediate post-operative period. Previous reports have shown that in the post-operative period, after sinus surgery, nasal debridement is associated with improved ostium patency and a lower rate of intranasal scarring [ 18 ]. As such, one hypothesis that could be deduced is that earlier mucosalisation of exposed bone may lead to less crusting, less need for debridement in the peri-operative period and possibly improved rates of longer-term patency.…”

Section: Discussionmentioning

confidence: 99%

Anterior Pedicled Nasal Flap in Frontal Sinus Drill-Out Patients: A Randomised Controlled Pilot Study

Bastianelli

Huang

Moore

et al. 2022

JCM

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Background: The endoscopic modified Lothrop procedure (EMLP) is a common procedure performed in patients with frontal sinus pathology. While performing this procedure, large segments of bone are exposed, which may lead to the promotion of frontal sinus neo-ostium stenosis. Here we examine the peri-operative differences in time to achieve healing in patients where a mucosal flap is used to cover the exposed bone on one side of the neo-ostium. Design: A randomised pilot study with 12 patients undergoing EMLP surgery participated in this study. Methods: Patients were randomised to undergo a mucosal flap on either the left or right side of the neo-ostium. Prior to surgery, patients completed a SNOT-22 and smell identification test. Patients were reviewed until the neo-ostium had healed on both sides. Once healing had occurred, a post-operative SNOT-22 score and smell identification test were recorded. Results: Average time to healing for the frontal sinus neo-ostium was 4.7 vs. 4.2 (p = 0.3) on the flap vs. non-flap side, respectively. There was an average 24.4 point (range: −75 to +9) decrease in SNOT-22 scores post-surgery. The post-operative USPIT score demonstrated an average increase of 6.6 points (range −13 to +27). Conclusion: We did not detect significant differences in peri-operative time toward healing in neo-ostiums where a single flap is utilised. Further studies are needed to determine whether the usage of a single neo-ostium flap affords any benefit over no flap on either ostium. SNOT-22 and UPSIT scores improved post-surgery.

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Section: Discussionmentioning

confidence: 99%

Anterior Pedicled Nasal Flap in Frontal Sinus Drill-Out Patients: A Randomised Controlled Pilot Study

Bastianelli

Huang

Moore

et al. 2022

JCM

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“…adhesion rates with or without debridement [26]. A metaanalysis on the benefit of sinonasal debridement after endoscopic sinus surgery stated low-quality evidence that postoper- ative debridement is associated with a significant lower adhesion rate after 3 months [27]. We therefore recommend postoperative sinonasal debridement in pituitary patients undergoing transsphenoidal surgery.…”

Section: Discussionmentioning

confidence: 99%

Rhinological Consequences of Microsurgical Endonasal-Transsphenoidal Surgery for Pituitary Tumors

Hondronikos

Alomari

Schrader

et al. 2020

Exp Clin Endocrinol Diabetes

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Background Transsphenoidal surgery for sellar lesions may affect patency and function of the nasal airways, smell and sinonasal quality of life. Below is our report on otorhinolaryngological data garnered from patients undergoing endonasal transsphenoidal pituitary microsurgery. Methods In a prospective study, 68 patients scheduled for transsphenoidal operations (32 female, 36 male, age 17–72 years) underwent otorhinolaryngological evaluation of their nasal morphology, a standardized smell test (sniffin’ sticks) and rhinomanometry to analyse nasal breathing function preoperatively, 3–5 days postoperatively (without rhinomanometry), after 3–4 months and after 9 months. Results Immediately after surgery, a reduction in smell sensation was detected in almost all patients. Within 3 months, this impairment resolved in all cases except one. In 2 patients (3%) with preoperative anosmia, improvement of smell function to>6 out of 12 sniffin’ sticks was observed. At final visit no patient was noted to have new anosmia. Within 3 months, the results of the rhinomanometry revealed that all patients except one, regained their preoperative nasal breathing function. In 6 patients (8.8%) an improvement in their nose breathing abilities compared to the preoperative state was found. Three patients (4.4%) underwent a LASER transection of mucosal synechiae. In one case with persistent nasal obstruction (1.5%), secondary septoplasty had to be performed. There was no case in which perforation of the nasal septum, nasal tip deflection, or saddle nose deformity was observed. Conclusion Microsurgical resection of pituitary tumors via the endonasal transsphenoidal approach poses an acceptable risk with regards to sinonasal complications. The incidence of secondary rhinosurgical interventions is low. Standardized comparative studies between endoscopic and microsurgical transsphenoidal operations should be undertaken.

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“…While debridement has been shown to reduce postoperative adhesions, assessment of multiple randomized controlled trials show no consistent benefit based on symptom scores [23]. Cochrane Database reviews on surgery for chronic rhinosinusitis and debridement have shown no benefit/ advantage compared to medical management (e.g., antibiotics, sinus irrigations, steroids) [24,25]. The subsequent advent of office balloon sinuplasty, which bypasses general anesthesia, has further accelerated intervention for this condition despite lack of clear benefit: since the introduction of CPT coding for this procedure in 2011, a sixfold increase in procedures (44 000 in 2017) and 433% increase in payments have been observed [26,27].…”

Section: Rationale For Surveillance For Benign Thyroid Nodulesmentioning

confidence: 99%

Radiofrequency ablation (RFA) compared to observation for benign thyroid nodules: emerging considerations for judicious use

Sinclair

Bastien

2022

Current Opinion in Endocrinology, Diabetes &Amp; Obesity

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Purpose of reviewRadiofrequency ablation (RFA) for thyroid nodules confers tangible advantages over surgery, which include promising outcomes in the context of a minimally invasive procedure and the functional benefits of organ preservation. However, the ubiquity of benign nodules worldwide may spur the risk of misuse in cases where there is negligible gain over conventional surveillance. This review summarizes new developments in RFA and examines its judicious utilization in benign nodules.Recent findings RFA appears to be safe and effective for addressing compressive or cosmetic issues caused by benign functional and nonfunctional thyroid nodules. Volume regression occurs over 12 months, with some cases requiring multiple staged RFA procedures to achieve adequate shrinkage or to address regrowth. Complication rates including recurrent laryngeal nerve injury are reportedly low and are mitigated by strategic technical maneuvers, training, and experience. Consensus guidelines across international societies have emerged to better define appropriate patient candidates. Although association of overuse in analogous disciplines has been well established, no evidence of misuse in thyroid RFA has been described thus far.

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Sinonasal debridement versus no debridement for the postoperative care of patients undergoing endoscopic sinus surgery

Abstract: Sinonasal debridement versus no debridement for the postoperative care of patients undergoing endoscopic sinus surgery (Review)

Cited by 11 publications

References 22 publications

Anterior Pedicled Nasal Flap in Frontal Sinus Drill-Out Patients: A Randomised Controlled Pilot Study

Anterior Pedicled Nasal Flap in Frontal Sinus Drill-Out Patients: A Randomised Controlled Pilot Study

Rhinological Consequences of Microsurgical Endonasal-Transsphenoidal Surgery for Pituitary Tumors

Radiofrequency ablation (RFA) compared to observation for benign thyroid nodules: emerging considerations for judicious use

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