Injection of the pterygopalatine fossa resulted in an improved surgical field during endoscopic sinus surgery.

Topical application of TA is effective in achieving hemostasis and improving the surgical field. In contrast to EACA, TA is a valuable tool in ESS that merits additional evaluation.

Standardized video-endoscopy has been demonstrated to significantly improve reliability and reproducibility of results and is recommended for future work evaluating bleeding in ESS. The new Wormald grading scale has been shown to be an inexpensive, reliable, and sensitive tool to rapidly evaluate intraoperative bleeding in ESS. It overcomes several limitations of the Boezaart scale, enabling us to analyze currently employed and newly developed hemostatic methods and agents.

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.

A series of hydrogels were formed from the reaction between an amine functionalized succinyl chitosan and an oxidized dextran. The properties and rate of formation of the gel were related to both the amine and aldehyde levels of the precursors. These levels could be readily changed by altering the reaction conditions, and allowed good control of the gel properties. Oxidation of the dextran with periodate was accompanied by chain scission and a large reduction in molecular weight. The gel showed excellent haemostatic properties and reduction of adhesions in animal models.

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Patients who have undergone UPPP and/or CCT surgery appear to have a deficiency in normal modulation of the swallowing mechanism and a reduced swallowing functional reserve. We speculate that these changes may become relevant in later life with the onset of age-related stressors to the swallowing mechanism. This case series strikes a note of caution that further studies are needed to determine the role of preoperative swallow assessment in patients undergoing UPPP and/or CCT surgery.

Procedures performed under local anaesthesia in the operating theatre are associated with shorter operating theatre time and length of stay in the hospital, and provide significant cost savings. Further savings could be achieved if local anaesthesia procedures were performed in the office setting.