Mucociliary clearance patterns following endoscopic sinus surgery.

Abstract

Detailed endoscopic evaluations of mucociliary transport were performed to define qualitatively the clearance patterns from the ethmoid cavity, sphenoidal sinus, and related nasal structures following sinus surgery for inflammatory disease. Forty patients participated in this clinical study. They were selected to represent a spectrum of disease severity and surgical outcomes. Powdered graphite was used as an insoluble tracer medium, and videodocumentation allowed multiple sites to be examined during a single study session. Mucociliary clearance was not uniformly observed to be linear, but was often associated with discontinuous movement, eddies, and pooling. Endoscopic appearance of the operative site and postoperative clinical course frequently did not correlate with observed patterns of mucus transport. Mucociliary stasis within the ethmoid cavity, at times localized, was the most common finding among patients with recurring acute and persistent sinusitis following surgery. Conservative partial middle turbinate resection for access to the ostiomeatal complex did not appear to impair transport from the anterior nose or ethmoid. Mucociliary clearance from the sphenoid was usually slower than that from the ethmoid, but this finding was not associated with a higher rate of persistent disease. Videoendoscopic analysis, using graphite powder as a tracer medium, is proposed as a safe and straightforward method of assessing mucociliary clearance patterns following endoscopic sinus surgery.