How does sinus surgery affect topical irrigation distribution?

Abstract

Purpose of review The current article reviews the literature on the distribution of nasal irrigation in the treatment of chronic sinusitis, especially in how sinus surgery and irrigation techniques affect its delivery to the nasal cavity and paranasal sinuses. Recent findings Nasal irrigation has become a useful tool in the treatment of chronic sinusitis. Used after endoscopic surgery of the paranasal sinuses, irrigation has shown to be effective in improving edema and removing crusts and secretions in that place. However, some relevant points have been considered in the surgical technique and in the postoperative period to improve irrigation access to the paranasal sinuses such as the amplitude of the sinus ostial opening, irrigation volume and device used, as well as head position during irrigation. Summary Postoperative lavage of the paranasal sinus is a recognized adjuvant in the treatment of chronic rhinosinusitis, reducing morbidity and improving local healing, besides allowing the association of topical medications that can be carried to the paranasal sinuses along with the saline increasing the reach of these drugs. Detailed attention to the techniques described in this review improves the distribution of irrigation in the paranasal sinuses after sinus surgery and considerably increases the efficacy of this therapy.

Effect of surgery, delivery device and head position on sinus irrigant penetration in a cadaver model

“…Hence, we can speculate that removal of the superior nasal and interfrontal septum during the Draf III procedure (with consequent flow of solution through the septal window and out the contralateral nostril) might be less relevant if the irrigant is delivered by positive pressure. This hypothesis is in accordance with the findings of de Paiva Leite and Douglas 11 who reported that Draf III procedures may reduce irrigation of the other sinuses.…”

“…6 studied the sinus penetration of irrigant according to 3 steps of surgical dissection in 10 cadaver heads and found that a wider sinus ostium resulted in better penetration of irrigant. In addition, in a recent review, de Paiva Leite and Douglas 11 concluded that functional endoscopic sinus surgery improves the reach and delivery of irrigation solutions to the paranasal sinuses.…”

“…Previous studies demonstrated that the efficacy of frontal distribution of the irrigant improves in a vertex down position, whereas the same position negatively affects the sphenoid irrigation. 10,11 Even if the above-mentioned factors may influence the efficacy of nasal irrigation, the combined effect of these three factors was not studied at the same time in any of the previous studies. In the absence of this information, it appears difficult to correctly prescribe nasal irrigation in the post-treatment care of patients undergoing endoscopic sinus surgery.…”

“…Previous studies demonstrated that the efficacy of frontal distribution of the irrigant improves in a vertex down position, whereas the same position negatively affects the sphenoid irrigation. 10,11…”

Development of a New Device for Postoperative Self-Irrigation of the Maxillary and Frontal Sinus

“…5,7 However, high-volume nasal irrigation (240 mL at least once a day) has been recommended by most experts. 7,8 The theoretical benefits of high-volume irrigation are (1) more effective debris, clots, and crusts removal and…”