الفهرس 
List of ContentsOnly 14 pages are availabe for public view
 |  | from | 129 |  |  |
| | | from | 129 | | |
Abstract
Summary
Endoscopic sinus surgery is a well-established treatment for medically refractory chronic rhinosinusitis with a symptomatic success rate ranging from 74% to 97.5%.
Adhesions remain one of the most common causes of recurrent nasal symptoms necessitating revision sinus surgery.
Most patients undergo packing with some sort of material following ESS, it has been noted that post-ESS packing exerts a significant effect on the patient’s quality of life and wound healing.
Middle meatal dressings are commonly used to reduce postoperative complications. In recent years several biodegradable materials have been used for this purpose with mixed results.
This study was to determine the efficacy of a biodegradable polyurethane middle meatal pack (Nasopore) compared with a traditional non absorbable hydroxylated polyvinyl acetal (Merocel) middle meatal pack on post ESS wound healing and synechiae formation.
A prospective randomized clinical study had been conducted on 30 patients (14 female and 16 male) ranging in age from 18 to 50 years with bilateral chronic rhinosinusitis with or without sinonasal polyposis who underwent endoscopic sinus surgery.
All patients had been selected from ORL clinics of Benha University Hospitals. Every patient in this study had been submitted for full history taking, General examination and full ENT examination Including conventional anterior rhinoscopy and endoscopic examination.
Coronal view CT scan on the nose and paranasal sinuses had been done with bone window and without contrast. Prior to CT scanning, most patients received a full course of medical treatment 1-2 weeks to dry up the nasal cavity.
All surgeries were done by one surgeon to avoid bias and under general anesthesia. After injecting appropriate topical decongestive, the procedure were performed by Messerklinger technique.
At the end of the operation, patients had their nasal cavities randomized by a coin toss to determine which side to receive a Nasopore packing and other side packed with Merocel.
Post operatively all patients had a pack of Merocel on one side and removed 1 day postoperatively, while the Nasopore pack on the other side start to dissolve spontaneously.
Subjective assessment of patients by visual analogue scale revealed significant improvement in Nasopore side regarding facial pain (P=0.001) and nasal discharge (P=0.001), insignificant regarding nasal blockage (P=0.09).
Endoscopic assessment of the patients 3 months after E.S.S revealed that adhesions mainly occurred on the Merocel side mean 1.07 ± 0.74, while the Nasopore side showed minimal adhesions mean 0.40 ± 0.62 with significant (P=0.001).
CT evaluation after 3 months revealed that significant improvement in all parameters of Lund-Mackay C.T score in Nasopore group than Merocel group with a significant difference (P<0.005).
Our results as regard to middle meatal dressing shows statistically significant difference between the polyurethane foam side and the Merocel side as regards reduction of synechia and adhesion formation after endoscopic sinus surgery.
Therefore, middle meatal packing with polyurethane foam is effective in reducing adhesion and synechiae after endoscopic sinus surgery. It is also the first fully synthetic, biodegradable middle meatal dressing and we found it to safe, biological inert, well tolerated and no local or systemic complications were observed.