Paper of reabsorbable nasal packing in endoscopic transsphenoidal surgery.


PAPER OF REABSORBABLE NASAL PACKING IN ENDOSCOPIC TRANSSPHENOIDAL SURGERY.

4th Congress Of European ORL-HNS 7-11 Octubre, 2017 Barcelona, Spain

Mata-Castro N (1), García de Sola R(2), García- Fernández (3)
(1) ENT Department. Hospital Universitario de Torrejón, Madrid, Spain.
(2) Neurosurgery Department. Hospital N. Sra. del Rosario,
(3) ENT Department. Hospital 12 de Octubre. Madrid, Spain.


The type of nasal dressing is an important decision as the final step of endoscopic reconstruction in pituitary surgery, septum and the graft.

A Foley catheter balloon tamponade (figure 1) was typically used to apply pressure on the reconstruction. The balloon was placed between the residual eby preventing migration of the graft.
Since the pressure was not adequately controlled and because of the possibility of necrosis of the flap itself, the Foley catheter was replaced by a Merocel nasal pack (figure 2).

Recently we have replaced this non-resorbable tamponade with a resorbable dressing (figure 3) that dissolves with nasal washes.

Figure 1. Foley catheter

Figure 2. Non-resorbable.

Figure 3. Resorbable tamponade.

MATERIAL AND METHODS

The aim of this study is to evaluate the role of resorbable tamponade in the control of immediate postoperative bleeding and its role in the reconstruction of the defect. Twelve patients underwent surgery from April 2016 to April 2017 were reviewed. The defect was closed by Hadad’s vascularized flap in case of intraoperative fistula or free middle turbinate flap, otherwise. Surgicel was placed on the periphery of the graft / flap and Vivostat was used for final sealing. Subsequently a central tamponade was placed with Surgicel to avoid contact with the silicone sheets placed in each nostril to avoid synechiae, and then the Nasopore resorbable tamponade.

RESULTS

No patient had early or late bleeding that required nonresorbable nasal packing. No patient required surgical revision for CSF leak.

CONCLUSIONS

Our study concluded that resorbable tamponade is a valid option for nasal packing in patients with endoscopic pituitary surgery and that the surgical technique of sealing the defect is the key in the reconstruction and not the alleged contention of the grafts intended by The Foley catheter balloon.

BIBLIOGRAPHY

Piski Z, Gerlinger I, Nepp N, Revesz P, Burian A, Farkas K, Lujber L. Clinical benefits of polyurethane nasal packing in endoscopic sinus surgery. Eur Arch Otorhinolaryngol. 2017 Mar;274(3):1449-1454.
Wang J, Cai C, Wang S. Merocel versus Nasopore for nasal packing: a meta-analysis of randomized controlled trials. PLoS One. 2014 Apr 7;9(4):e93959. doi: 10.1371/journal.pone.0093959. eCollection 2014.
Kastl KG, Reichert M, Scheithauer MO, Sommer F, Kisser U, Braun T, Havel M, Leunig A. Patient comfort following FESS and Nasopore® packing, a double blind, prospective, randomized trial. Rhinology. 2014 Mar;52(1):60-5.

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