Thin rubber sheeting in frontal sinus surgery: Animal and clinical studies

Abstract

Closure of the nasofrontal communication is the most common cause of failure of nonobliterative external of nonobliterative external frontal sinus operations for chronic sinus disease. To determine whether silicone rubber sheeting or tubing might prevent closure, we designed animal experiments and conducted a clinical study. We enlarged the nasofrontal duct in dogs, inserted silicone rubber tubing or sheeting and assessed ductal patency grossly and microscopically. The tubes prevented epithelization and failed to prevent local osteoblastic reaction, fibroplasia, and scar formation. In contrast, sheeting permitted rapid mucosal regeneration, less osteoblastic activity, and less fibrosis. Our 16 patients with chronic sinus disease underwent a modified Lynch operation, with enlargement of the nasofrontal duct and stenting with rubber tubes or sheeting. The sheeting provided the best long-term result. In our experience, it raised the success rate of the classic Lynch external operation.

Long-Term Effect of Stenting after an Endoscopic Modified Lothrop Procedure

“…This has been shown previously in animal models. 29 Different materials have been used for frontal sinus stenting, including Foley catheters, silicone T-tubes, and rolled silastic sheets as well as various customized and specially designed stents. All of the reports have been for unilateral frontal sinus stenting after external, endoscopic, or combined procedures.…”

Nasal packing and stenting

“…The opinion that firm frontal sinus stents are inferior to soft materials is based on the results of Neel et al in 1976, who investigated the influence of stents on the frontal sinus drain in 8 dogs [89]. 2 dogs received surgery apart from the frontal sinus, in 2 cases the frontal sinus ostium was drilled to a size of 1.5 cm diameter without stent placement, in the remaining 4 cases one soft (rolled silicone membrane) and one hard stent (silicone tube) was placed.…”

O treinamento da operação osteoplástica usando o seio frontal do cão

“…For those initiating in Otolaryngology, there are only a few opportunities to learn the technique due to a reduced number of cases indicated for this type of procedure [4][5][6] . Due to great similarity of the correspondent region in men [7][8][9][10][11][12][13] , the use of dog's frontal sinus is a way to train this technique, which has been used for research trials in the last decades. However, there are some anatomical differences between the species: the canine frontal sinus is divided or composed by two or three compartments with distinct drainages and no communication among them: lateral, medial and rostral sinuses, the latter not recognized by some authors [14][15][16] .…”

“…If the anatomical features of a dog's frontal sinus are similar to men, an adequate reproduction of this technique is possible, should the frontal sinus anatomy of the dog be well known. Perhaps because some authors' had different research purposes and gross localization of canine frontal sinus is relatively easy, they had not described the method used to operate animal models [7][8][9][10][11][12][13] . Bretan et al (1983) reported a method that provided the delimitation of dogs' sinusal lumen.…”