“The feasibility of free septal mucosal grafts in preventing postoperative middle meatus synechia after endoscopic sinus surgery”

Abstract This study aimed to evaluate the feasibility and safety of using a free septal mucosal graft to prevent middle meatal synechiae following endoscopic sinus surgery (ESS). This prospective observational study was conducted at a tertiary referral center between March 2022 and February 2024. Adult patients with chronic rhinosinusitis without nasal polyps (CRSsNP) who were refractory to medical therapy were included. All patients underwent unilateral ESS followed by placement of a free septal mucosal graft over exposed bone in the middle meatus. Postoperative outcomes were assessed using the Sinonasal Outcome Test-22 (SNOT-22), Lund–Kennedy Endoscopic Score (LKES), and Perioperative Sinus Endoscopy (POSE) score. A total of 116 patients completed the study. Significant improvement in SNOT-22 scores was observed at 6 months postoperatively ( p < 0.001). Significant improvement was also noted in endoscopic findings (LKES, p < 0.001). Stable middle turbinate position without lateralization was achieved in 91 (78%) of cases. Free septal mucosal grafting appears to be a feasible, biocompatible, and technically straightforward method to reduce middle meatal synechiae following ESS.