Cadaveric assessment of the efficacy of sinus irrigation after staged clearance of the medial maxillary wall

Eugene Wong*, E. Ritter Sansoni, Timothy Quy-Phong Do, Ian Matchett, Larry H. Kalish, Raymond Sacks, Richard J. Harvey

*Corresponding author for this work

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Background: Nasal irrigation is a significant component of effective medical management in patients with chronic rhinosinusitis (CRS). Irrigations facilitate distribution of topical medical therapies to affected mucosal surfaces and lavage of hypersecretory mucin and inflammatory products. Objective: To compare the effectiveness of cadaveric nasal irrigation distribution and force following different surgical techniques commonly used to open the maxillary sinus. Methods: Fresh human cadaver heads were dissected sequentially with uncinectomy, maxillary antrostomy, endoscopic maxillary mega-antrostomy, and modified endoscopic medial maxillectomy. After each surgical technique was performed, the corresponding nasal cavity was irrigated with 240 mL irrigation bottles containing 1/1000 10% fluroscein-labeled free water. A nasal endoscope passed through the canine fossa into a fixed position in the maxillary sinus recorded the extent of sinus irrigation. These videos then underwent blinded assessment by 2 observers assessing for irrigation sinus penetration (scored as 0–4) and force (0–2). Ordinal correlation scores were assessed using Kendall’s tau-B. Results: A total of 17 sinuses (age 53.4 ± 12.6, 36.4% female) were assessed. There was a statistically significant positive correlation between increasing extent of maxillary sinus dissection and both sinus penetration and force as assessed by both observers (Kendall’s tau-B P <.0001). Conclusion: Increasing the extent of surgical dissection appears to improve penetration and force of the nasal irrigation into the maxillary sinus. This study suggests that while a standard maxillary antrostomy may be sufficient to achieve good topical therapy distribution, more extensive surgery such as a modified medial maxillectomy may be required for sufficient force of sinus lavage.

Original languageEnglish
Pages (from-to)290-296
Number of pages7
JournalAmerican Journal of Rhinology and Allergy
Volume34
Issue number2
Early online date16 Dec 2019
DOIs
Publication statusPublished - 1 Mar 2020

Keywords

  • chronic rhinosinusitis
  • maxillary sinus
  • mega-antrostomy
  • modified medial maxillectomy
  • nasal irrigation

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