Silastic Splints Reduce Middle Meatal Adhesions after Endoscopic Sinus Surgery

Abstract

Adhesions frequently form between the middle turbinate and lateral nasal wall after endoscopic sinus surgery (ESS) and are a possible cause for surgical failure. Many absorbable and nonabsorbable spacers have been tried to improve healing. This study was designed to ascertain whether placement of a thin silastic splint into the middle meatus after sinus surgery for 2 weeks reduces adhesion formation and whether a reduction in the adhesion rate improves patient outcomes in the early postoperative phase. Forty-two patients who were scheduled to undergo ESS for chronic rhinosinusitis were randomized to have a silastic splint placed into the middle meatus on one side of the nose but not the other at the completion of surgery. Splints were removed 2 weeks postoperatively. Symptom scores were recorded for each side of the nose up to 12 weeks after surgery and ethmoid cavities were graded at the 6- and 12-week visits along with assessment of adhesions. Patients were blinded to which side was splinted as was the surgeon assessing ethmoid cavities at 6 and 12 weeks. Thirty-three patients completed 12 weeks of follow-up. Nasal obstruction and facial pain/discomfort were significantly higher on splinted sides for the first 2 weeks. More interventions were performed to debride adhesions in nonsplinted sides. Endoscopy revealed no adhesions at 12 weeks for sides treated with a splint whereas 9 of 33 nonsplinted sides had persistent adhesions. There were no significant differences in symptom or ethmoid cavity scores at 6 or 12 weeks between sides treated with splints versus sides treated without splints or between sides with adhesions versus without adhesions. Middle meatal silastic splints reduce adhesions after ESS but increase early nasal obstruction and discomfort. Their use did not significantly change symptom or ethmoid cavity scores at 12 weeks.