Efficacy of different techniques of sinonasal irrigation after modified Lothrop procedure.

A Beule
T Athanasiadis
E Athanasiadis
J Field
Peter-John Wormald, Government of South Australia, SA Health

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Abstract

Background: Post-operative irrigation after endoscopic sinus surgery and endoscopic Lothrop procedure is used to remove nasal crusts and to improve wound healing. To evaluate the optimal application protocol for irrigation of the frontal sinus, a prospective cadaver study was performed. Methods: An endoscopic modified Lothrop procedure and complete sphenoethmoidectomy were performed in 19 heads. Each was irrigated with a 1.5% solution of water and different colours using nasal spray and a squeeze bottle filles with 50, 100 and 200 mL. Intensity of local staining and percentage of area were documented using standardized videoendoscopy after irrigation in 'bending over the sink' or 'vertex to floor' position. Grading was performed by two independent observers for 23 anatomic regions, including the stained circumference of maxillary and frontal ostia. To evalute the influence of the anatomy, acoustic rhinometry was performed. ANOVA was used to evaluate effects of application methods and head positions using GenStat 8.2 (Lawes Agricultural Trust, Rothamsted Experimental Station, Harpenden, UK) using an appropriate block structure. Results: With regard to the frontal sinus, we were able to show clear superiority of the squeeze bottle technique filled with 200mL and applied in the 'vertex to floor' position. Conclusion: In a relatively fit and flexible patient the 'vertex to floor' position using a squeeze bottle technique is advocated. There may be some patients, however, for whom this position is not feasible. In these patients 'bending over the sink', while inferior to the 'vertex to floor' position, still ensures some irrigation of the frontal sinus.