The use of modified Silastic nasal splints as frontal sinus stents: a technical note

Abstract

BackgroundEndoscopic frontal sinus surgery is frequently complicated by post-operative stenosis and obstruction of the frontal sinus outflow tract, resulting in recurrent disease. Frontal sinus stents may help prevent re-occlusion of the frontal neo-ostia.ObjectiveThis paper presents a simple and cost-effective approach to frontal sinus stenting using modified Silastic nasal splints.Results and conclusionThe current technique provides an effective, reliable and inexpensive method for achieving post-operative frontal sinus outflow tract patency.

The use of modified Montgomery T-tubes as frontal sinus stents: how I do it

“…Regardless of the procedure performed, one-third of the patients will have recurrent disease requiring revision surgery. 3,5…”

“…However, the different types of stents described have varying results; so far, there are no universally accepted indications. 5,7 The majority of the authors of previous studies favour six-month stenting in order to allow good and stable re-mucosalisation. 1,2,8 Authors favouring a stent technique claim a success rate ranging from 80 to 94 per cent.…”

“…Our technique offers the advantage of a soft stent, 2,5 which is well tolerated by the patients; because of its shape, the stent is self-retaining and does not require any sutures. The procedure described here is inexpensive, cost-effective, simple and can be easily performed by experienced endoscopic sinus surgeons.…”

Frontal sinus stenting in endoscopic sinus surgery: the 10-year Oxford experience

“…extension of frontal sinusotomy) and post-operative (optimisation of the post-operative wound-healing process) conditions, 1 the frontal recess seems to be more prone to re-stenosis with subsequent occlusion of the outflow tract, 1,[6][7][8] which thus reflects in a lower success rate compared with the other sinuses. 1 In fact, a high failure rate and disease recurrence, as a consequence, have been reported in up to one third of the patients, 6,8,9 with 10 per cent requiring revision surgery at 3 years and 20 per cent at 5 years, independently from the type of approach used (external or endonasal) and the extension of the sinusotomy achieved. 1,4,10,11 In order to decrease the rate of synechiae and stenosis, stents have been introduced.…”

“…12 Since the early 1900s, 9 the same principles have been applied for frontal sinus stents and spacers, initially using external approaches and, more recently, following endoscopic ones. 1,4,6,8 Over the years, several types of stents have been proposed, including absorbable and non-absorbable, self-retaining or non-self-retaining, drug-eluting (steroid, 11,13–15 antibiotic, 16 anti-neoplastic 1,17 ), stents of different materials (silastic, 18,19 gold, 3 silicon, 7,20 pigtail 17 ), and different shapes (double J 5 or silastic sheet 4 ). So far, there are no guidelines on the best type of stent, 6–8 indications and duration of stenting.…”