Young Jin Kim; Jae Wook Yang

doi:10.7469/JKOS.2015.56.05.656

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Kim and Yang: The Clinical Efficacy of Cutanplast® Nasal Packing after Endonasal Dacryocystorhinostomy

Original Article

J Korean Ophthalmol Soc 2015;56(5):656-663.

Published online: 7 September 2015

DOI: https://doi.org/10.7469/JKOS.2015.56.05.656

The Clinical Efficacy of Cutanplast^® Nasal Packing after Endonasal Dacryocystorhinostomy

Young Jin Kim, MD^1,², Jae Wook Yang, MD, PhD^1,²

¹Department of Ophthalmology, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea

²Therapeutics Center for Ocular Neovascular Disease, Busan, Korea

￭ Address reprint requests to Jae Wook Yang, MD, PhD Department of Ophthalmology, Inje University Busan Paik Hospital, #75 Bokji-ro, Busanjin-gu, Busan 614-735, Korea Tel: 82-51-890-6356, Fax: 82-51-890-6329 E-mail: eyeyang@inje.ac.kr

Received 14 August 201431 October 2014 Accepted 9 April 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

초록

Purpose:

The purpose of this study was to investigate the clinical efficacy of Cutanplast^® nasal packing after endonasal dacryocystorhinostomy.

Methods:

The present study included a total of 76 adult patients (98 eyes) with primary acquired nasolacrimal duct obstruction who underwent endonasal dacryocystorhinostomy. Fifty-four eyes were packed with Cutanplast^® and 44 eyes were packed with Merocel^®. Patient discomfort while the packing was in situ, degree of bleeding during the day after operation, functional and anatomical success rate, and postoperative complications such as synechiae, granulation, wound healing (osteal mucosal epithelium epithelization), and revision rate were compared between the packing materials.

Results:

The Cutanplast^® was significantly more comfortable and effective at preventing hemorrhage after endonasal dacryocystorhinostomy during the day following the operation. There was no significant difference between the two groups in postoperative anatomical and functional surgical success rate at 1 week, 1 month and 3 months. In comparison with postoperative complications, the Cutanplast^® group showed a lower incidence of delayed wound healing (delayed epithelialization of the osteal mucosal epithelium) than the Merocel^® group, whereas there was no difference in granulation, synechiae, or revision rate.

Conclusions:

The Cutanplast^® nasal pack resulted in significantly less discomfort and less bleeding compared to the Merocel^® nasal pack. Moreover, the Cutanplast^® showed a lower proportion of delayed wound healing after endonasal dacryocystorhinostomy and had the advantage of low cost compared to other hemostatic nasal packing materials. Therefore, Cutanplast^® nasal packing after endonasal dacryocystorhinostomy can be considered a comfortable, cost-effective and clinically-effective method.

Keywords: Absorbable nasal packing, Cutanplast^®, Endonasal dacryocystorhinostomy, Wound healing

References

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Figure 1.

(A) The Cutanplast® is prepared by dividing it into four pieces. (B) Cutanplast® folded in half is inserted through the nose and (C) packed into the middle meatus. Several Cutanplast® are further inserted.

Figure 2.

Endoscopic findings of the middle meatus after endonasal dacryocystorhinostomy with Cutanplast® packing. (A), (B) Liquefied hemostatic gelatin sponge (Cutanplast®) 1 week after application and can be gently removed by a suc-tion device. (C) Normal epithelization of the osteal mucosal epithelium with a silicone tube at 2 months. (D) Normally recovered epithelization of the osteal mucosal epithelium when the silicone tube removed at 3 months. C = liquefied Cutanplast®; NS = nasal septum; MT = middle turbinate; ST = silicone tube. ^* Osteal opening.

Table 1.

Postoperative bleeding day after surgery

Grade
0	No bleeding
1	Slightly staining of dressing
2	Oozing, staining of half of dressing
3	Moderated bleeding, soaking almost all of dressing
4	Severe bleeding, soaking all of dressing and fresh blood show or bleeding after packing removal

Table 2.

