Outpatient Treatment of Post Functional Endoscopic Sinus Surgery Adhesions: How we do it?

Outpatient Treatment of Post Functional Endoscopic Sinus Surgery Adhesions: How we do it?

Objective: The formation of intra-nasal adhesions following functional endoscopic sinus surgery (FESS) is a well-known cause of surgical failure. Many publications discuss the roles of various intra-operative nasal packing or haemostatic agents with regard to post-operative haemostasis and wound healing but not after the adhesions have formed. We describe our technique using Gelfoam in outpatient based adhesiolysis post-operatively.

Methods: A retrospective study on all patients operated by the senior author who had ESS for chronic sinusitis or nasal polyposis between Jan 2011 and Dec 2011 revealed 16 nasal cavities who developed post-operative intra-nasal adhesions. Adhesiolysis was performed with a sickle knife under local anaesthesia in the outpatient department. Gelfoam was placed over the raw edges as a spacer to avoid reformation of adhesions. Repeated adhesiolysis and replacement of the Gelfoam was carried out on a weekly basis until the edges healed.

Results: A combination of different adhesion types were observed and treated - 12 middle to inferior turbinate/lateral wall adhesions, 6 middle turbinate to septal adhesions and 5 inferior turbinate to septal adhesions. 7 nasal passages had multiple adhesion formation needing more judicious management.