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Bioabsorbable steroid-releasing sinus implants in the frontal and maxillary sinuses: 2-year follow-up.

Matheny KE - Allergy Rhinol (Providence) (2015)

Bottom Line: Mometasone furoate-releasing implants have been approved for use in the ethmoid sinuses following endoscopic sinus surgery (ESS) to reduce the need for medical and surgical intervention postoperatively.To present a case in which bioabsorbable steroid-eluting implants were used to maintain patency and to decrease inflammation in the frontal and maxillary sinuses after revision ESS. 52-year-old male with lifelong allergic rhinitis, chronic allergic fungal rhinosinusitis, and inflammatory bowel disease had previously undergone four endoscopic sinus surgeries, subcutaneous injection immunotherapy, and topical therapy with budesonide and amphotericin sinus irrigations.Two year followup demonstrated near complete clinical, endoscopic, and radiographic resolution of the patient's signs and symptoms of chronic rhinosinusitis.

View Article: PubMed Central - PubMed

Affiliation: Collin County Ear Nose and Throat, Dallas, Texas, USA.

ABSTRACT

Background: Mometasone furoate-releasing implants have been approved for use in the ethmoid sinuses following endoscopic sinus surgery (ESS) to reduce the need for medical and surgical intervention postoperatively. Outcomes have not yet been studied when these implants are utilized in other paranasal sinuses after ESS.

Objective: To present a case in which bioabsorbable steroid-eluting implants were used to maintain patency and to decrease inflammation in the frontal and maxillary sinuses after revision ESS.

Methods: 52-year-old male with lifelong allergic rhinitis, chronic allergic fungal rhinosinusitis, and inflammatory bowel disease had previously undergone four endoscopic sinus surgeries, subcutaneous injection immunotherapy, and topical therapy with budesonide and amphotericin sinus irrigations. In July, 2012, during revision left frontal sinusotomy and right maxillary antrostomy (the fifth ESS), two bioabsorbable steroid-releasing implants were placed in the left frontal recess and the right maxillary sinus respectively and followed clinically, endoscopically, and radiographically for two years.

Results: Two year followup demonstrated near complete clinical, endoscopic, and radiographic resolution of the patient's signs and symptoms of chronic rhinosinusitis.

Conclusions: The steroid-releasing implants during the critical phase of wound-healing appear to have allowed the patient, now over two years postoperatively, to achieve a healthier state and to allow more successful management than the preceding 15-20 years.

No MeSH data available.


Related in: MedlinePlus

Preoperative coronal computed tomography (CT) of sinuses, demonstrating left frontal recess and right maxillary sinus.
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Figure 1: Preoperative coronal computed tomography (CT) of sinuses, demonstrating left frontal recess and right maxillary sinus.

Mentions: The patient had been previously managed by two otolaryngologists for 15–20 years, including four previous ESS procedures, three of which occurred in consecutive years (2005, 2006, and 2007). After his 2007 operation, he was managed with long courses of daily budesonide and amphotericin nasal irrigations, and a full course of immunotherapy via subcutaneous injections, with mediocre improvement in quality of life and employment functionality. Nasal endoscopy and stereotactic localization computed tomography of the sinuses (Fig. 1) in July 2012 after a 12-day prednisone taper confirmed mucosal stenosis of the left frontal sinus outflow tract and complete soft tissue opacification of the right maxillary sinus and right anterior ethmoid cavity, despite patent bony outflow tracts. Revision ESS was recommended by both otolaryngologists.


Bioabsorbable steroid-releasing sinus implants in the frontal and maxillary sinuses: 2-year follow-up.

Matheny KE - Allergy Rhinol (Providence) (2015)

Preoperative coronal computed tomography (CT) of sinuses, demonstrating left frontal recess and right maxillary sinus.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4541632&req=5

Figure 1: Preoperative coronal computed tomography (CT) of sinuses, demonstrating left frontal recess and right maxillary sinus.
Mentions: The patient had been previously managed by two otolaryngologists for 15–20 years, including four previous ESS procedures, three of which occurred in consecutive years (2005, 2006, and 2007). After his 2007 operation, he was managed with long courses of daily budesonide and amphotericin nasal irrigations, and a full course of immunotherapy via subcutaneous injections, with mediocre improvement in quality of life and employment functionality. Nasal endoscopy and stereotactic localization computed tomography of the sinuses (Fig. 1) in July 2012 after a 12-day prednisone taper confirmed mucosal stenosis of the left frontal sinus outflow tract and complete soft tissue opacification of the right maxillary sinus and right anterior ethmoid cavity, despite patent bony outflow tracts. Revision ESS was recommended by both otolaryngologists.

Bottom Line: Mometasone furoate-releasing implants have been approved for use in the ethmoid sinuses following endoscopic sinus surgery (ESS) to reduce the need for medical and surgical intervention postoperatively.To present a case in which bioabsorbable steroid-eluting implants were used to maintain patency and to decrease inflammation in the frontal and maxillary sinuses after revision ESS. 52-year-old male with lifelong allergic rhinitis, chronic allergic fungal rhinosinusitis, and inflammatory bowel disease had previously undergone four endoscopic sinus surgeries, subcutaneous injection immunotherapy, and topical therapy with budesonide and amphotericin sinus irrigations.Two year followup demonstrated near complete clinical, endoscopic, and radiographic resolution of the patient's signs and symptoms of chronic rhinosinusitis.

View Article: PubMed Central - PubMed

Affiliation: Collin County Ear Nose and Throat, Dallas, Texas, USA.

ABSTRACT

Background: Mometasone furoate-releasing implants have been approved for use in the ethmoid sinuses following endoscopic sinus surgery (ESS) to reduce the need for medical and surgical intervention postoperatively. Outcomes have not yet been studied when these implants are utilized in other paranasal sinuses after ESS.

Objective: To present a case in which bioabsorbable steroid-eluting implants were used to maintain patency and to decrease inflammation in the frontal and maxillary sinuses after revision ESS.

Methods: 52-year-old male with lifelong allergic rhinitis, chronic allergic fungal rhinosinusitis, and inflammatory bowel disease had previously undergone four endoscopic sinus surgeries, subcutaneous injection immunotherapy, and topical therapy with budesonide and amphotericin sinus irrigations. In July, 2012, during revision left frontal sinusotomy and right maxillary antrostomy (the fifth ESS), two bioabsorbable steroid-releasing implants were placed in the left frontal recess and the right maxillary sinus respectively and followed clinically, endoscopically, and radiographically for two years.

Results: Two year followup demonstrated near complete clinical, endoscopic, and radiographic resolution of the patient's signs and symptoms of chronic rhinosinusitis.

Conclusions: The steroid-releasing implants during the critical phase of wound-healing appear to have allowed the patient, now over two years postoperatively, to achieve a healthier state and to allow more successful management than the preceding 15-20 years.

No MeSH data available.


Related in: MedlinePlus