Clinical use of mometasone furoate-coated sinus implant PROPEL® in Draf type IIb or III frontal sinus drainage

Introduction:

Endonasal endoscopic frontal sinus surgery has shown continuous progress, yet stenosis of the sinus drainage can lead to recurrent blockage and subsequent relapse with need of revision surgery. Steroid-eluting sinus implants enable targeted drug application into areas, in which local inflammation and scaring induce reduction of the drainage.

Methods:

A retrospective study enrolled n = 15 patients, who had endonasal endoscopic frontal sinus surgery Draf type IIb or III with insertion of a mometasone furoate-coated sinus implant (PROPEL® or PROPEL® Mini, Intersect ENT). Patients' data was investigated with regard to indication, surgical technique, postoperative follow up and aperture ratio of drainage pathway.

Results:

On n = 12 patients a Draf type III frontal sinus drainage procedure was performed, n = 3 patients received a Draf type IIb frontal sinus drainage. In n = 11 patients raw bone surfaces were covered with pedicled mucosal grafts. The sinus implant was removed after a median of ten days. All patients endoscopically showed an open drainage pathway in the follow up period of up to ten months. A wide to maximally wide drainage was seen in n = 9 patients. Facial swelling, headache or bleeding was observed in n = 6 patients.

Conclusions:

Placement of mometasone furoate-coated sinus implants after extended frontal sinus surgery may lead to open drainage pathways in long term follow up by reducing local tissue response. Additionally, frontal sinus stenting mechanically supports postoperative wound healing through adhesion of vascularized mucosal grafts to bony structures. Postoperative stent removal prevents sinus implant associated complications.

Publikationsverlauf

Publikationsdatum:
23. April 2019 (online)