Giombi F1,2#, Pirola F1,2#, Pace GM1,2* and Malvezzi L1,2
1Department of Biomedical Sciences, Humanitas University, Italy 2Otorhinolaryngology Unit, IRCCS Humanitas Research Hospital, Italy #These two authors contributed equally to this workFulltext PDF
Background: Endoscopic Sinus Surgery (ESS) failures are often due to the physiological deposition of fibrotic tissue determining post-surgical scars, stenosis and re-obliteration of sinuses ostia, especially at the level of the frontoethmoidal sinusotomy and middle meatus. Many efforts have been directed to prevent it, with rarely satisfying results. The Jackson-Pratt (JP) is a suction catheter that limits body fluid collection near the site of surgery and thanks to its softness and elasticity can be used in different clinical and surgical practices. In this video-article we show two possible exceptional uses of the JP drain in endoscopic sinus surgery to avoid immediate post-surgical scarring obliterations. Methods: During ESS, a modified JP drain was inserted into the Frontal Recess (FR) and Middle Meatus (MM) of two different patients and removed one month after surgery. Booth patients were re-assessed by nasal endoscopy 4 months after the procedure. We present video, text, and picture to illustrate this technique for educational purposes. Results: The optimal length of JP about 6 cm for frontal sinusotomy 4 cm for middle meatus. The duration of surgery is not affected by the positioning of the drain, and no complications have occurred. At 4 months follow-up, surgical sinusotomy were still wide open and correctly draining. Also, no scaring synechiae between the lateral wall and middle turbinate were observed. Finally, costs (about 2$) resulted reasonably low. Conclusion: JP positioning in FR and MM appears to be a safe, feasible and convenient domestic solution to prevent short-term ESS failure due to scarring or inflammatory restenosis. Longer follow-up and randomized clinical trials with larger cohorts will allow the assessment of its safety and cost-effectiveness.
Nose and paranasal sinuses; Frontal sinus; Jackson-Pratt drain; Endoscopic sinus surgery; Nasofrontal recess; Rhinosinusitis
Giombi F, Pirola F, Pace GM, Malvezzi L. Exceptional Use of Jackson-Pratt Drain for Preventing Stenosis in Endoscopic Sinus Surgery. Ann Clin Otolaryngol. 2023; 8(1): 1057..