Bioabsorbable steroid-eluting sinus stents for patients with refractory frontal diseases undergoing a revision Draf 3 procedure: a case series

Abstract

Background: Bioabsorbable steroid-eluting sinus stents are safe and effective in maintaining the patency of the frontal sinus ostium.

Aims/objectives: To assess the efficacy of steroid-eluting sinus stents in improving postoperative outcomes following revision and re-revision Draf 3 procedures in patients with frontal diseases.

Material and methods: Patients with recalcitrant chronic frontal rhinosinusitis (FRS) and mucocele who underwent revision and re-revision Draf 3 procedures from 2015 to 2017 were included. Preoperative disease parameters, demographics, and endoscopic and radiographic images were recorded.

Results: Seven patients undergoing the Draf 3 procedure for recalcitrant chronic FRS (43%) and mucocele after complete resection of benign tumours in the frontal sinus (57%) were followed up for a mean of 16.5 months. At the end of follow-up, seven (100%) patients were asymptomatic and all patients (100%) had patent neo-ostia.

Conclusions and significance: The use of bioabsorbable steroid-eluting sinus stents had no unanticipated consequences, and the drainage pathways of the frontal neo-ostium remained patent. Steroid-eluting sinus stents may decrease recurrence rates in revision cases where patients have extensive scarring or neo-osteogenesis of the operative field from prior Draf 2 or 3 procedures. Further follow-up of the current cases and studies with larger cohorts are needed.

Chinese abstract

背景：生物可吸收类固醇洗脱鼻窦支架对维持额窦口通畅是安全有效的。

目的：评估类固醇洗脱鼻窦支架在额叶疾病患者修正手术和再修正Draf3手术后改善术后结果的效果。

材料和方法：对2015-2017年进行Draf3修订和再修订的顽固性慢性额鼻窦炎（FRS）和粘液囊肿患者进行回顾性分析。记录术前疾病参数、人口统计学、内窥镜和影像学图像。

结果：7例患者在额窦良性肿瘤完全切除（57%）后接受Draf3手术治疗顽固性慢性FRS（43%）和粘液囊肿, 平均随访16.5个月。随访结束时, 7例（100%）患者无症状, 所有（100%）患者均出现明显的新开口。

结论与意义：生物可吸收类固醇洗脱窦支架的使用没有意外后果, 额叶新开口的引流途径仍然是明显的。类固醇洗脱鼻窦支架可降低复诊病例的复发率, 这些病例的患者在先前的Draf2或Draf3手术中有大范围瘢痕或新骨形成于手术区域。需要对目前的病例进行进一步的随访, 并对更大的患者群进行研究。

Keywords:

• Bioabsorbable
• steroid-eluting sinus stent
• Draf 3 procedure
• frontal diseases
• restenosis

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported by grants from the National Natural Science Foundation of China (No. 81271063 and 81500770), Beijing Municipal Administration of Hospitals' “Dengfeng” (DFL20150202) and “Qingmiao” (QML20160201) Program and Clinical Medicine Development of Special Funding Support in Beijing Tongren Hospital, Capital Medical University (No.trzdyxy201702).