Thursday, January 24, 2013

Future prospects in rhinosinusitis and postoperative care

Future prospects in rhinosinusitis and postoperative care

The classic postoperative care after sinonasal surgery has followed the recommendations made more than a decade ago by Professor Stammberger. This expert advised using merocel+beclometasone solution for 1-2 days and antibiotic ointment + corticoid (although it has since been shown that this measure does not offer any advantage and that it may even be contraindicated). In addition, during the first three days of the postoperative period, aspiration and removal of clots and secretions were recommended. As with other types of care, the importance of performing non-routine irrigations with saline and soaking with merocel + beclometasone was pointed out. It was considered that at least six weeks were required for re-epithelialisation. The monitoring visits were scheduled for after 1 week and after 4-6 weeks.

Another reference author, Professor Hosemann, established in 2000 a series of basic postoperative care procedures: mechanical cleaning, topical steroids, inhalations and irrigations, use of ointments/gels or solutions, removal of scabs and bone fragments, removal of synechias and aspiration of all the cavities. He recommended not performing nasal suction by hand and reminded that the level of postoperative care depended on the patient’s progress. According to this expert, scabs appeared during the first ten days and, after about 30 days, a lymphatic-obstructive oedema appeared while the mesenchymal reaction is usually detected after 3 months and healing usually occurs any time beyond 90 days after surgery.
Quoting another acknowledged expert, Professor Bernal et al. pointed out in 2001 on the subject of postoperative care that dressing changes had to be performed 3-5 times during the first 15 days, 1-2 times/week during the first month, and then once a week until the healing process was complete. Inhalations, irrigations and topical medication were recommended after the operation.

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