Silastic splints reduce middle meatal adhesions after endoscopic sinus surgery.

BACKGROUND: Adhesions frequently form between the middle turbinate and lateral nasal wall after endoscopic sinus surgery (ESS) and are a possible cause for surgical failure. Many absorbable and nonabsorbable spacers have been tried to improve healing. This study was designed to ascertain whether placement of a thin silastic splint into the middle meatus after sinus surgery for 2 weeks reduces adhesion formation and whether a reduction in the adhesion rate improves patient outcomes in the early postoperative phase. METHODS: Forty-two patients who were scheduled to undergo ESS for chronic rhinosinusitis were randomized to have a silastic splint placed into the middle meatus on one side of the nose but not the other at the completion of surgery. Splints were removed 2 weeks postoperatively. Symptom scores were recorded for each side of the nose up to 12 weeks after surgery and ethmoid cavities were graded at the 6- and 12-week visits along with assessment of adhesions. Patients were blinded to which side was splinted as was the surgeon assessing ethmoid cavities at 6 and 12 weeks. RESULTS: Thirty-three patients completed 12 weeks of follow-up. Nasal obstruction and facial pain/discomfort were significantly higher on splinted sides for the first 2 weeks. More interventions were performed to debride adhesions in nonsplinted sides. Endoscopy revealed no adhesions at 12 weeks for sides treated with a splint whereas 9 of 33 nonsplinted sides had persistent adhesions. There were no significant differences in symptom or ethmoid cavity scores at 6 or 12 weeks between sides treated with splints versus sides treated without splints or between sides with adhesions versus without adhesions. CONCLUSION: Middle meatal silastic splints reduce adhesions after ESS but increase early nasal obstruction and discomfort. Their use did not significantly change symptom or ethmoid cavity scores at 12 weeks.

Repair of injuries to the thoracic aorta and great vessels: Auckland, New Zealand 1995-2004.

BACKGROUND: Traumatic injury to the aorta and great vessels is a surgical emergency with survivors who reach hospital typically having suffered multiple injuries. There are several diagnostic and treatment options available, with new modalities emerging to challenge the gold standards. A review of recent trends in management of these injuries in Auckland, New Zealand was carried out and patient outcomes assessed. METHODS: The charts of patients admitted to Auckland and Green Lane Hospital's cardiothoracic intensive care unit, with a diagnosis of injury to the thoracic aorta or great vessels since 1995 were retrospectively reviewed. Imaging techniques, injury types and treatment methods were analysed along with survival and neurological morbidity. RESULTS: In the study period our unit operated on 29 cases of traumatic rupture of the thoracic aorta or great vessels. Digital subtraction angiography and more recently, multidetector computed tomography scanning have been used to diagnose the injury. Twenty-seven injuries were to the aorta and two to the innominate artery. The 30-day survival rate of those reaching the operating theatre was 90%. There was one case of postoperative hemiparesis and five cases of recurrent laryngeal nerve injury, but none of spinal cord ischaemic injury. Endoluminal stent grafting was carried out for one patient, without complication. CONCLUSIONS: Good survival rates exist for those who reach surgery for traumatic rupture of the aorta or great vessels. Multidetector computed tomography scanning is an alternative to digital subtraction angiography, potentially reducing treatment delay. In addition endoluminal grafting as opposed to open repair has been reported as a safe technique. The injury remains a surgical emergency requiring urgent diagnosis and transfer to an equipped cardiothoracic unit for definitive treatment.