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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

Postoperative coronal computed tomography (CT) of the right maxillary sinus 2 years after revision ESS.
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Figure 3: Postoperative coronal computed tomography (CT) of the right maxillary sinus 2 years after revision ESS.

Mentions: No oral steroids or antibiotics were initially prescribed postoperatively. The patient underwent routine postoperative nasal endoscopy with debridement at 2- to 3-week intervals. Acute right maxillary and ethmoid sinusitis was identified 4 weeks postoperatively. Nasal endoscopy confirmed that the implant in the right maxillary sinus was absent by this time point. After culture and sensitivity were obtained, the patient was treated satisfactorily with clarithromycin and an oral prednisone taper. No further infections occurred during the early postoperative period. Limited CT of the sinuses was obtained in October 2012, which demonstrated wide patency of the left frontal recess and right maxillary antrostomy, without polypoid recurrence (Figs. 2 and 3).


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

Matheny KE - Allergy Rhinol (Providence) (2015)

Postoperative coronal computed tomography (CT) of the right maxillary sinus 2 years after revision ESS.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Postoperative coronal computed tomography (CT) of the right maxillary sinus 2 years after revision ESS.
Mentions: No oral steroids or antibiotics were initially prescribed postoperatively. The patient underwent routine postoperative nasal endoscopy with debridement at 2- to 3-week intervals. Acute right maxillary and ethmoid sinusitis was identified 4 weeks postoperatively. Nasal endoscopy confirmed that the implant in the right maxillary sinus was absent by this time point. After culture and sensitivity were obtained, the patient was treated satisfactorily with clarithromycin and an oral prednisone taper. No further infections occurred during the early postoperative period. Limited CT of the sinuses was obtained in October 2012, which demonstrated wide patency of the left frontal recess and right maxillary antrostomy, without polypoid recurrence (Figs. 2 and 3).

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