Munk’s score

Grade
0	No epiphora
1	Occasional epiphora requiring dabbing less than twice a day
2	Epiphora requiring dabbing two to four times per day
3	Epiphora requiring dabbing 5-10 times per day
4	Epiphora requiring dabbing more than 10 times per day
5	Constant tearing

Table 3.

Patient demographics and characteristics at baseline

	Merocel®	Cutanplast®	p-value
Age (years)	56.4 ± 10.6	55.1 ± 8.5	0.561^*
Sex (n, %)			0.617^†
Male	5 (14.7)	8 (19.0)
Female	29 (85.3)	34 (81.0)
Side (n, %)			0.888^†
OD	23 (52.3)	29 (53.7)
OS	21 (47.7)	25 (46.3)
Previous dacryocystitis history (n, %)	1 (2.27)	1 (1.9)	0.883^†
Mean time to tube removal (weeks)	11.8 ± 1.1	11.7 ± 1.2	0.629^*

Values are presented as mean ± SD unless otherwise indicated.

OD = right eye; OS = left eye.

^* Independent t-test,

^† Chi-square test.

Table 4.

Comparision of postoperative discomfort, bleeding, Munk’s score

	Type	VAS/Grade					Mean ± SD	p-value
	Type	0	1	2	3	4	Mean ± SD	p-value
Discomfort during insertion	Merocel®	0	3	21	9	1	2.05 ± 0.86	0.00^*
Discomfort during insertion	Cutanplast®	14	20	16	4	0	1.13 ± 0.62
Postoperative bleeding day after surgery	Merocel®	0	5	20	14	5	1.98 ± 0.70	0.00^*
Postoperative bleeding day after surgery	Cutanplast®	1	22	25	4	1	0.65 ± 0.59

	Type	Munk’s score						Mean ± SD	p-value
	Type	0	1	2	3	4	5	Mean ± SD	p-value
Postoperative 1 week	Merocel®	16	21	4	3	0	0	0.86 ± 0.85	0.423^*
Postoperative 1 week	Cutanplast®	25	23	3	2	1	0	0.72 ± 0.88
Postoperative 1 month	Merocel®	15	20	4	2	3	0	1.05 ± 1.1	0.278^*
Postoperative 1 month	Cutanplast®	25	19	6	3	1	0	0.81 ± 0.97
Postoperative 3 months	Merocel®	16	16	6	4	2	0	1.09 ± 1.1	0.401^*
Postoperative 3 months	Cutanplast®	23	19	7	4	1	0	0.91 ± 1.0

Values are presented as mean ± SD unless otherwise indicated.

VAS = visual analogue scale.

^* Independent t-test.

Table 5.

Comparision of functional success rate and anatomical success rate

	Functional success rate			Anatomical success rate
	Merocel®	Cutanplast®	p-value	Merocel®	Cutanplast®	p-value
Postoperative 1 week (%)	41/44 (93.18)	51/54 (94.44)	0.795^*	42/44 (95.45)	51/54 (94.44)	0.821^*
Postoperative 1 month (%)	39/44 (88.64)	50/54 (92.59)	0.500^*	41/44 (93.18)	51/54 (94.44)	0.795^*
Postoperative 3 months (%)	38/44 (86.36)	49/54 (90.74)	0.495^*	41/44 (93.18)	50/54 (92.60)	0.910^*

^* Chi-square test.

Table 6.

Comparison of postoperative general complication

	Merocel®	Cutanplast®	p-value
Granuloma formation (n, %)	12 (27.3)	13 (24.7)	0.718^*
Synechiae (n, %)	2 (4.5)	1 (1.9)	0.441^*
Delayed wound healing (delayed epithelialization) (n, %)	5 (11.36)	1 (1.82)	0.051^*
Revision (n, %)	3 (6.82)	1 (1.82)	0.217^*

^* Chi-square test.

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