Modified ribbon gauze packing technique versus merocel nasal packing in reducing nasal adhesions following functional endoscopic sinus surgery. A randomized controlled study

Objective: This study compares the efficacy of 2 common techniques of nasal packing [compressed sponge [Merocel] and Vaseline ribbon gauze] in preventing intranasal adhesions following functional endoscopic sinus surgery [FESS] in adult patients

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Study design: Prospective, blinded, randomized controlled trial. Setting: Tertiary care referral hospital

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Patients: Sixty seven adult patients aged between 19 - 70 years, who had undergone FESS for chronic sinusitis, were included in the study. All patients had diagnostic nasal assessment and preoperative coronal and axial CT scanning of nasal and paranasal sinuses. FESS was performed following Messerklinger technique. Additional surgical procedures were performed as indicated. After completion of surgery, one side of the nasal cavity was packed with compressed sponge [Merocel] and the other side with Vaseline ribbon gauze filling the nasal cavity from above downward

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Main outcome measure: Three months post-operatively, all patients were assessed endoscopically for the development of postoperative intranasal adhesions. Anatomical distribution of post-FESS adhesions was noted

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Results: One hundred and thirty four sides were operated upon. On 3 months post-operative follow up, nasal adhesions developed in 18 [27%] and 6 [9%] of sides packed with Merocel and ribbon gauze respectively [p = 0.007]. The described modified technique of ribbon gauze nasal packing has reduced the incidence of post operative adhesions mainly between the middle turbinate and lateral nasal wall. No major complications were recorded in association of either packing technique. Two out of six sides [33%] packed with ribbon gauze had symptoms of recurrent sinusitis and showed endoscopic signs of persistent infection at the middle meatus while 4 out of 18 sides [22%] packed with Merocel showed similar signs. All these patients improved with medical treatment and none of them required revision surgery with a mean follow up 5 months

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Conclusion: Vaseline ribbon gauze nasal packing is more effective than compressed sponge [Merocel] in reducing postoperative nasal adhesions. This packing technique is safe and could reduce the need for further [revision] endoscopic surgery