title: Synechia formation after endoscopic sinus surgery and middle turbinate medialization with and without FloSeal.
abstract: BACKGROUND
  The aim of this study was to determine the incidence, outcomes, and risk factors for synechia formation after endoscopic sinus surgery (ESS) and middle turbinate medialization with and without FloSeal.
  
  
  METHODS
  A retrospective review was performed of patients who underwent primary ESS with middle turbinate medialization, with or without the placement of FloSeal. Medialization was performed with the placement of an absorbable conchopexy suture and silastic splint. Operative variables and outcomes were analyzed to identify risk factors for synechia formation.
  
  
  RESULTS
  One hundred thirty-five patients underwent medialization alone and 37 patients underwent medialization with placement of FloSeal. Overall, synechia formation was noted in 16 patients (9.3%). A statistically significant higher incidence of synechia formation was noted in patients who underwent middle turbinate medialization with the placement of FloSeal versus medialization alone (18.9% versus 6.7%). The incidences of intraoperative complications (6.2% versus 4.7%) and postoperative complications (6.2% versus 7%) were similar between patients with and without synechia, respectively. Patients experiencing synechia, however, underwent a statistically significant higher rate of revision procedures (25% versus 5.1%).
  
  
  CONCLUSIONS
  Despite adequate prevention with middle turbinate medialization, synechia formation after ESS may result in higher rates of revision procedures. The placement of FloSeal in conjunction with middle turbinate medialization may result in a higher incidence of synechia formation.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, New York Presbyterian Hospital, Columbia University College of Physicians and Surgeons, New York, New York, USA.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Shrime
authors.forename: Abtin
authors.initials: A
authors.lastname: Tabaee
authors.forename: Amy K
authors.initials: AK
authors.lastname: Hsu
authors.forename: Scott
authors.initials: S
authors.lastname: Rickert
authors.forename: Lanny Garth
authors.initials: LG
authors.lastname: Close
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005781:Gelatin Sponge, Absorbable / Q000627:therapeutic use*; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013517:Otorhinolaryngologic Surgical Procedures / Q000379:methods*; D011183:Postoperative Complications; D012189:Retrospective Studies; D012220:Rhinitis / Q000601:surgery*; D012852:Sinusitis / Q000601:surgery*; D000267:Tissue Adhesions / Q000209:etiology*; D014420:Turbinates / Q000601:surgery*
chemical_list: C411004:FloSeal Matrix; D006490:Hemostatics