Abstract
It is acknowledged that many causes of failures in endoscopic sinus surgery are related to scarring and narrowing of the maxillary antrostomy. We assessed the effect of low-pressure spray cryotherapy in preventing the maxillary antrostomy stenosis in a chronic rhinosinusitis (CRS) rabbit model. A controlled, randomized, double-blind study was conducted on 22 New Zealand rabbits. After inducing unilateral rhinogenic CRS, a maxillary antrostomy was performed and spray cryotherapy was employed on randomly selected 12 rabbits, while saline solution was applied to the control group (n = 10). The antrostomy dimensions and the histological scores were assessed 4 weeks postoperatively. The diameter of cryotreated antrostomy was significantly larger at 4 weeks than that in the control group. At 4 weeks, the maxillary antrostomy area in the study group was significantly larger than the mean area in the control group (103.92 ± 30.39 mm2 versus 61.62 ± 28.35 mm2, P = 0.002). Submucosal fibrous tissues and leukocytic infiltration in saline-treated ostia were more prominent than those in cryotreated ostia with no significant differences between the two groups regarding the histological scores. Intraoperative low-pressure spray cryotherapy increases the patency of the maxillary antrostomy at 4 weeks postoperatively with no important local side effects.
Highlights
Endoscopic sinus surgery (ESS) is highly effective in curing medically resistant maxillary chronic rhinosinusitis (CRS)
Intraoperative low-pressure spray cryotherapy increases the patency of the maxillary antrostomy at 4 weeks postoperatively with no important local side effects
In the fourth postoperative week, there were no cryotherapy-induced changes to the periantrostomy sinus mucosa, so we consider that the blinding was accurate
Summary
Endoscopic sinus surgery (ESS) is highly effective in curing medically resistant maxillary chronic rhinosinusitis (CRS). It is accounted that up to 25% of maxillary ESS failures are related to ostium stenosis [1,2,3,4]. In order to enhance success rates, various methods were forecasted: mucosal sparing surgical techniques [5], postoperative endoscopic debridements [6], perioperative druginfused dressings [7,8,9,10,11,12,13], bioabsorbable drug-coated stents [14,15,16,17,18], mucoadhesive drug-eluting polymers [19, 20], and the use of oral and topical corticosteroids [21]. The recent reports of successful noncontact lowpressure spray cryotherapy [25, 26] to modify the wound response in granulation-induced glottic and subglottic stenosis have prompted us to investigate its effect on mucosal healing after ESS
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