MUCOCILIARY CLEARANCE PATTERNS FOLLOWING ENDOSCOPIC SINUS SURGERY

Detailed endoscopic evaluations of mucociliary transport were performe d to define qualitatively the clearance patterns from the ethmoid cavi ty, sphenoidal sinus, and related nasal structures following sinus sur gery for inflammatory disease. Forty patients participated in this cli nical study. They were selected to represent a spectrum of disease sev erity and surgical outcomes. Powdered graphite was used as an insolubl e tracer medium, and videodocumentation allowed multiple sites to be e xamined during a single study session. Mucociliary clearance was not u niformly observed to be linear, but was often associated with disconti nuous movement, eddies, and pooling. Endoscopic appearance of the oper ative site and postoperative clinical course frequently did not correl ate with observed patterns of mucus transport. Mucociliary stasis with in the ethmoid cavity, at times localized, was the most common finding among patients with recurring acute and persistent sinusitis followin g surgery. Conservative partial middle turbinate resection for access to the ostio-meatal complex did not appear to impair transport from th e anterior nose or ethmoid. Mucociliary clearance from the sphenoid wa s usually slower than that from the ethmoid, but this finding was not associated with a higher rate of persistent disease. Videoendoscopic a nalysis, using graphite powder as a tracer medium, is proposed as a sa fe and straightforward method of assessing mucociliary clearance patte rns following endoscopic sinus surgery.