Comparison of conventional instruments and mechanical debriders for surgery of patients with chronic sinusitis

This article compares the use of the microdebrider as a form of powered instrumentation designed to decrease mucosal trauma with traditional surgical instruments for endonasal sinus surgery.

Surgery was performed with the shaver or conventional instruments using an endonasal approach in 24 patients with bilateral chronic rhinosinusitis. Each patient served as his/her own control, meaning that one side was operated on with conventional instruments and the opposite side was operated on with the microdebrider to evaluate postoperative recovery, healing, and incidence of complications. They were stratified preoperatively and reassessed during 3- and 6-month follow-up and long-term (mean, 13 month) follow-up visits, which included nasal endoscopy, saccharin transport time, assessment of mucociliary transport times and clinical symptoms.

In this prospective randomized study we were unable to find a statistical difference (p > 0.05) in surgical outcome for patients when using either conventional instruments or mechanical debriders.

In the literature, mechanical debriders are supposed to provide for mucosal preservation and faster healing. However, for surgical outcome, the use of microdebriders in our study was not better than the results at 3-, 6-, and at 13-month follow-up visits when compared with conventional instruments. Synechia formation, patency of middle meatal antrostomy, and ostial reocclusion were the same in both groups. The incidence of polxyposis as a sign of recurrent or persistent infection was similar. Functional results using the saccharin transport time, as a marker of mucociliary function, or episodes of recurrent purulent secretions, again, were identical.