Orta meaya tampon uygulamasının orta konka laterizasyonuna etkisi

Abstract

Amaç: Nazal polipli kronik rinosinüzitli hastalarda fonksiyonel endoskopik sinüs cerrahisi sonrası orta meaya tampon uygulamasının ve uygulanacaksa tampon çeşidinin orta konka lateralizasayonu üzerine etkili olup olmadığını randomize kontrollü bir çalışma ile objektif yöntemlerle ortaya koymayı amaçladık.Gereç ve Yöntem:Nazal polipli kronik rinosinüzit nedeni ile bilateralfonksiyonel endoskopik sinüs cerrahisi yapılan toplam 55 hasta randomize olarak 3 gruba ayrıldı. Grup 1'e emilmeyen tampon Grup 2'ye emilebilir tampon koyuldu. Grup 3'e ise tampon koyulmadı. Preoperaitif (ameliyattan hemen önce), erken postoperatif (ameliyatın sonunda tampon koyulmadan hemen önce) ve postoperatif 1. ayında nazal kavite videokayıtları alındı. Videokayıtlardan orta konkanın latreal duvarla oluşturduğu açı ve orta konka ile lateral duvar arasındaki alan ölçüldü. Bu ölçümlerin preoperativ, erken postoperatif ve postoperative 1. ay değerleri kendi aralarında ve gruplar arasında karşılaştırıldı. Bunun dışında sineşi, kabuk, sekresyon, mukozal ödem, granülasyon ve kanama durumu değerlendirldi.Bulgular: Çalışmaya toplam 55 hasta alındı. Grup 1 ve Grup 2'nin her birinde 18, Grup 3'te 19 hasta vardı. Grup1 ve Grup2'de erken postoperatif açıyı preoperatif açıyla karşılaştırdığımızda istatisteksel olarak anlamsız olan bir artış (p>0,05), postoperatif 1. ay açısını preoperatif açıyla karşılaştırldığımızda istatistiksel anlamlı azalma saptandı (p<0,05). Grup 2'de erken postoperatif açıyı preoperatif açıyla karşılaştırdığımızda istatistiksel anlamlı artış (p<0,05), postoperativ 1. ayı preoperatif açıyla karşılaştırdığımızda istatistiksel anlamlı azalma (p<0,05) saptandı. Grupları biribireriyle kıyasladığmızda ise, preoperatif, erken postoperatif ve postoperatif 1.ay açı değişim değerlerinde istatistiksel anlamlı fark saptanmadı (p>0,05).Alan sonuçlarında ise Grup 1'de erken postoperatif alanı preoperatif alanla karşılaştırdığımızda istatisteksel olarak anlamsız olan bir artış (p>0,05), postoperatif 1. ay alanı preoperatif alanla karşılaştırldığımızda ise istatistiksel anlamlı azalma saptandı (p<0,05). Grup 2 ve 3'de ise erken postoperatif alanı preoperatif alanla karşılaştırdığımızda istatistiksel anlamlı artış (p<0,05), postoperatif 1. ay alanı preoperatif alanla karşılaştırdığımızda istatistiksel anlamlı azalma (p<0,05) saptandı.xiGrupları biribireriyle kıyasladığmızda ise preoperatif, erken postoperatif ve postoperatif 1. ay alan değişim değerlerinde istatistiksel anlamlı fark saptanmadı (p>0,05).Postoperatif 1. ayda kabuklanma, sekresyon, mukozal ödem, granulasyon, kanama ve revizyon ihtiyacı açısından gruplar arasında istatiksel anlamlı fark izlenmedi.Sonuç: Fonksiyonel endoskopik sinüs cerrahisi yapılan hastalarda orta meya emilebilir ya da emilemeyen tampon uygulanması veya tampon uygulanmaması OKL, sineşi, adezyon ve bu nedenle oluşacak revizyon cerrahi üzerine etkisi yoktur.Anahtar Kelimeler: FESC, orta mea, orta konka, tampon

ABSTRACTObjective: We aimed to present in this randomized controlled study with objective methods if presence and type of middle meatal packing are associated with lateralization of middle turbinate after functional endoscopic sinus surgery (FESS) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP).Material and Methods: A total of 55 patients with CRSwNP who underwent bilateral FESS were randomized into three separate groups. Non-absorbable packing was applied to patients in Group 1 and absorbable packing was used in patients in Group 2. No nasal packing was used in Group 3. Video recordings of patients' nasal cavities were taken preoperatively (just before surgery), early postoperatively (just before nasal packing is applied at the end of surgery) and at postoperative 1st month. Cross-sections of images showing the angle and the area between middle turbinate and lateral nasal wall were obtained from these video recordings. The angle between middle turbinate and lateral nasal wall and the area between these two anatomical structures were calculated using ImageJ application. These values were compared between preoperative, early postoperative and postoperative 1st month and between patient groups. Other than that; synechia, crusting, secretion, mucosal edema, granulation and bleeding status were evaluated.Results: A total of 55 patients were included. There were 18 patients in each of Group 1 and Group 2 and 19 patients in Group 3. A statistically insignificant increase (p>0.05) in middle turbinate angle was found in Group 1 and Group 2 between preoperative angle and early postoperative angle. There was a statistically significant decrease (p<0.05) in Group 1 and Group 2 when preoperative and postoperative 1st month angles were compared. In Group 2, there was a statistically significant increase in middle turbinate angle when preoperative and early postoperative angles were compared (p<0.05), and a statistically significant decrease was found when preoperative and postoperative 1st month angles were compared. When patient groups were compared with each other, no statistical significance was found in changes of preoperative, early postoperative and postoperative 1st month values (p>0.05).xiiiIn area results in Group 1, a statistically insignificant increase was found when preoperative area were compared with early postoperative area (p>0.05), and a statistically significant decrease was found when preoperative area and postoperative 1st month area were compared (p<0.05). In Groups 2 and 3, a statistically significant increase were found when preoperative and early postoperative areas were compared (p<0.05), and a statistically significant decrease was found when preoperative and postoperative 1st month areas were compared (p<0.05). When groups were compared within each other, there was no statistically significant change was found between preoperative, early postoperative and postoperative 1st month area change values (p>0.05).One patient in Group 1 and one patient in Group 2 had minimal bleeding that stopped without any need for additional nasal packing. There was no statistically significant difference between groups in terms of postoperative bleeding status (p>0.05).In postoperative 1st month evaluation; there was obstructive synechia in two patients in Group 1, three patients in Group 2, and two patients in Group 3. In these patients, there was a need for revision surgery in 2, 1 and 1 patient, respectively. When synechia presence and need for revision surgery were compared between groups, no statistically significance was found.At postoperative 1st month, when groups were compared in terms of crusting, secretion, mucosal edema, and granulation; no statistically significant difference was found.Conclusion: The presence of absorbable or non-absorbable middle meatal packing or absence of middle meatal packing in patients with CRSwNP who underwent FESS is not related with middle turbinate lateralization, synechia, adhesion, and need for revision surgery.Keywords: FESS, middle meatus, middle turbinate, packing.