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 cm2, diameter—0.645 ± 0.1024 cm; 0.605 ± 0.1891 cm2, 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.
Highlights
Endoscopic sinus surgery (ESS) represents the treatment of choice for chronic rhinosinusitis (CRS)which is unresponsive to maximal medical therapy [1,2,3,4,5]
On the spray cryotherapy (SC) side, we found a better organization of collagen fibers, the absence of epithelial hyperplasia, and that the number of goblet cells was statistically reduced (0–10 cells/field 40×)
Credited with high success rates, suboptimal ESS outcomes could be attributed to different factors, such as persistent infection, massive inflammation, or poor surgical technique, all resulting in defective wound healing [1,2,3,4,5,6,7,8]
Summary
Endoscopic sinus surgery (ESS) represents the treatment of choice for chronic rhinosinusitis (CRS)which is unresponsive to maximal medical therapy [1,2,3,4,5]. ESS has been used extensively in the management of odontogenic CRS and for the extraction of foreign bodies, impacted teeth, and dentigerous cysts from the maxillary sinus [6,7]. Trimarchi et al described the successful management of dental CRS with the combined transoral (root canal therapy, dental extraction, dental implant removal, oro-antral fistula closure) and ESS approaches [6]. It is widely acknowledged that dental implantation with or without sinus lifting requires close cooperation between otorhinolaryngologists (ENT) and dentists. ENT surgeons are involved in the treatment of post-implant CRS, but mainly in the pre-implant management in order to prevent the development of sinus complications [8,9,10,11]. Adhesions and stenosis of the middle meatus antrostomy (MMA) are intensely associated with unsuccessful ESS outcomes [13,14]
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